New guidelines released by the World Health Organization (WHO) are warning maternity care providers against trying to speed up labour, unless there is a medical need.
Around 140 million births occur globally every year. Most of these birth are uncomplicated, but leading health experts are alarmed and concerned about the increasing rates of medical interventions.
Induction, augmentation, forceps or vacuum births and c-section births are among the interventions being performed because of active management of labour.
Obviously, women and their care providers want to achieve safe births. The increasing use of medical technology, however, is interfering with women’s ability to give birth without assistance.
This lack of trust in birth and women’s bodies is having a negative impact on women’s physical and mental health.
Don’t Speed Up Labour, WHO Says
The WHO has recently released the WHO recommendations: intrapartum care for a positive childbirth experience, which bring together new and existing WHO recommendations, to make sure best practice and evidence-based care are at the forefront of maternity care for women around the world.
The updated guidelines disregard previous advice, which recommended the speeding up of labour if dilation didn’t progress at least 1cm per hour during the first stage. It was believed a prolonged dilation was risky to both mother and baby.
In the mid 1950s, Dr Emanuel Friedman plotted a graph of data taken from 500 first time mothers who gave birth at full term. He calculated the average time a woman took to dilate one centimetre.
This graph is known as Friedman’s Curve. Despite more recent research that dispelled the myth of 1cm per hour cervical dilation, the graph has been used to underpin maternity care for over 60 years.
You can read more about how this graph was designed, and about its flaws, in Friedman’s Curve – How It’s Used During Labour.
Women who don’t meet this 1cm per hour criterion for dilation are told their labour is ‘failing to progress’ and they will need ‘help’ to get things moving. This help is usually in the form of interventions, such as breaking the amniotic sac or giving artificial oxytocin.
It’s hardly surprising many women go on to have further interventions, such as epidurals, forceps and c-sections. They are the result of the long-held yet erroneous belief every woman’s cervix dilates in exactly the same way.
Why Is The WHO Recommendation Good News?
This updated recommendation from the world’s leading health organisation is welcome news. It demonstrates to all maternity care providers just how irrelevant Friedman’s Curve is.
It also points the way for new and experienced care providers to become fully aware of best practice and evidence-based research.
A recent study found during normal labour, women can dilate more slowly than the widely accepted benchmark of 1cm per hour. The use of information sources such as Friedman’s Curve, as the basis for decision making during labour care, is no longer relevant.
There is also a large body of evidence to show the rate of cervical dilation actually begins to pick up after 6cm, rather than 4cm, which is when Friedman considered active labour to begin.
What Does This Mean For Birthing Women?
The new guidelines from the WHO highlight the importance of maternity care providers acknowledging the individual women they are caring for. This creates a more positive and empowering birth experience.
The recommendations overturn the incorrect practices that have been responsible for removing women’s autonomy with regard to their birth experiences.
Pregnant women can refer to these new guidelines as they discuss their maternity care with their care providers. They can make sure they are not being put ‘on the clock’, which increases the risk of interventions for both mother and baby.