The World Health Organization (WHO) recently published a significant document outlining current intrapartum practices that are likely to harm mothers and babies and recommends that they should be discarded. For healthy women who go into labor on their own, the WHO maintains no interventions are necessary as long as the mother and baby are stable. To improve the quality of maternity care, the WHO affirms that a positive experience of childbirth is just as important for optimal maternal, newborn, and family health and well-being as evidence-based, clinical care.

Intrapartum care for a positive childbirth experience is a framework for a woman-centered model of care that is a holistic, evidence-based, and human-rights-based approach. It empowers women to make their own decisions on how they want to give birth. The WHO recommendations ensure that women maintain their dignity, privacy, and confidentiality, and that they are free from harmful practices and mistreatment. In addition, the WHO recommends that all women have continuous support during labor and childbirth. The guidelines state,

 Women want a positive childbirth experience that fulfils or exceeds their prior personal and sociocultural beliefs and expectations. This includes giving birth to a healthy baby in a clinically and psychologically safe environment with continuity of practical and emotional support from birth companion(s) and kind, technically competent clinical staff. 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 improve the quality of care for mothers and babies the WHO has outlined specific intrapartum practices that are likely to harm mothers and babies and recommends that they should be discarded.

• Normal labor progress is different for each woman. Healthy women who go into labor on their own should not be expected to progress at a rate of 1cm dilation per hour in the first stage of labor and therefore need no interventions to speed up their labor.
• Labor may not naturally accelerate on its own (active phase) until 5cm of dilation and introducing interventions like oxytocin augmentation or performing a cesarean for failure to progress when the mother’s or baby’s condition is stable is not recommended.
• Routine pelvimetry (measurement of the female pelvis to identify if the pelvis is wide enough for the fetus to pass through to the birth canal) is not useful, and all healthy pregnant women should be allowed to labor.
• Electronic fetal monitoring (cardiotocography) to assess fetal wellbeing on admission for labor and throughout labor should be replaced by the use of a Doppler ultrasound device or Pinard fetal stethescope.
• Routine perineal/pubic shaving, vaginal cleansing, and administering an enema to speed up labor are potentially harmful and should be discontinued as a form of care.
• Early amniotomy alone (breaking the bag of waters), amniotomy with early augmentation of oxytocin, and use of oxytocin to speed up labor for women who choose an epidural for pain relief are not recommended.
• Routine use of intravenous fluids (IVs) to shorten labor should not be used for healthy women in labor and birth.
• When giving birth, care providers should not apply manual fundal pressure nor perform an episiotomy.

To improve health outcomes for mothers and babies the WHO guidelines also include a set of recommended care practices that can be implemented in any maternity care setting. The WHO guidelines emphasize two main issues: support for the normality of uncomplicated labor and birth; and respect for women’s choices and psychosocial needs.

Perhaps, the most important concept emphasized in these guidelines is that women’s positive experience of childbirth is as critical as the quality of clinical care they receive.

Resource

Download Module 12 of the VBAC Education Project for information on making informed decisions about labor and birth.