To optimize maternal health, all women must have access to high quality care before, during and after childbirth. To complement the 2016 antenatal care (ANC) recommendations, the World Health Organization (WHO) has published new recommendations on intrapartum care for a positive childbirth experience. The up-to-date, comprehensive and consolidated guidance on essential intrapartum care comprises 26 newly-developed recommendations and 30 recommendations incorporated from existing WHO guidelines. The recommendations are organized by the following phases: care throughout labor and birth, first stage of labor, second stage of labor, third stage of labor, care of the newborn and care of the woman after birth. Given that the recommendations are neither country nor region specific, care options are categorized as recommended, not recommended, recommended only in specific contexts or recommended only in the context of rigorous research. WHO proposes that health systems implement this new model of intrapartum care, which advances a woman-centered and human-rights-based-approach to labor and childbirth.
Consistent with the recent ANC guideline, the document highlights every woman’s right to a “positive childbirth experience,” or one that “fulfils or exceeds a woman’s prior personal and sociocultural beliefs and expectations, including giving birth to a healthy baby in a clinically and psychologically safe environment with continuity of practical and emotional support from a birth companion(s) and kind, technically competent clinical staff.” Furthermore, the guideline seeks to identify the most common practices used throughout labor to establish norms of good practice for uncomplicated labor and childbirth—while clarifying that “the concept of ‘normality’ in labor and childbirth is not universal or standardized.” It also addresses medicalization in childbirth, calling for clear indications for interventions not only to ensure women’s autonomy but also to reduce the health equity gap between high and low-resource settings.
Notably, the guideline recommends respectful maternity care and companionship of choice during labor and childbirth for all women. WHO also specifies that the midwife-led continuity-of-care model is recommended for pregnant women in settings with well-functioning midwifery programs. Other recommendations include the use of pain relief/management strategies based on a woman’s preference, birth position of the individual woman’s choice, breastfeeding for all newborns who are able to breastfeed and routine assessment of vaginal bleeding, uterine contraction, heart rate and blood pressure following childbirth.
Key messages
All women have a right to a positive childbirth experience that includes the following:
- Respect and dignity
- A companion of choice
- Effective communication by maternity staff
- Pain relief strategies
- Freedom to move around in the early stage of labor
- Comfortable birth position of choice
Every birth is unique. Some labors progress quickly while others do not.
Unnecessary medical procedures should be avoided if labor is progressing normally and the woman and her baby are in good condition.
Labor progression at 1 centimeter per hour during the active first stage of labor may be unrealistic for some women.
This threshold should not be used as an indication for medical interventions.
Care options
Below is a sample of care options covered in the new guideline:
Care throughout labor and birth
- Respectful maternity care
- Companionship of choice during labor and childbirth
- Continuity of care
First stage of labor
- Duration
- Progress of the first stage
- Pain relief and pain management
Second stage of labor
- Definition and duration
- Position choice
- Episiotomy
Third stage of labor
- Prophylactic uterotonics
- Delayed cord clamping
- Controlled cord traction
Care of the newborn
- Routine nasal or oral suction
- Skin-to-skin contact
- Breastfeeding
Care of the woman after birth
- Uterine tonus assessment
- Antibiotics for uncomplicated vaginal birth
- Routine postpartum maternal assessment