On February 15, 2018, the WHO issued new recommendations to establish global care standards for healthy pregnant women and reduce unnecessary medical interventions. The agency said that worldwide, an estimated 140 million births take place every year. Most of these occur without complications for women and their babies. Yet, over the past 20 years, practitioners have increased the use of interventions that were previously used only to avoid risks or treat complications, such as oxytocin infusion to speed up labour or caesarean sections42.

The agency further said that childbirth is a normal physiological process that can be accomplished without complications for the majority of women and babies. However, studies show a substantial proportion of healthy pregnant women undergo at least one clinical intervention during labour and birth. They are also often subjected to needless and potentially harmful routine interventions. The new WHO guideline includes 56 evidence-based recommendations where care is needed throughout labour and immediately after for the woman and her baby. These include having a companion of choice during labour and childbirth, ensuring respectful care and good communication between women and health providers, maintaining privacy and confidentiality, and allowing women to make decisions about their pain management, labour and birth positions and natural urge to push, among others.

Every labour is unique and progresses at a different rate

The new WHO guideline recognizes that every labour and childbirth is unique and that the duration of the active first stage of labour varies from one woman to another. In a first labour, it usually does not extend beyond 12 hours. In subsequent labours, it usually does not extend beyond 10 hours. To reduce unnecessary medical interventions, the WHO guideline states that the previous benchmark for cervical dilation rate at 1 cm/hr during the active first stage of labour (as assessed by a partograph or chart used to document the course of a normal labour) may be unrealistic for some women and is inaccurate in identifying women at risk of adverse birth outcomes. The guideline emphasizes that a slower cervical dilation rate alone should not be a routine indication for intervention to accelerate labour or expedite birth.

Recommendations

The WHO technical consultations have led to 56 recommendations on intrapartum care - 26 of these are newly developed recommendations and 30 are recommendations integrated from existing WHO guidelines. Recommendations are presented according to the intrapartum care context to which they are relevant, namely, care throughout labour and birth, care during the first stage of labour, care during the second stage of labour, care during the third stage of labour, immediate care of the newborn, and immediate care of the woman after birth. Each of these 56 recommendation have also been classified into one of the following categories defined below:

  • Recommended: This category indicates that the intervention or option should be implemented.
  • Not recommended: This category indicates that the intervention or option should not be implemented.
  • Recommended only in specific contexts: This category indicates that the intervention or option is applicable only to the condition, setting or population specified in the recommendation, and should only be implemented in these contexts.
  • Recommended only in the context of rigorous research: This category indicates that there are important uncertainties about the intervention or option. In such instances, implementation can still be undertaken on a large scale, provided that it takes the form of research that is able to address unanswered questions and uncertainties related both to effectiveness of the intervention or option, and its acceptability and feasibility.

Download >> World Health Organization Recommendations Intrapartum Care For A Positive Childbirth Experience

Footnote

42 http://www.who.int/mediacentre/news/releases/2018/positive-childbirth-experience/en/

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