n the last 40 years, the birth care model that still prevails in most of the world has been consolidated. In the countries of central and northern Europe, in Canada and in Japan, there have been significant advances and changes towards a new focus on childbirth accompaniment.
We say a failure, in that sense Latin America is a clear exponent, for some reasons such as the following:
a) High and unacceptable rate of cesarean section. b) High incidence of premature babies c) High incidence of perinatal infections. d) High rate of bleeding in repeat caesarean section, for example, with the frequent incidence of placenta accreta or percreta. e) High incidence of separation of the newborn from its mother during its first hours of life f) High rate of drug interventions, restrictions, devices connected to the body, during normal delivery care. g) Significant increase in postpartum bleeding. h) High use of antibiotics during birth care. i) Low rate of exclusive breastfeeding. j) Significant increase in allergies, bronchial asthma and obesity in children as a result of these interventions. k) Low percentage of satisfaction of the mother in the birth of her children. l) High incidence of abuse and mistreatment of women during the birth of their children.
Many more can be added to this list of adverse results of the current model that governs Latin America.
The United Nations and international organizations for some years became aware of the magnitude of the problem.
He took two significant steps.
1- Human rights-based approach to abuse and violence against women in reproductive health services, with special emphasis on childbirth care and obstetric violence. Report of the Special Rapporteur on violence against women, its causes and consequences on a human rights-based approach to abuse and violence against women in reproductive health services, with special emphasis on childbirth and obstetric violence
«The Secretary-General has the honor to transmit to the members of the General Assembly the report of the Special Rapporteur on violence against women, its causes and consequences, Dubravka Šimonović, which is submitted in accordance with resolution 71/170 of the General Assembly».
July 11, 2019
2 – WHO recommendations: care during childbirth for a positive childbirth experience.
Most of the approximately 140 million births that occur worldwide each year are to women who do not have risk factors for complications for themselves or their babies at the start of and during labor. However, the timing of delivery is critical for the survival of women and babies, as the risk of morbidity and mortality can increase considerably if complications arise. In accordance with the goals established in the Sustainable Development Goal (ensure healthy lives and promote well-being for all at all ages), and the new Global Strategy for the Health of Women, Children and Adolescents (2016–2030 ), the global agenda is broadening its focus to ensure that women and babies not only survive birth complications (if they occur), but also that they develop and reach their potential for health and life… The recommendations in this guideline are intended to inform the development of relevant health policies and clinical protocols at national and local levels. Therefore, the main audiences of this guideline are those responsible for formulating public health policies at the national and local levels, those responsible for the implementation and administration of maternal and child health programmes, administrators of health care facilities non-governmental organizations (NGOs), professional societies involved in planning and managing maternal and child health services, health professionals (including nurses, midwives,
September 18, 2019
Link to original WHO document
The report of the UN special rapporteur was delivered after years of work during which the UN team traveled the world, collecting information from governments, hospitals, maternity hospitals, NGOs, medical and nursing associations, social organizations, testimonies of women.
The stories and documentation collected allowed the world to become aware of the resounding failure of the current delivery care model that still prevails in most countries.
As a result of that devastating report, the second document emerges.
What is the main reason for the failure of the current model of care at birth.
It’s actually quite obvious and elementary:
It proposes a physician-centered approach to birth. It is a vertical approach. From top to bottom. It is simply like this:
“I am the doctor. I have the responsibility that everything is okay. That there are no complications during childbirth. I have at my disposal a hospital, medical equipment, medicines and a human team at my orders and entirely at my disposal.»
I can, for example, write medical orders upon admission of a future mother to the delivery unit, with the following tenor:
a) Admit to the delivery room. b) Nothing by mouth. c) Absolute rest. d) Canalize vein. e) Venoclysis as follows: 1 liter of 5% dextrose in water to pass in 8 hours. f) Continuous fetal monitoring. g) Vaginal exam every two hours.
That is to say, all the responsibility is mine and the others must abide by the medical orders that I issue.
The second document:
«WHO recommendations: care during childbirth for a positive childbirth experience», which can be purchased free online, incorporates for the first time, the holistic approach in the process of accompanying childbirth.
