“At one end of the spectrum, they are offered too many medical interventions too soon. At the other, they get too little support too late – or none at all. At neither end, do women have the positive childbirth experience they desire and deserve.” – Princess Nothemba Simelela
The World Health Organization wants women to have more positive childbirth experiences and has issued 56-evidence-based recommendations to guide health practitioners all over the world in ensuring a healthy delivery process without unnecessary medical interventions.
According to WHO, most women can deliver their babies without complications, yet there has been an increased medicalization of normal childbirth process with the flippant use of interventions such as oxytocin infusion to speed up labour and caesarean sections, that should only be used to avoid risks or treat complications.
“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,” says Dr. Princess Nothemba Simelela, WHO Assistant Director-General for Family, Women, Children and Adolescents. These interventions undermine women’s capabilities and negatively impacts the experience of delivery.
The organizations new guideline recommends that women should have a companion of choice during labour and childbirth; should be allowed to make decisions about their pain management, labour, birth positions and natural urge to push; should be cared for respectfully with their privacy and confidentiality maintained; and given room to communicate with their health providers.
To reduce these interventions the WHO states that the previous benchmark for cervical dilation rate at one centimetre an hour during the active first stage of labour – a guideline set down by American obstetrician Emanuel Friedman in the 50s – may be unrealistic for some women and is inaccurate in identifying women at risk of adverse birth outcomes. The new guideline recognizes the individuality of every labour and childbirth and that the duration of labour varies for different women.
“It’s not a one-size-fits-all kind of thing”, says Dr. Olufemi Oladapo, a medical officer in WHO’s department of reproductive health and research. “We feel that everybody is unique, and some women can go slower than that and still have a normal vaginal birth.” Dr. Oladopa adds that years of research including a study of 10,000 women in Nigeria and Uganda has shown dilation can be slower without endangering the health of a woman or child.
The WHO also reports that women have no access to care services during childbirth in some parts of the world, while others often have their rights violated because health providers control the birthing process in most parts of the world. “Women are also reporting high levels of disrespect and abusive care during facility-based childbirth in all regions and cultures”, Dr. Simelela says. “This can totally overshadow one of the most pivotal moments in a woman’s life.”
This new guideline and recommendations by the WHO are in line with Sustainable Development Goal 3 to promote good health and well-being, part of which is by reducing infant and maternal mortality by promoting high-quality care for all pregnant women and their newborns.