Long-Awaited Intrapartum Guidelines from WHO Reduce Unnecessary Interventions and Ensure Respectful Care

Author:
Theresa Shaver, Senior Maternal Health Advisor in the Office of Maternal and Child Health and Nutrition
Organization:
USAID

WHO’s new and updated recommendations for women and childbirth establish global guidelines for intrapartum care intended to reduce unnecessary medical interventions during childbirth.

 

Fewer unnecessary interventions and greater satisfaction

These recommendations could have an enormous, transformative impact for maternal and newborn well-being, if implemented across the planet for the approximately 140 million births that take place each year. It’s an attempt to stem the rising tide of unnecessary intrapartum interventions seen in the last two decades. In a departure from past practice where interventions were used only to prevent maternal/newborn risk or mitigate complications, providers are now using interventions to initiate, accelerate, terminate, regulate or monitor the natural childbirth process. This trend toward over medicalization of a natural physiological process could be unwarranted for  many women and babies, and could lead to potentially harmful consequences. 

WHO’s intrapartum care model

The new recommendations, the first update in 20 years, include 26 newly developed guidelines and 30 recommendations from existing WHO guidelines. They fall into five intrapartum care contexts:

  • Care throughout labor and birth (4 recommendations)
  • First stage of labor (28 recommendations)
  • Second stage of labor (14 recommendations)
  • Care of the newborn (5 recommendations)
  • Care of the woman (5 recommendations)

Greater emphasis on maternal satisfaction in the childbirth experience is key. Most women want to be involved in decision-making, especially when medical interventions are needed or wanted, for a sense of respect, knowledge, control, and personal achievement. Salient issues covered in the guidelines are highlighted below.

Uniqueness of labor

The guidelines redefine and encourage the concept that every labor and childbirth advances at its own pace and, therefore, the duration of the first stage of labor (from 5 cm to full cervical dilatation) can vary from woman to woman. Guideline changes such as these should help stop the current epidemic of unnecessary cesareans, augmentation of labor, and also narrow the health equity gap between high-resource and low-resource settings.

Respectful maternity care

A major advance from previous guidelines is the focus on respectful maternity care. The guidelines encompass a woman-centered philosophy and a human-rights based approach. Research studies and reports have illustrated disrespectful, abusive and undignified care in both developing and developed countries which leads to poor health outcomes for women. The new recommendations call for respectful maternity care, effective communication, companionship during labor and childbirth, pain relief strategies, and mobility in labor and birth position of choice, all with the objective of curbing disrespect, mistreatment and abuse. These new recommendations that prioritize respectful maternity care, if implemented, would help women feel safe, an active participant in their birth, and nurtured throughout the childbirth process.

The guidelines serve as a framework for country governments to adopt policies that can help ensure a healthy and respectful birthing process for women and their newborns everywhere.