WHO recommendations: intrapartum care for a positive childbirth experience. Geneva: World Health Organization; 2018. Licence: CC BY-NC-SA 3.0 IGO.
The majority of approximately 140 million births that occur globally every year are among women without risk factors for complications for themselves or their babies at the beginning and throughout labour. Nevertheless, the time of birth is critical to the survival of women and their babies, as the risk of morbidity and mortality could increase considerably if complications arise. In line with the targets of Sustainable Development Goal 3 – ensure healthy lives and promote well-being for all at all ages – and the new Global Strategy for Women’s, Children’s and Adolescents’ Health (2016–2030), global agendas are expanding their focus to ensure that women and their babies not only survive labour complications if they occur but also that they thrive and reach their full potential for health and life.
In spite of the considerable debates and research that have been ongoing for several years, the concept of “normality” in labour and childbirth is not universal or standardized. There has been a substantial increase over the last two decades in the application of a range of labour practices to initiate, accelerate, terminate, regulate or monitor the physiological process of labour, with the aim of improving outcomes for women and babies. This increasing medicalization of childbirth processes tends to undermine the woman’s own capability to give birth and negatively impacts her childbirth experience. In addition, the increasing use of labour interventions in the absence of clear indications continues to widen the health equity gap between high- and low-resource settings.
This guideline addresses these issues by identifying the most common practices used throughout labour to establish norms of good practice for the conduct of uncomplicated labour and childbirth. It elevates the concept of experience of care as a critical aspect of ensuring high-quality labour and childbirth care and improved woman-centred outcomes, and not just complementary to provision of routine clinical practices. It is relevant to all healthy pregnant women and their babies, and takes into account that childbirth is a physiological process that can be accomplished without complications for the majority of women and babies.
The guideline recognizes a “positive childbirth experience” as a significant end point for all women undergoing labour. It defines a positive childbirth experience as one that fulfils or exceeds a woman’s prior personal and sociocultural beliefs and expectations, including giving birth to a healthy baby in a clinically and psychologically safe environment with continuity of practical and emotional support from a birth companion(s) and kind, technically competent clinical staff. It is based on the premise that 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.
This up-to-date, comprehensive and consolidated guideline on essential intrapartum care brings together new and existing World Health Organization (WHO) recommendations that, when delivered as a package, will ensure good-quality and evidence-based care irrespective of the setting or level of health care. The recommendations presented in this guideline are neither country nor region specific and acknowledge the variations that exist globally as to the level of available health services within and between countries. The guideline highlights the importance of woman-centred care to optimize the experience of labour and childbirth for women and their babies through a holistic, human rights-based approach. It introduces a global model of intrapartum care, which takes into account the complexity and diverse nature of pre-vailing models of care and contemporary practice.
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