New WHO guidelines on childbirth to prevent unnecessary interventions

20 February 2018
Mother meeting baby for the first time

The World Health Organization has issued new recommendations to establish global care standards for healthy pregnant women and reduce unnecessary medical interventions.

The move comes in response to an increase in interventions over the past 20 years, such as oxytocin infusion to speed up labour or caesarean sections for otherwise normal births.

The WHO Assistant Director-General for Family, Women, Children and Adolescents Dr Princess Nothemba Simelela says there’s no need for interventions if labour is progressing normally.

 “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,” she says.

Dr Simelela says childbirth is a normal physiological process and does not result in complications for the majority of women and babies.

However, she says studies show a substantial proportion of healthy pregnant women undergo at least one clinical intervention during labour and birth. They are also often subjected to needless and potentially harmful routine interventions.

The new WHO guidelines include 56 evidence-based recommendations on what care is needed throughout labour and immediately after for the woman and her baby.

These include:

  • Having a companion of choice during labour and childbirth
  • Ensuring respectful care and good communication between women and health providers
  • Maintaining privacy and confidentiality
  • Allowing women to make decisions about their pain management, labour and birth positions and natural urge to push.

The WHO says its guidelines recognise that every labour and childbirth is unique and that the duration of the active first stage of labour varies from one woman to another.

The guidelines emphasise that a slower cervical dilation rate alone should not be a routine indication for intervention to accelerate labour.

Ian Askew, WHO Director, Department of Reproductive Health and Research says women should always be involved in any decision-making around interventions.

“Many women want a natural birth and prefer to rely on their bodies to give birth to their baby without the aid of medical intervention.

“Even when a medical intervention is wanted or needed, the inclusion of women in making decisions about the care they receive is important to ensure that they meet their goal of a positive childbirth experience.”

He says unnecessary labour interventions are widespread in low-, middle- and high-income settings, often putting a strain on already scarce resources in some countries, and further widening of the equity gap.

The WHO says more women give birth in health facilities with skilled health professionals and timely referrals, they deserve better quality of care. About 830 women die from pregnancy- or childbirth-related complications around the world every day – the majority could be prevented with high-quality care in pregnancy and during childbirth.

The organisation says achieving the best possible physical, emotional, and psychological outcomes for the woman and her baby requires a model of care in which health systems empower all women to access care that focuses on the mother and child.

You can read the guidelines here.