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labour and delivery guidelines

WHO Issues New, Women-Friendlier Labour and Delivery Guidelines

The world’s premier health body, the World Health Organisation, is finally recognizing that a birth that concludes with a physically healthy and safe mother and child is a very good outcome — but not the best yet. Too many women around the globe feel frustrated — often violated — after giving birth in situations wherein health care practitioners, relatives, or both deny them information, agency and decision-making power over their own bodies and their children’s bodies. To address this, the WHO has issued new guidelines on how practitioners can make pregnant women feel safe, comfortable and positive during the labour and delivery process.

“The increasing medicalization of normal childbirth processes are undermining a woman’s own capability to give birth and negatively impacting her birth experience,” says Dr Princess Nothemba Simelela, the WHO’s assistant director-general for family, women, children and adolescents.

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Medicalization of birth is a double-edged sword. In India, the percentage of women giving birth in a medical institution doubled between 2005 and 2009, according to the Ministry of Health and Family Welfare; in the same period, the infant mortality rate fell from 55.7 deaths in every 1,000 live births to 47.6, an important decline in part linked to the institutional care of trained health care professionals during labour and delivery.

Yet, this care is often perfunctory, peremptory and patriarchal, with women being denied mundane requests without reason, and procedures being performed on them without their understanding, consent or even knowledge. The result is often a birth experience in the best interest of the institution, or the male counterpart, rather than in the interest of the woman.

Simelela called the WHO’s new labour and delivery guidelines a “holistic, human-rights based approach” that adds the psychological and emotional well-being of mothers as a focus for practitioners. The new process is aimed at leading not only to a healthy birth outcome, but also a positive one — one that “fulfills or exceeds a woman’s prior personal and sociocultural beliefs and expectations, including giving birth to a healthy baby in a clinically and psychologically safe environment with continuity of practical and emotional support from a birth companion(s) and kind, technically competent clinical staff,” the full report explains. “It is based on the premise that most women want a physiological labour and birth, and to have a sense of personal achievement and control through involvement in decision-making, even when medical interventions are needed or wanted.”

To give you an idea of what you should expect (or demand) during labour and delivery going forward, some of the WHO’s new recommendations include:

  • Effectively communicating with women in labour, using simple and culturally acceptable methods
  • Allowing a companion of the woman’s choice to be with her throughout labour and childbirth
  • Intermittent monitoring of fetal heart rate
  • Offering all pain relief options — from manual massage techniques, to breathing exercises, to epidural to opioid-based pain killers
  • Allowing women to eat and drink during the first stage of labour
  • Encouraging and allowing women to be mobile and upright during the first stage of labour
  • Encouraging women to assume a birth position of their choice
  • Encouraging women to push according to their sensations
  • Including midwives to ensure continuity across pre- to post-natal care, in settings where strong midwifery programs are established

The report also suggests phasing out or avoiding certain practices that make the birth experience unpleasant for women without serving any counterbalancing medical value for healthy pregnancies.

  • Measuring labour progress by a cervical dilation rate of 1 cm/hour, which the report calls “unrealistically fast for some women”
  • Avoiding intervention, like oxytocin augmentation or C-section, before the cervix dilates to 5 cm
  • Determining the likelihood of a vaginal birth through pelvimetry (measuring the pelvis)
  • Perineal or pubic shaving
  • Administering enemas
  • Continuous monitoring of fetal heartbeat
  • Hastening labour during the first stage via amniotomy or oxytocin
  • Intravenous (IV) fluids
  • Episiotomies
  • Uterine massage
  • Antibiotics following an uncomplicated vaginal birth

 

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