|Care in Normal Birth (WHO, 1996, 60 p.)|
In defining normal birth two factors must be taken into consideration: the risk status of the pregnancy, and the course of labour and delivery. As already discussed, the predictive value of risk scoring is far from being 100% - a pregnant woman who is at low risk when labour starts may eventually have a complicated delivery. On the other hand, many high-risk pregnant women ultimately have an uncomplicated course of labour and delivery. In this report our primary target is the large group of low-risk pregnancies.
We define normal birth as: spontaneous in onset, low-risk at the start of labour and remaining so throughout labour and delivery. The infant is born spontaneously in the vertex position between 37 and 42 completed weeks of pregnancy. After birth mother and infant are in good condition.
However, as the labour and delivery of many high-risk pregnant women have a normal course, a number of the recommendations in this paper also apply to the care of this women.
According to this definition how many births can be considered normal? This will largely depend on regional and local risk assessment and referral rates. Studies on alternative birthing care in developed countries show an average referral rate during labour of 20%, while an equal number of women have been referred during pregnancy. In multiparous women the referral rates are much lower than in nulliparae (MacVicar et al 1993, Hundley et al 1994, Waldenstrt al 1996). In these studies risk assessment usually is painstaking, which means that many women are referred who will eventually end up with a normal course of labour. In other settings the number of referrals might be lower. In Kenya it was found that 84.8% of all labours were uncomplicated (Mati et al 1983). Generally, between 70 and 80% of all pregnant women may be considered as low-risk at the start of labour.