WHO recommendations
Intrapartum care
TEMPLATE
for a positive
childbirth
experience
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EXECUTIVE
SUMMARY 01 02 03 04
Background Methods Recommendations Implementation
Pages 1–7 Pages 8–9 Pages 10–18 Pages 19–167 Pages 168–170
05 06 07 08
Research Dissemination Applicability Updating the
Implications Issues Guideline
Pages 171–172 Page 173 Page 174 Page 175
+ Conferences
+ Implementation
Tools
01
+ Childbirth and the 2030 Agenda for Sustainable
Development
+ Medicalization of Childbirth
+ Labour Progression: What’s Normal?
+ Guideline Scope: Who & What?
process of labour.
The validity of one of the most The question of whether the current
cervicograph design can safely and
important components of the unequivocally identify healthy labouring
partograph, the alert and women at risk of adverse outcomes has
action lines, has been called become critical to clinical guidance on
intrapartum care.
into question in the last
decade, as findings of several
studies suggest that labour
can indeed be slower than the
To safely monitor labour and childbirth, a
limits proposed in the 1950s clear understanding of what constitutes
by Emmanuel Friedman. normal labour onset and progress is
essential.
02
+ Guideline Contributors
+ Priority Questions: Focusing on What Matters to Women
+ Confidence in Evidence: The GRADE Approach
+ Making of the Recommendations
Observers The GDG is a diverse group of individuals with expertise in research, clinical
practice, policy and programmes, and guideline development methods
Representatives of FIGO; ICM; RCOG; relating to intrapartum care practices and service delivery.
UNFPA; and USAID
03
+ Care Throughout Labour and Birth
+ First Stage of Labour
+ Second Stage of Labour
+ Third Stage of Labour
+ Care of the Woman and Newborn After Birth
There is insufficient evidence to support the use of the partograph alert line as a classifier to
detect women at risk of adverse birth outcomes.
1 cm per hour rule inaccurate < 1 cm/hour ≠ obstetric intervention Every birth is unique
For pregnant women with A minimum cervical dilatation rate of Labour may not naturally accelerate
spontaneous labour onset, the 1 cm/hour throughout active first until a cervical dilatation threshold of
cervical dilatation rate threshold of stage is unrealistically fast for some 5 cm is reached. Therefore the use
1 cm/hour during active first stage women and is therefore not of medical interventions to
(as depicted by the partograph alert recommended for identification of accelerate labour and birth (such as
line) is inaccurate to identify women at normal labour progression. A slower oxytocin augmentation or caesarean
risk of adverse birth outcomes and is than 1-cm/hour cervical dilatation section) before this threshold is not
therefore not recommended for this rate alone should not be a routine recommended, provided fetal and
purpose. indication for obstetric intervention. maternal conditions are reassuring.
But why?
either a handheld Doppler ultrasound device • Duration: Each auscultation should last for
at least 1 minute
or a Pinard fetal stethoscope is
recommended for healthy pregnant women • Timing: During a uterine contraction and for
at least 30 seconds thereafter
in labour.
• Recording: Record the baseline as a single
counted number in beats per minute, and
acceleration or deceleration
It is likely that the care context and the type of care provision and care provider have a strong
effect on the need for labour pain relief, and on the choices women make in relation to this need.
Recommendations on selected essential practices during the third stage of labour were
integrated from the 2012 WHO recommendations for the prevention and treatment of PPH.
04
+ Putting the Guideline into Context
+ WHO Intrapartum Care Model
+ Considerations Specific to Individual Recommendations
Develop or revise existing Ensure necessary physical Obtain technical support for
clinical guidelines, protocols or resources, supplies, equipment implementation, engage
job aids for intrapartum care and staff to deliver recommended stakeholders and partners, and
practices provide training
05
+ Underlying Principles
+ Priority Research Worth the Investment
+ Top Three Research Priorities
Ideal paper-based
or digital tool
for labour
Delaying versus monitoring and Comparative
direct labour ward clinical decision- effects of different
admission for making. intermittent
health pregnant auscultation
women. protocols.
06
+ Global Launch With Press Release
+ International Conferences
+ WHO Web Resources
+ Social Media
+ Translations
WHO and other partners will support national and subnational working groups to adapt and
implement this guideline.
07
+ Potential Barriers at Country Level
+ Organization of Care : What Needs to Change
+ Monitoring and Impact Evaluation
08
+ Living Guidelines Approach
+ New Guideline Questions?
+ Connecting With WHO
The WHO Steering Group will continue to monitor the research developments in the
area of intrapartum care, particularly for those questions that are supported by low-
quality evidence, where new recommendations or a change in the published
recommendations may be warranted.
”
comprehensive care for women and their
newborn babies.
Ana Pilar Betrán, Mercedes Bonet, Maurice Bucagu, Blami Dao, Justus Hofmeyr, Caroline Homer,
A. Metin Gülmezoglu, Olufemi Oladapo, Anayda Vanora Hundley, and Ashraf Nabhan
Portela, João Paulo Souza, and Joshua Vogel
Email:
oladapoo@who.int
Facebook:
Email: Twitter:
World Health Twitter:
Department of @HRPresearch
Organization @oladapo_olufemi
Reproductive Health
and Research
LinkedIn:
Femi Oladapo