Optimal intrapartum care essential for women and babies
As more women around the world are encouraged to choose to give birth in health facilities, it is essential that their right to a positive childbirth experience remains at the heart of the care they receive.
Optimal Intrapartum Care, a special supplement edited by staff at the WHO Department of Sexual and Reproductive Health and Research including HRP, presents some of the challenges emerging from the global shift towards facility-based childbirth over the last two decades.
Strategies to improve the quality of care every woman receives during childbirth are central to many of the solutions.
Quality of care is fundamental to WHO approach to maternity care
Every pregnancy and birth is unique, meaning that the best intrapartum care for each woman and her baby is individualized as well as evidence-based.
This principle of person-centred care is reflected across all WHO guidance on maternal health and enshrined in the 2016 framework for improving quality of maternal and newborn care in health facilities.
The WHO 2018 recommendations on intrapartum care, 2016 recommendations on antenatal care and upcoming recommendations on postnatal care are each grounded in respectful, person-centered maternity care.
Respectful intrapartum care maintains women’s dignity, privacy and confidentiality, ensuring freedom from harm and mistreatment, and enabling informed choice during labour and childbirth. This WHO model of intrapartum care provides a basis for empowering all women to access and to demand the type of care that they want and need.
Inequalities and challenges to quality of care for all
Many of the challenges highlighted in the special supplement are related to poor quality of care. These can significantly and negatively affect women’s clinical and psychological experience of childbirth.
‘Optimal intrapartum care in the twenty-first century,’ the first paper in the series, recalls evidence from a recent WHO-led study in four countries showing that more than one-third of women experienced mistreatment during childbirth in health facilities. This included physical and verbal abuse, stigma and discrimination, failure to meet professional standards of care, poor rapport between women and providers, and health system conditions and constraints.
Poor quality of care may be a significant barrier to uptake of facility-based birth services, in particular in low and middle-income countries. For example, experience of mistreatment and poor quality care is likely to influence women’s decisions about where to give birth in subsequent pregnancies.
Geography can also determine the quality of care available to a woman in childbirth: the partograph, an important tool for monitoring maternal and foetal wellbeing during labour, was found to be more frequently and appropriately used in urban facilities than in rural areas. Other interventions during labour and childbirth, including companion of choice or pain relief, are not always offered to women in low resource settings and access is highly inequitable.
Access to good quality medicines, including drugs for pain relief or for prevention of complication during childbirth, such as uterotonics and antibiotics, is another key global issue highlighted for improvement.
Progress in maternal health is not fast enough
The number of women choosing to give birth in health facilities has increased in past decades, driven by urgent global efforts to reduce maternal deaths.
Progress has been made towards maternal and newborn targets set out in the 2030 Agenda for Sustainable Development – but it is slow, with vast inequalities worldwide.
“Abiding by the human rights principles of right for life, health, confidentiality, privacy, provision of information, agreeing with the woman’s informed choice will help to deliver personalised respectful care and that must be the norm in any birth care setting,” explained Sir Sabaratnam Arulkumaran, Past President FIGO, RCOG and the BMA.
The WHO vision for maternal and newborn health globally
WHO, with Member States and international partners, is working towards a global vision where every pregnant woman and newborn receives quality care throughout pregnancy, childbirth and the postnatal period, under the umbrella of Universal Health Coverage.
“Increasing facility births has contributed to reducing maternal deaths, but this must not come at the price of overmedicalization of childbirth and poorer quality of care for women,” said Dr Mercedes Bonet, Medical Officer at WHO/HRP.
“Simply surviving pregnancy and childbirth can never be the marker of successful maternity care. Addressing inequalities and promoting respectful maternity care for all women is critical to improve health equity and quality.”
To make this a reality, evidence-based approaches to maternal health must be adapted for different settings.
The ongoing evolution and implementation of quality of care across the maternal health continuum is equally important. This means going beyond clinical requirements for a safe labour and childbirth to meet the needs of all women and their babies.