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A “good birth” goes beyond having a healthy baby

Dr Princess Nothemba Simelela, WHO Assistant Director-General for Family, Women, Children and Adolescents

Commentary
15 February 2018

Dr Princess Nothemba Simelela, WHO Assistant Director-General for Family, Women, Children and Adolescents
Dr Princess Nothemba Simelela, WHO Assistant Director-General for Family, Women, Children and Adolescents
WHO

Today, there is a massive discrepancy in the support provided to women around childbirth. 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.

A normal uncomplicated pregnancy should result in the birth of a healthy child. — Unfortunately, this natural process is too often treated as a high-risk event for fear of adverse birth outcomes. This results in an intense global focus on good clinical outcomes, which, although desirable, can over-ride women’s own preferences, and lead to their subjection to unnecessary interventions.

Women are also reporting high levels of disrespect and abusive care during facility-based childbirth in all regions and cultures. This can totally overshadow one of the most pivotal moments in a woman’s life – the day she welcomes her baby into the world.

Placing women at the centre of their care

"Women are also reporting high levels of disrespect and abusive care during facility-based childbirth in all regions and cultures."

Dr Princess Nothemba Simelela, WHO Assistant Director-General for Family, Women, Children and Adolescents

Undoubtedly, encouraging women to give birth in health facilities, where there are skilled birth attendants, is essential and has helped reduced global newborn and maternal mortality rates for decades. However, there is room for improvement on the quality of care provided in these facilities.

To meet Sustainable Development Goal 3 of ensuring healthy lives and promoting well-being for all at all ages, we cannot keep our focus solely on survival. High quality care for all pregnant women and their newborns, throughout pregnancy, childbirth and the postnatal periods, is essential to ensure that mothers and children both survive and thrive.

The World Health Organization (WHO) believes “high quality care” should encompass both service delivery and the woman’s experience. Our new recommendations on intrapartum care set the global standard on the provision and experience of care during birth. The guidelines place the woman and her baby at the centre of the care model, to achieve the best possible physical, emotional and psychological outcomes.

Critical components of a woman-centred approach include: avoiding unnecessary medical interventions, encouraging women to move around freely during early labour, allowing them to choose their birth position and have a companion of their choice by their side. It also means ensuring privacy and confidentially and providing adequate information about pain relief.

Each labour is unique

WHO’s recommendations recognize that the previous benchmark for cervical dilation rate at 1 cm/hr during the active first stage of labour may not apply to all women and is inaccurate in identifying those at risk of adverse birth outcomes. A slower cervical dilation rate than this benchmark should not be seen as a routine indication for interventions to accelerate labour or expedite birth.

These guidelines are a step towards reducing high rates of unnecessary or ineffective medical interventions. Pregnancy, childbirth and the postnatal period are memorable events in a woman’s life. The application of these guidelines will enhance this experience for all women across the world.