Only accelerate labour if real risks are involved

As more women forsake the experience of natural childbirth for medical or personal reasons, the World Health Organization (WHO) advises that the birthing process should only be accelerated when there are real risks.

Decades of previous advice issued by the WHO has cautioned that labour progressing at a slower rate than one centimetre of cervical dilation per hour in the first stage of childbirth is considered risky. In such situations, women are often given the drug oxytocin to speed up labour, which usually leads to them taking epidurals for the pain, followed by vacuum deliveries and in some cases a caesarean section. The new WHO guidance overturns this practice.

“We want women to give birth in a safe environment with skilled birth attendants in well-equipped facilities. However, the increasing medicalisation of normal childbirth processes is undermining a woman’s own capability to give birth and negatively impacting her birth experience,” said Dr Princess Nothemba Simelela, WHO assistant director-general for family, women, children and adolescents, to The Guardian. “If labour is progressing normally, and the woman and her baby are in good condition, they do not need to receive additional interventions to accelerate labour.”

The new WHO guidance comes amidst a significant increase in practitioners using medical interventions to speed up labour or caesarean sections over the past 20 years.

Although an estimated 140 million births take place every year worldwide mostly without any complications for both the babies and mothers, women are increasingly being subjected to medical interventions in the name of risk-avoidance, which may be unnecessary and unwelcome to them, according to the WHO.

Cathy Daub PT, a paediatric physical therapist and founder of BirthWorks International, explained that some of the common types of complications in natural childbirth that would require intervention include a mother who is exhausted from a long labour or who is in fear of labour, a mother with eclampsia (seizures) or DIC (blood clots) or other life-threatening disease, certain physical conditions such as temporary paralysis of the pelvic muscles from an epidural, and certain conditions with the foetus such as true foetal distress.

“This is a good and wise change of advice by the WHO. We sometimes say that babies are like cakes -- some need more time to bake (in medical terms “dilate”) than others. This new advice gives women the freedom to feel safe to labour without the pressure of restrictive timeframes,” she said to Global Health and Travel.

“Many women want a natural birth and prefer to rely on their bodies to give birth to their baby without the aid of medical intervention,” said Dr Ian Askew, director of the WHO’s department of reproductive health and research to The Guardian. “Even when a medical intervention is wanted or needed, the inclusion of women in making decisions about the care they receive is important to ensure that they meet their goal of a positive childbirth experience.”

According to the WHO, about 830 women die from complications in pregnancy or childbirth worldwide every day. Most could be prevented with high-quality care in pregnancy and during childbirth.

“The good news is that when women are upright and moving around during labour, changing positions frequently, many of these situations can be alleviated and the chances of a normal birth are greatly increased,” said Daub. “These positions help to keep the pelvis tipped forward which gives the baby more space in which to move into optimal positions for birth. Childbirth preparation classes need to teach these exercises to pregnant women along with relaxation exercises, good nutrition, and a philosophy that all women are born with the knowledge about how to give birth. Birth is instinctive.”

This story was originally published in the Global Health and Travel issue of August-September 2018.