World Health Organization Releases New Intrapartum Care Guidelines and They ROCK!

The World Health Organization just released updated guidelines "WHO recommendations: Intrapartum care for a positive childbirth experience" and it is an important 212-page tome. Right off the bat, I appreciated the title which recognizes that some birth experiences can be less than positive. Hearing this news may bring back memories of ACOG's release of "Approaches to Limit Interventions During Labor and Birth" which came out this time last year. Science & Sensibility covered this here and here.

Maternal-infant health organizations worldwide recognize that there is a lot of room for improvement in the standard care that most people receive during labor and birth. In the words of Dr. Neel Shah ' we are challenged with doing "too much, too soon or too little, too late." The purpose of this newly released document is to establish standards of care for healthy low-risk. pregnancies and reduce intrapartum interventions.

Dr. Princess Nothemba Simelela, WHO Assistant Director-General for Family, Women, Children, and Adolescents states "We want women to give birth in a safe environment with skilled birth attendants in well-equipped facilities. However, the increasing medicalization of normal childbirth processes are undermining a woman's own capability to give birth and negatively impacting her birth experience. 'If labour is progressing normally, and the woman and her baby are in good condition, they do not need to receive additional interventions to accelerate labour."

Sidenote: I encourage you to read Dr. Simelela's commentary "A 'good birth' goes beyond having a healthy baby." I could not agree with her more.

There are 56 recommendations in these new guidelines that confirm that childbirth is a normal physiological process with all the variations that one might expect and advises health care providers to recognize these variations and have the patience to let the process unfold. WHO also recognizes that childbirth should be a positive, life-changing experience and currently that is not the case for all those who give birth. There are many physical and emotional reasons why starting off parenting a newborn would benefit from a healthy, positive birth. All of the recommendations are based on current evidence-based principals and take a human rights approach to childbirth.

Some of the selected current recommendations include:

I encourage you to read (or try to, it is 212 pages long, but there is a wonderful summary table at the beginning) this new WHO publication for all the details and supporting documents.

The first thing that came to my mind, and maybe yours too, was how similar these recommendations are to Lamaze International's Six Healthy Birth Practices. How strange and sad that NO interventions are now being debated and finally recommended when that was the way things were "before". To have to now recommend "doing nothing" unless needed is crazy to think about. The Institute of Medicine states that it takes 17 years for information to go from research to practice - or as is commonly noted, "from lab bench to bedside." How long will it take for world practices to change and people begin to be the recipients of this evidence-based, low intervention appropriate care?

One thing we can do as childbirth educators and other birth professionals is to inform the families of what current best practice recommendations are. When they know what the research shows, they can ask for those practices to be applied to their care. If discussions with their health care provider do not assure them that they will be receiving this evidence-based care, then they can make a change to receive care elsewhere. I recognize that ability to change providers is a sign of privilege and we need to make this option available to everyone and remove any barriers that exist.

I have long been facilitating discussions and activities focused on the Six Healthy Birth Practices (and then later, the ACOG recommendations) and will now include the information from the WHO in my childbirth classroom learning. I applaud the WHO for clearly stating what good maternity care looks like and making this information available in many different languages and in many different formats. These recommendations can only help to improve maternal-infant health worldwide for years to come. How will you incorporate this new information into your childbirth classes? Are you seeing these recommendations already in practice in the hospital facilities in your community? Please share your thoughts in the comments below.

Published: February 15, 2018

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