Thanks to a comment on the last post I would like to elaborate on the safe motherhood statement from WHO.

The paper is very interesting and the conclusion is split into 3 categories. Here are categories B and C – practices not recommended.

CATEGORY B:
Practices which are Clearly Harmful or Ineffective and Should be Eliminated

1. Routine use of enema.
2. Routine use of pubic shaving.
3. Routine intravenous infusion in labour.
4. Routine prophylactic insertion of intravenous cannula.
5. Routine use of the supine position during labour.
6. Rectal examination.
7. Use of X-ray pelvimetry.
8. Administration of oxytocics at any time before delivery in such a way that their effect cannot be controlled .
9. Routine use of lithotomy position with or without stirrups during labour.
10. Sustained, directed bearing down efforts (Valsalva manoeuvre) during the second stage of labour .
11. Massaging and stretching the perineum during the second stage of labour.
12. Use of oral tablets of ergometrine in the third stage of labour to prevent or control haemorrhage.
13. Routine use of parenteral ergometrine in the third stage of labour.
14. Routine lavage of the uterus after delivery.
15. Routine revision (manual exploration) of the uterus after delivery.

CATEGORY C:
Practices for which Insufficient Evidence Exists to Support a Clear recommendation and which Should be Used with Caution while Further Research Clarifies the Issue.

1. Non-pharmacological methods of pain relief during labour, such as herbs, immersion in water and nerve stimulation .
2. Routine early amniotomy in the first stage of labour .
3. Fundal pressure during labour.
4. Manoeuvres related to protecting the perineum and the management of the fetal head at the moment of birth.
5. Active manipulation of the fetus at the moment of birth .
6. Routine oxytocin, controlled cord traction, or combination
7. Early clamping of the umbilical cord .
8. Nipple stimulation to increase uterine contractions during the third stage of labour.

It looks like lots of practices that are normalised at the hospital aren’t even acceptable to WHO, like early cord clamping, ARM, supine position etc etc. When are we going to get consensus on this so we can all move forward? The full paper explains lots about acceptable practice.

The obvious way to stay safe from harmful practice done at the hospital, with little or no evidence to back it up, is to stay home. Hospital has a great place, if you have complications then Obs are vital but for normal birth a midwife in the safety of your own home is sensible.

Related posts:

1. WHO Statement Birth Is Not An Illness
2. Cord Clamping
3. Homebirth Safe After All
4. Cord Around The Neck
5. Birth In The News