Reduce Unnecessary Interventions In Childbirth: WHO

The WHO has made 26 new recommendations regarding childbirth. It has said the traditional benchmarks for labour wards are unrealistic and that interventions are being applied unnecessarily to women.

"Things like Caesarean sections, using a drug called oxytocin to speed up labour is becoming very rampant in several areas of the world," said Dr Olufemi Oldapo of the WHO

In the 1950s, general guidelines for women in labour were laid out. It was said that a woman’s cervix should dilate at the rate on 1 cm per hour in the initial stage. Ever since, if the cervix hasn’t dilated at that speed, drugs have been used to speed up the process. Women have Caesareans as a result this as well. Now the WHO says this is not a good benchmark and it is not a one-size fits all.

“We feel that everybody is unique, and some women can go slower than that and still have a normal vaginal birth,” said Oldapo

Among middle-income economies, Latin America, Turkey, China and Iran have high Caesarean rates, but so do some hospitals in sub-Saharan Africa, "and often not for the right reasons", he said.

New norms

Now, the WHO is saying that a better threshold is 5cm of dilation during the first 12 hours for a new mother and during the first 10 hours for mothers who have given birth before.

The WHO says women want a natural birth. They should be included in making decisions about how they want to give birth. The increasing medicalisation of normal childbirth progresses is undermining a woman’s capability to give birth. It also increases the health equity gap between high and low resource settings.

Some recommendations

Respectful maternity care - which refers to care organized for and provided to all women in a manner that maintains their dignity, privacy and confidentiality, ensures freedom from harm and mistreatment, and enables informed choice and continuous support during labour and childbirth.

Effective communication between maternity care providers and women in labour, using simple methods is recommended.

A companion of choice is recommended for all women throughout labour and childbirth.

For pregnant women with spontaneous labour onset, the cervical dilatation rate threshold of 1 cm/hour during active first stage (as depicted by the partograph alert line) is inaccurate to identify women at risk of adverse birth outcomes. It is therefore not recommended 

Digital vaginal examination at intervals of four hours is recommended for routine assessment of active first stage of labour in low-risk women.

Manual techniques, such as massage or application of warm packs, are recommended for healthy pregnant women requesting pain relief during labour.

Encouraging the adoption of mobility and an upright position during labour in women at low risk is recommended.

Also Read: Equal Women In Labour Force Can Up India’s GDP By 27%: WEF