The World Health Organisation has recently distributed a supplement outlining the importance of optimal intrapartum care, drawing attention to the needs of women who experience childbirth in healthcare facilities.
As more and more women around the world experience facility-based childbirth, WHO seeks to prioritise individualised, person-centred intrapartum care that is also evidence-based.
Obstetrician and gynaecologist Dr. Lisa Joels of Integra Healthcare agrees with this move. “Healthcare providers should always respect a patient’s dignity and privacy and provide compassionate care.”
WHO’s recent call for optimal maternity care comes after a 2016 framework calling for the improvement of both maternal and newborn care in hospitals. As well, recommendations in 2018 concerning intrapartum care have emphasized the need for dignity and privacy. Additionally, WHO asserts that freedom from harm and informed choices are also essential to empowering women in labour.
According to Dr. Joels, women’s trust in their healthcare providers is fundamental to a positive childbirth experience. When women learn what to expect during labour, they are also able to understand why plans may need to change. “If [women are] aware of what options are available in terms of pain relief, remaining mobile and positioning during the delivery, [they are] likely to feel more in control and less stressed.”
WHO’s special supplement describes challenges that characterise poor quality of care. In one study led by WHO, more than 33% of women in four countries experience harm during childbirth. The study documented complaints about physical and verbal abuse, discrimination and stigma, unprofessional care and poor conditions, as well as poor regard between women and healthcare providers.
Reports of poor quality care and negative childbirth experiences often discourage women to give birth subsequently in healthcare facilities, which works against the mission to reduce maternal deaths by increasing facility births.
WHO reports that the geographic location of a facility impacts the kind of intrapartum care women receive, and women in low resource settings often must cope with a lower quality of care. Certain interventions, like pain relief and medicines that prevent birth complications, and tools, like the partograph, which monitors the wellbeing of both mother and foetus, are not widely available in rural areas of many low and middle-income countries. Also worrying is the fact that a woman in childbirth is not always permitted to select a companion of choice, and for Dr. Joels, this situation warrants particular concern. “The constant support of a birth partner is key to supporting her, being her advocate when discussing interventions with healthcare providers and reducing her anxiety.”
WHO seeks to improve maternal care worldwide, but progress appears to be slow. Universal Health Coverage seeks to combine evidence-based approaches with the unique needs of individual healthcare settings, adapting requirements for safe labour and childbirth to the various realities of each healthcare facility.
