Monitoring childbirth in a new era for maternal health

WHO and HRP are launching an Occupational Care Guide to improve every woman’s childbirth experience and help ensure the health and well-being of women and their babies.

The philosophy of work and care, as well as the recommended approach of the World Health Organization (WHO), have developed significantly in recent decades.

Recognition that every birth is unique is now the cornerstone of the WHO for 2018 recommendations on intrauterine care for a positive birth experience.

Over one-third of maternal mortality, half of stillbirths, and a quarter of newborn deaths are the result of complications during childbirth. Most of these deaths occur in low-resource settings and can be prevented by timely interventions. Knowing when to wait – and when to take rescue action – is crucial.

What is the new Work Care Guide?

The WHO Guide to Occupational Care is a new tool put by the WHO recommendations on intrauterine care in practice. It helps qualified healthcare professionals to provide safe and effective care focused on women and to optimize the outcome and experience of childbirth for every woman and baby.

Launched with WHO User Manual Occupational Care Guide, the tool promotes a personal approach to monitoring the health and well-being of a woman and her baby from the active first stage of labor to the end of the second phase of labor.

This creates positive feedback and a decision-making loop, as healthcare professionals are encouraged to regularly:

• estimate the well-being of the woman and her baby
• record their observations
• check for signs that exceed health and well-being thresholds during work
• plan what attention may be needed, in agreement with the woman.

The guide and manual recognize that every birth is unique – from the personal experience of care to the speed with which her birth progresses.

“New WHO Work Guide strengthens the relationship between women and their health care providers during childbirth and childbirth, improving both individual experience and clinical outcome. It is a practical tool for a new era of maternal health, where women’s values ​​and preferences are at the heart of their own care”Says Mercedes Bonet, a medical officer in the WHO’s Department of Sexual and Reproductive Health and Research, including HRP, UNDP / UNFPA / UNICEF / WHO / World Bank Special Research, Development and Training Program for Research in Human Reproduction.

Behind the partograph

The Occupational Care Guide revises and replaces the traditional WHO partograph, a labor tracking tool that is now at odds with the latest evidence on the duration of labor, drivers for clinical interventions, and the importance of parental care with respect.

Many women do not have a birth that matches the expected rate of the original WHO partographer. For example, there is no evidence to support the use of a 1 cm / hour cervical dilatation rate as a screening tool to initiate medical interventions or referrals.

Instead, the Occupational Care Guide includes updated, evidence-based benchmarks for work progress. By recording and reviewing their observations against these references, healthcare professionals are encouraged to think critically, avoid unnecessary interventions, and act on warning signs.

They can also involve each woman in making decisions about their own work, part of the emphasis of the Work Care Guide the importance of the woman and the child’s experience of childbirth.

A revolution in the quality of maternal health care

The work care guide was evaluated in six countries, using combined methods a study recently published in BIRTH. It has been found to be feasible and acceptable for use in a variety of clinical settings, promoting woman-centered care and improving outcomes.

“By using the Occupational Care Guide we provide our patients with more care than before, we have provided them with what they need. So we had less complications and less intervention [due to] early detection and decision makingg ”, explained the midwife who was evaluating the tool in Nigeria.

Achieving the best possible physical, emotional, and psychological outcomes for every woman and child requires that health systems support a person-centered model of care that simultaneously empowers the user and enables health care staff.

In this way, the Work Care Guide is much more than a technical tool for monitoring work progress. It represents revolutionary steps towards individualized evidence-based care.