A positive childbirth experience is central to a woman's health and well-being, defined as one that meets or surpasses her personal and sociocultural expectations, encompassing a healthy baby in a safe environment, supported by continuous emotional care from companions and skilled, compassionate staff. This vision underpins a comprehensive set of recommendations for intrapartum care, moving beyond mere survival to ensuring that every woman thrives throughout her journey of labor and birth. These guidelines emphasize woman-centered care, recognizing that the increasing medicalization of childbirth can often undermine a woman's inherent capability and negatively impact her experience.
Throughout labor and birth, respectful maternity care is paramount. This means that every woman receives care that upholds her dignity, privacy, and confidentiality, free from harm or mistreatment, and empowers her to make informed choices with continuous support. Effective communication, delivered in simple and culturally sensitive ways, is essential between care providers and the woman in labor. Furthermore, the presence of a chosen companion throughout labor and childbirth is strongly recommended, fostering a supportive environment for the birthing person.
During the first stage of labor, women at low risk are encouraged to consume oral fluids and food, maintaining their energy and comfort. Mobility and upright positions are also recommended to facilitate the labor process. Routine vaginal cleansing with chlorhexidine is not advised for preventing infections. For assessing labor progression in low-risk women, digital vaginal examinations at four-hour intervals are recommended. Continuous cardiotocography for fetal well-being assessment is not recommended for healthy pregnant women in spontaneous labor; instead, intermittent auscultation of the fetal heart rate is suggested.
As labor progresses, women requesting pain relief should have access to options like epidural analgesia, based on their preferences. However, pain relief specifically to prevent delay or reduce the need for augmentation is not recommended. Practices such as amniotomy alone or a package of care for active management of labor are not recommended solely for preventing delay in labor.
Immediate care for both the newborn and the birthing woman after delivery is crucial. Following an uncomplicated vaginal birth in a healthcare facility, it is recommended that healthy mothers and newborns remain in the facility for at least 24 hours to receive essential postnatal care.
These recommendations are not specific to any country or region, acknowledging the diverse healthcare landscapes globally. They are intended to serve as a consolidated, evidence-based package of care, guiding national and local health policies and clinical protocols. The ultimate goal is to empower women to access the woman-centered care they desire and need, grounded in a human rights-based approach, and delivered by kind, competent, and motivated healthcare professionals in settings with adequate resources.
