BULLETIN N° 122
We participated in the development and dissemination of the WHO Guide to Care during Labor, the tool for intrapartum care designed to replace the traditional partogram, which today is inconsistent with the latest evidence and birth-centered care. women.
In the last half century, the number of births per year in the world barely increased by 16%. However, the philosophy of intrapartum care and childbirth underwent great transformations during that period.
One of the changes has been the development and subsequent promotion of the traditional “partogram” of the World Health Organization (WHO) to monitor labor and trigger interventions, based on work by Harvard gynecologist and obstetrician Emanuel Friedman started in the '50s that assumed a “normal” cervical dilation of 1 cm/hour.
However, over the last decade, evidence has been accumulating that using this tool was not a good predictor of a good birth outcome, that it did not help in making decisions and that, on the contrary, it could promote unnecessary cesarean sections. On the other hand, concern grew that the partogram focused exclusively on clinical aspects, but ignored other dimensions of labor, such as whether the woman is accompanied, whether she can change position, or whether she receives resources to relieve pain. .
In 2018, the WHO produced a guide with 56 recommendations for a positive childbirth experience that put women at the center of decisions, as reflected in a Editorial of the Dr. Fernando Althabe, one of the authors. In this context, the consensus of the specialists was that it was necessary to update the partogram. And the same group proposed a first draft of what would be the “WHO Guideline for Care during Labor” or LCG, for its acronym in English.
From the IECS Mother and Child Research Department, we had several instances of participation from that moment on. The first was a survey of 110 professionals who attend births in 23 countries to have a feedback initial on clarity, content and applicability of the tool. The second study explored its specific usability through the opinions of 142 health service providers who were trained and applied it to 1.226 pregnant women. More than 90% reported that they had been able to use the guide to manage childbirth, that they had completed it and that they felt satisfied, although they provided some proposals for improvement that were considered in a joint review process with the WHO. Finally, we participated in the process of modifying and generating the final version of the LCG (in English), which was published at the end of 2020.
Likewise, we developed a manual for using the guide and took part in three educational webinars aimed at its dissemination, although for its effective implementation at the country level it is necessary to first adapt the national clinical practice guidelines.
It is a historic change that helps consolidate a women-centered perspective and offer safe and effective care. We are proud to have contributed to the initiative. The new guide incorporates, operationalizes and promotes a more objective approach to supportive care within labor monitoring, where women's values and preferences are taken into account. As a recent comment in BJOG: An International Journal of Obstetrics and Gynecology, "Much has changed in the way we provide respectful, evidence-based intrapartum care over the past 50 years, and we hope that the Guide to Labor Care responds to these advances and encourages best practices that include promoting better good quality, respectful and compassionate care for all women, newborns and their families".
By Verónica Pingray, Lic. in Obstetrics, master in Epidemiology, Management and Health Policies and researcher at the IECS.