WHO wants docs to encourage normal deliveries

Hyderabad: In its guidelines on childbirth and care for pregnant women released last week, World Health Organisation (WHO) has quite forcefully suggested that obstetricians should wait till all options for normal delivery are exhausted before deciding to take up caesarean sections.

While health officials here are gearing up to adopt these new WHO guidelines on childbirth in State-run hospitals, the fact, however, remains that caesarean sections are increasingly being seen by families as a convenience rather than a medical procedure to be taken up as a last resort.

In its recommendations, UN health agency has rejected a majority of the existing traditional benchmarks being implemented in labour wards since 1950s. The UN body said that women in labour should be given more time to give birth and should have fewer surgical procedures like C-Sections.

One of the major recommendations of the health agency was rejecting the traditional standard in labour wards for the dilation of women’s cervix at the rate of one centimetre per hour. The WHO was referring to the first stage of labour in which the women’s cervix should completely dilate to 10 cm for delivery.

Pregnant women progressing through labour at a rate slower than one cm of cervical dilation per hour are generally considered as ‘abnormal’, which makes it possible to opt for surgical interventions like C-sections. Recent studies, however, have shown that the rate of dilation (1 cm for an hour) can be slower without endangering the health of women or child, WHO said.

Dilation can be slower than the earlier benchmarks and women in labour can still have a normal vaginal birth. The WHO now recommends 5 cm of dilation in the first 12 hours for a new mother and 10 hours among subsequent labours.

But the real question is how many doctors, especially in the private sector, and how many pregnant women and their families are willing to wait for the cervix to dilate and endure the pain.

Need for better maternity care
In addition to recommending health care workers to wait for a longer period of time during labour before taking up surgical interventions in the form of C-sections, the WHO in its guidelines has said that hospitals must ensure respectful maternity care.

This refers to care provided to pregnant women that maintains dignity, privacy, confidentiality and continues support during labour and child birth.

A companion of choice is recommended for all women throughout the labour and childbirth.

During the first stage of labour, pregnant women must be informed that the standard period of dilation of cervix (from 5 cm until full cervix dilation of 10 cm) usually does not extend beyond 12 hours in first labour or first time mothers and does not exceed 10 hours among women who are undergoing second time labour.

WHO has also recommended relaxation techniques including progressive muscle relaxation, breathing, music, mindfulness and other techniques for pregnant women requesting pain relief during labour. Stressing on the importance of midwives, the WHO in its guidelines said that midwives or a small group of known midwives supports women throughout antenatal, labour and postnatal stages and there is a need to have a proper functioning midwifery programme.

Telangana has high burden of C-sections
Telangana State has been grappling with large number of caesarean sections, which have become almost normal in private hospitals. In districts too, the number of C-sections taking place in both State-run and private health institutions are pretty much on the higher side.

According to the National Family Health Survey (NFHS-2015-16) data, 58 per cent of pregnant women in Telangana undergo C-sections while in Andhra Pradesh, it is 40 per cent.

The high surgical interventions reflect the present-day commercialisation of deliveries and also behavioural patterns of individual families who tend to prefer the baby delivered as an appropriate date and time.

According to figures available with health officials, close to 75 deliveries out of 100 in private hospitals happen through C-section. In State-run health institutions, the percentage of C-sections hovers between 40 per cent and 41 per cent.

It’s not just in India, caesarean sections have become a major challenge and a public health concern for its potential risk to mother and child health for many countries across the globe.

Even countries like Brazil have a high rate of surgical intervention of 50 per cent. According to WHO, the typical C-section rate in tertiary maternal care centres should be less than 15 per cent.