Table 1.
Individual WHO recommendations and how they impact on a positive childbirth experience
| Practices recommended (facilitators) | Positive childbirth experience | Practices not recommended (hindrances) |
|---|---|---|
| Intermittent fetal heart auscultation with a Doppler device or Pinard stethoscope; uterotonics (oxytocin or misoprostol) and controlled cord traction for the prevention of postpartum haemorrhage; delayed neonatal cord clamping; regular postnatal maternal assessment of vaginal bleeding, uterine tonus, and vital signs; intramuscular vitamin K, skin‐to‐skin contact; breastfeeding; delayed newborn bathing; postnatal maternal and newborn care for at least 24 hours in facility | Healthy mother and baby (including prevention and treatment of risks, and avoidance of death) | Routine clinical pelvimetry and cardiotocography at labour admission; continuous cardiotocography during labour; routine vaginal cleansing with chlorhexidine during labour; sustained uterine massage after birth; routine oral or nasal suction for babies with clear amniotic fluid; routine antibiotics for uncomplicated birth |
| Active phase starts at 5‐cm dilatation and continues for up to 12 h and 10 h; duration of second stage up to 3 h and 2 h; for nulliparous and parous women, respectively | ‘Physiological labour and birth’ (without medical interventions) | Use of cervical dilatation threshold of 1 cm/h for the assessment of normal labour progression; interventions to accelerate or terminate labour before 5‐cm dilatation; perineal shaving and enema at labour admission; active management of labour; routine amniotomy, early amniotomy and early oxytocin, antispasmodics, intravenous fluids, and oxytocin for women with epidural for preventing ‘delay’ in labour; routine or liberal episiotomy; manual fundal pressure for second stage |
| Respectful maternity care; effective communication; 4‐hourly vaginal examination; pain relief (e.g. relaxation, manual techniques, opioids, and epidural); oral fluids and food intake, adoption of mobility, and upright position during first stage; comfortable birth position of choice regardless of epidural use, delayed pushing in women with epidural, supportive perineal techniques to reduce perineal trauma in second stage | Desire to be in control (including preserving maternal self‐esteem, competence, and autonomy, and sense of personal achievement and involvement in decision making) | Continuous cardiotocography; active management of labour; routine episiotomy; manual fundal pressure for second stage |
| Companion of choice, effective communication; continuity of care | Emotional support of a labour and birth companion | |
| Respectful maternity care; effective communication; continuity of care | Sensitive, caring, kind, skilled, and competent staff | |
| Postnatal care for at least 24 hours | Clinically and psychologically safe environment | Discharge prior to 24 hours |