1.4 Definition of Normal Birth
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.
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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.
