Care in Normal Birth (WHO, 1996, 60 p.): 1. INTRODUCTION: 1.1 Preamble

Care in Normal Birth (WHO, 1996, 60 p.)

(introduction...)

ACKNOWLEDGEMENTS

1. INTRODUCTION

1.1 Preamble

1.2 Background

1.3 Risk Approach in Maternity Care

1.4 Definition of Normal Birth

1.5 Aim of the Care in Normal Birth, Tasks of the Caregiver

1.6 The Caregiver in Normal Birth

2. GENERAL ASPECTS OF CARE IN LABOUR

2.1 Assessing the Well-being of the Woman during Labour

2.2 Routine Procedures

2.3 Nutrition

2.4 Place of Birth

2.5 Support in Childbirth

2.6 Labour Pain

(introduction...)

2.6.1 Non-pharmacological methods of pain relief

2.6.2 Pharmacological pain relief in labour

2.7 Monitoring the Fetus during Labour

(introduction...)

2.7.1 Assessment of amniotic fluid

2.7.2 Monitoring the fetal heart rate

2.7.3 Fetal scalp blood examination

2.7.4 Comparison of auscultation and electronic fetal monitoring

2.8 Cleanliness

3. CARE DURING THE FIRST STAGE OF LABOUR

3.1 Assessing the Start of Labour

3.2 Position and Movement during the First Stage of Labour

3.3 Vaginal Examination

3.4 Monitoring the Progress of Labour

3.5 Prevention of Prolonged Labour

(introduction...)

3.5.1 Early amniotomy

3.5.2 Intravenous infusion of oxytocin

3.5.3 Intramuscular oxytocin administration

4. CARE DURING THE SECOND STAGE OF LABOUR

4.1 Physiological Background

4.2 The Onset of the Second Stage

4.3 The Onset of Pushing during the Second Stage

4.4 The Procedure of Pushing during the Second Stage

4.5 Duration of the Second Stage

4.6 Maternal Position during the Second Stage

4.7 Care of the Perineum

(introduction...)

4.7.1 “Guarding the perineum” during delivery

4.7.2 Perineal tear and episiotomy

5. CARE DURING THE THIRD STAGE OF LABOUR

5.1 Background

5.2 Prophylactic use of Oxytocics

5.3 Controlled Cord Traction

5.4 Active Versus Expectant Management of the Third Stage

5.5 Timing of Cord Clamping

5.6 Immediate Care of the Newborn

5.7 Care of the Mother Immediately after Delivery of the Placenta

6. CLASSIFICATION OF PRACTICES IN NORMAL BIRTH

(introduction...)

6.1 Practices which are Demonstrably Useful and Should be Encouraged

6.2 Practices which are Clearly Harmful or Ineffective and Should be Eliminated

6.3 Practices for which Insufficient Evidence Exists to Support a Clear Recommendation and which Should be Used with Caution while Further Research Clarifies the Issue

6.4 Practices which are Frequently Used Inappropriately

7. REFERENCES

8. LIST OF PARTICIPANTS

SAFE MOTHERHOOD RESOURCE LIST

BACK COVER

1.1 Preamble

Despite considerable debate and research over many years the concept of “normality” in labour and delivery is not standardised or universal. Recent decades have seen a rapid expansion in the development and use of a range of practices designed to start, augment, accelerate, regulate or monitor the physiological process of labour, with the aim of improving outcomes for mothers and babies, and sometimes of rationalising work patterns in institutional birth. In developed countries where such activity has become generalised questions are increasingly raised as to the value or desirability of such high levels of intervention. In the mean time, developing countries are seeking to make safe, affordable delivery care accessible to all women. The uncritical adoption of a range of unhelpful, untimely, inappropriate and/or unnecessary interventions, all too frequently poorly evaluated, is a risk run by many who try to improve the maternity services. After establishing a working definition of “normal birth” this report identifies the commonest practices used throughout labour and attempts to establish some norms of good practice for the conduct of non-complicated labour and delivery.

The report addresses issues of care in normal birth irrespective of the setting or level of care. Its recommendations on those interventions which are or should be used to support the processes of normal birth are neither country nor region specific. Enormous variations exist worldwide as to the place and level of care, the sophistication of services available and the status of the caregiver for normal birth. This report aims simply to examine the evidence for or against some of the commonest practices and to establish recommendations, based on the soundest available evidence, for their place in normal birth care. In 1985 a meeting of the World Health Organization (WHO) European region, the regional office of the Americas, together with the Pan American Health Organization in Fortaleza, Brazil, made a number of recommendations based on a similar range of practices (WHO 1985). Despite this, and despite the rapidly increased emphasis on the use of evidence-based medicine, many of these practices remain common, without due consideration of their value to women or their newborns. This is the first time that a meeting involving childbirth experts from each of the WHO regions worldwide has had the opportunity to clarify, in the light of current knowledge, what they consider to be the place of such practices in normal birth care.

After debating the evidence, the working group classified its recommendations on practices related to normal birth into four categories:

A. Practices which are demonstrably useful and should be encouraged

B. Practices which are clearly harmful or ineffective and should be eliminated

C. Practices for which insufficient evidence exists to support a clear recommendation and which should be used with caution while further research clarifies the issue

D. Practices which are frequently used inappropriately