The WORLD HEALTH
"CARE IN NORMAL
BIRTH: A Practical Guide"
Following are the
recommendations appearing on pages 34-37 of the Report:
CLASSIFICATION OF PRACTICES IN
NORMAL BIRTH, WHO
This chapter classifies the
practices common in the conduct of normal childbirth into four categories,
dependent on their usefulness, effectiveness and harmfulness. The
classification reflects the views of the Technical Working Group on Normal
Birth. Arguments for this classification are not given here; the reader is
referred to the preceding chapters, which are the outcome of the reflection
and debates of the Working Group, based on the best currently available
evidence (numbers of chapters between brackets).
6.1 Practices which are
Demonstrably Useful and Should be Encouraged
A personal plan determining
where and by whom birth will be attended, made with the woman during
pregnancy and made known to her husband/partner and, if applicable, to the
Risk assessment of pregnancy
during prenatal care, reevaluated at each contact with the health system and
at the time of the first contact with the caregiver during labour, and
throughout labour (1.3).
Monitoring the woman's
physical and emotional well-being throughout labour and delivery, and at the
conclusion of the birth process (2.1).
Offering oral fluids during
labour and delivery (2.3).
Respecting women's informed
choice of place of birth (2.4).
Providing care in labour and
delivery at the most peripheral level where birth is feasible and safe and
where the woman feels safe and confident (2.4, 2.5).
Respecting the right of
women to privacy in the birthing place (2.5).
Empathic support by
caregivers during labour and birth (2.5).
Respecting women's choice of
companions during labour and birth (2.5).
Giving women as much
information and explanation as they desire (2.5).
non-pharmacological methods of pain relief during labour, such as massage
and relaxation techniques (2.6).
Fetal monitoring with
intermittent auscultation (2.7).
Single use of disposable
materials and appropriate decontamination of reusable materials throughout
labour and delivery (2.8).
Use of gloves in vaginal
examination, during delivery of the baby and in handling the placenta (2.8).
Freedom in position and
movement throughout labour (3.2).
Encouragement of non-supine
position in labour (3.2, 4.6).
Careful monitoring of the
progress of labour, for instance by the use of the WHO partograph (3.4).
Prophylactic oxytocin in
the third stage of labour in women with a risk of postpartum haemorrhage, or
endangered by even a small amount of blood loss (5.2, 5.4).
Sterility in the cutting of
the cord (5.6).
Prevention of hypothermia
of the baby (5.6).
Early skin-to-skin contact
between mother and child and support of the initiation of breast-feeding
within 1 hour postpartum in accordance with the WHO guidelines on
Routine examination of the
placenta and the membranes (5.7).
6.2 Practices which are Clearly
Harmful or Ineffective and Should be Eliminated
Routine use of enema (2.2).
Routine use of pubic shaving
Routine intravenous infusion
in labour (2.3).
Routine prophylactic insertion
of intravenous cannula (2.3).
Routine use of the supine
position during labour (3.2, 4.6).
Rectal examination (3.3).
Use of X-ray pelvimetry (3.4).
Administration of oxytocics at
any time before delivery in such a way that their effect cannot be controlled
Routine use of lithotomy
position with or without stirrups during labour (4.6).
Sustained, directed bearing
down efforts (Valsalva manoeuvre) during the second stage of labour (4.4).
Massaging and stretching the
perineum during the second stage of labour (4.7).
Use of oral tablets of
ergometrine in the third stage of labour to prevent or control hemorrhage (5.2, 5.4).
Routine use of parenteral
ergometrine in the third stage of labour (5.2).
Routine lavage of the uterus
after delivery (5.7).
Routine revision (manual
exploration) of the uterus after delivery (5.7).
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
Non-pharmacological methods of
pain relief during labour, such as herbs, immersion in water and nerve
Routine early amniotomy in the
first stage of labour (3.5).
Fundal pressure during labour
Manoeuvres related to
protecting the perineum and the management of the fetal head at the moment of
Active manipulation of the
fetus at the moment of birth(4.7).
Routine oxytocin, controlled
cord traction, or combination of the two during the third stage of labour
(5.2, 5.3, 5.4).
Early clamping of the
umbilical cord (5.5).
Nipple stimulation to increase
uterine contractions during the third stage of labour (5.6).
6.4 Practices which are
Frequently Used Inappropriately
Restriction of food and fluids
during labour (2.3).
Pain control by systemic
Pain control by epidural
Electronic fetal monitoring
Wearing masks and sterile
gowns during labour attendance (2.8).
Repeated or frequent vaginal
examinations especially by more than one caregiver (3.3).
Oxytocin augmentation (3.5).
Routinely moving the labouring
woman to a different room at the onset of the second stage (4.2).
Bladder catheterization (4.3).
Encouraging the woman to push
when full dilatation or nearly full dilatation of the cervix has been
diagnosed, before the woman feels the urge to bear down herself (4.3).
Rigid adherence to a
stipulated duration of the second stage of labour, such as 1 hour, if maternal
and fetal conditions are good and if there is progress of labour (4.5).
Operative delivery (4.5).
Liberal or routine use of
Manual exploration of the
uterus after delivery (5.7).
PLEASE NOTE: The WORLD
HEALTH ORGANIZATION report,
"CARE IN NORMAL
BIRTH: A Practical Guide"
can be ordered from
WHO Publications Center
USA, 49 Sheridan Ave, Albany, N.Y. 12210
Tel: (518) 436-9686
(ask for publications) or Fax: (518) 436-7433.
Cost: $9. plus $5
To use credit card send
name, card name and card number with order.