It states verbatim:
“The guideline recognizes a ‘positive birth experience’ as a significant outcome for all women in labour. It defines a positive childbirth experience as one that meets or exceeds a woman’s prior personal and sociocultural beliefs and expectations. This includes giving birth to a healthy baby in a clinically and psychologically safe environment and having ongoing practical and emotional support, i.e. being accompanied at the time of birth and being assisted by friendly and technically competent staff. adequate. It is based on the premise that most women want to have a physiological labor and birth and to achieve a sense of personal accomplishment and control through participation in decision-making, including when medical interventions are required or desired.
This updated, comprehensive and consolidated guideline on essential care during childbirth
brings together existing and new recommendations from
the World Health Organization (WHO) that, being part of a package of recommendations, will guarantee the quality of care based on evidence, regardless of the setting or the level of health care. The recommendations presented in this guideline are not speci c to any country or region, and recognize the global differences in the level of health services available within and between countries. The guideline highlights the importance of woman-centred care to optimize the labor and delivery experience for women and their babies through a holistic approach based on human rights. It presents a global model of care during childbirth that considers the complexity and heterogeneity of prevailing models of care and current practice.
In other words, the only adequate approach in the way of accompanying the birth proposes a total change with the current model. It goes from a one-person, vertical approach to a holistic approach, that is, TRANSVERSAL.
Said document of transcendental importance is also accompanied by a detailed enumeration of 56 specific recommendations that allow it to be applied in each childbirth care site.
We can explain the holistic approach proposed by the WHO as follows:
1- It is centered on the baby who is beginning to be born, on his mother and father (failing that, a family member trusted by the mother).
2- The figure of the Doula, or the Doula Nurse (incorporated in Latin America for the first time, with the Salvadoran law).
3- The figure of the doctor or midwife.
These three participating aspects of the holistic model interact fluidly, each one of the components covering the field of care that corresponds to it. They do not get in the way, they are combined, they are coordinated throughout the delivery accompaniment, in such a way that it flows harmoniously, with excellent results in delivery care and an excellent degree of satisfaction for the mother and her family, as well as for the delivery staff. Greetings who accompanied them.
Conceptually, the one who guides, stimulates and initiates labor is the baby. It has the perfect biological programming, not only to start the birth event, but also to perfectly fulfill all the following stages that will allow it to flex, rotate, descend, accommodate the head, shoulders and body, to finally recognize its parents and spontaneously initiate breastfeeding continuously, without interruption during the first 3 hours of life.
The mother, biologically and emotionally connected with him, in the free position of her body, with free movement, allows her body to tune in with her baby so that it continues with its task of coming into the world.
The mother-to-be has her own cultural beliefs and values that will flow freely and respectfully. She will be able to ingest the foods and liquids that she wishes, during the entire event of the birth.
She will be continuously and permanently accompanied by her partner or husband, who will serve as support and support throughout the birth process. She may also be a good interlocutor with the rest of the staff, facilitating communication with the mother.
The female figure, as a companion to childbirth, is developed by the Doula nurse. She will be able to adequately interpret emotional, cultural patterns and fears of the future mother, as well as being an excellent interpreter of her wishes. She will fulfill the role of giving confidence and support, for example in different postures of her body both during labor and during the birth of the baby.
The health personnel will be able to contribute their knowledge and experience, in order to evaluate that it flows in a healthy and healthy way. It will allow the state of well-being and health of the mother and her baby, which will translate into a better degree of security and tranquility for the mother and her family.
The medical and nursing staff will be the ones who make the decisions at a given time, which involve some type of medical or surgical intervention and will be explained, analyzed and discussed with the future mother and her family.
There are already some countries in Latin America have initiated changes in order to adopt the new model.
El Salvador, for example, in just one year of the implementation of the Nacer con Cariño law for a respected delivery and loving and sensitive care for the newborn, is giving magnificent results.
In the following publication we will make a detailed analysis of the 56 WHO recommendations and how they can be implemented smoothly, thus achieving a transcendental turn and excellent results in perinatal care.
Dr. Rodrigo Aybar Garcia
Gynecologist Obstetrician Perinatologist
Panama September 10, 2022