WHO recommendations
Intrapartum care for
a positive childbirth experience
, WHO recommendations
Intrapartum care for a
positive childbirth experience
,WHO recommendations: intrapartum care for a positive childbirth experience
ISBN 978-92-4-155021-5
© World Health Organization 2018
Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike
3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo).
Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided
the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO
endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt
the work, then you must license your work under the same or equivalent Creative Commons licence. If you create a
translation of this work, you should add the following disclaimer along with the suggested citation: “This translation
was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this
translation. The original English edition shall be the binding and authentic edition”.
Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of
the World Intellectual Property Organization.
Suggested citation. WHO recommendations: intrapartum care for a positive childbirth experience. Geneva: World
Health Organization; 2018. Licence: C C BY-NC-SA 3.0 IGO.
Cataloguing-in-Publication (CIP) data. CIP data are available at http://apps.who.int/iris.
Sales, rights and licensing. To purchase WHO publications, see http://apps.who.int/bookorders. To submit requests for
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General disclaimers. The designations employed and the presentation of the material in this publication do not imply the
expression of any opinion whatsoever on the part of WHO concerning the legal status of any country, territory, city or
area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps
represent approximate border lines for which there may not yet be full agreement.
The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or
recommended by WHO in preference to others of a similar nature that are not mentioned. Errors and omissions excepted,
the names of proprietary products are distinguished by initial capital letters.
All reasonable precautions have been taken by WHO to verify the information contained in this publication. However, the
published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for
the interpretation and use of the material lies with the reader. In no event shall WHO be liable for damages arising from its
use.
, Contents
Foreword v
Acknowledgements vi
Acronyms and abbreviations vii
Executive summary 1
Introduction 1
Target audience 1
Guideline development methods 1
Recommendations 2
1. Background 8
1.1 Target audience 9
1.2 Scope of the guideline 9
2. Methods 10
2.1 WHO Steering Group 10
2.2 Guideline Development Group 10
2.3 External Review Group 10
2.4 Technical Working Group 10
2.5 External partners and observers 11
2.6 Identifying priority questions and outcomes 11
2.7 Integration of recommendations from published WHO guidelines 13
2.8 Focus and approach 13
2.9 Evidence identification and retrieval 13
2.10 Quality assessment and grading of the evidence 14
2.11 Formulation of the recommendations 15
2.12 Decision-making during the GDG meetings 16
2.13 Declaration of interests by external contributors 17
2.14 Document preparation and peer review 17
2.15 Presentation of guideline content 17
3. Evidence and recommendations 19
3.1 Care throughout labour and birth 19
3.2 First stage of labour 35
3.3 Second stage of labour 120
3.4 Third stage of labour 159
3.5 Care of the newborn 162
3.6 Care of the woman after birth 165
4. Implementation of this guideline: introducing the WHO intrapartum care model 168
5. Research implications 171
6. Dissemination 173
7. Applicability issues 174
7.1 Anticipated impact of the guideline on the organization of intrapartum care 174
7.2 Monitoring and evaluating the impact of the guideline 174
8. Updating of the guideline 175
9. References 176
CONTENTS
iii
Intrapartum care for
a positive childbirth experience
, WHO recommendations
Intrapartum care for a
positive childbirth experience
,WHO recommendations: intrapartum care for a positive childbirth experience
ISBN 978-92-4-155021-5
© World Health Organization 2018
Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike
3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo).
Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided
the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO
endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt
the work, then you must license your work under the same or equivalent Creative Commons licence. If you create a
translation of this work, you should add the following disclaimer along with the suggested citation: “This translation
was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this
translation. The original English edition shall be the binding and authentic edition”.
Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of
the World Intellectual Property Organization.
Suggested citation. WHO recommendations: intrapartum care for a positive childbirth experience. Geneva: World
Health Organization; 2018. Licence: C C BY-NC-SA 3.0 IGO.
Cataloguing-in-Publication (CIP) data. CIP data are available at http://apps.who.int/iris.
Sales, rights and licensing. To purchase WHO publications, see http://apps.who.int/bookorders. To submit requests for
commercial use and queries on rights and licensing, see http://www.who.int/about/licensing.
Third-party materials. If you wish to reuse material from this work that is attributed to a third party, such as tables,
figures or images, it is your responsibility to determine whether permission is needed for that reuse and to obtain
permission from the copyright holder. The risk of claims resulting from infringement of any third-party-owned component
in the work rests solely with the user.
General disclaimers. The designations employed and the presentation of the material in this publication do not imply the
expression of any opinion whatsoever on the part of WHO concerning the legal status of any country, territory, city or
area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps
represent approximate border lines for which there may not yet be full agreement.
The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or
recommended by WHO in preference to others of a similar nature that are not mentioned. Errors and omissions excepted,
the names of proprietary products are distinguished by initial capital letters.
All reasonable precautions have been taken by WHO to verify the information contained in this publication. However, the
published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for
the interpretation and use of the material lies with the reader. In no event shall WHO be liable for damages arising from its
use.
, Contents
Foreword v
Acknowledgements vi
Acronyms and abbreviations vii
Executive summary 1
Introduction 1
Target audience 1
Guideline development methods 1
Recommendations 2
1. Background 8
1.1 Target audience 9
1.2 Scope of the guideline 9
2. Methods 10
2.1 WHO Steering Group 10
2.2 Guideline Development Group 10
2.3 External Review Group 10
2.4 Technical Working Group 10
2.5 External partners and observers 11
2.6 Identifying priority questions and outcomes 11
2.7 Integration of recommendations from published WHO guidelines 13
2.8 Focus and approach 13
2.9 Evidence identification and retrieval 13
2.10 Quality assessment and grading of the evidence 14
2.11 Formulation of the recommendations 15
2.12 Decision-making during the GDG meetings 16
2.13 Declaration of interests by external contributors 17
2.14 Document preparation and peer review 17
2.15 Presentation of guideline content 17
3. Evidence and recommendations 19
3.1 Care throughout labour and birth 19
3.2 First stage of labour 35
3.3 Second stage of labour 120
3.4 Third stage of labour 159
3.5 Care of the newborn 162
3.6 Care of the woman after birth 165
4. Implementation of this guideline: introducing the WHO intrapartum care model 168
5. Research implications 171
6. Dissemination 173
7. Applicability issues 174
7.1 Anticipated impact of the guideline on the organization of intrapartum care 174
7.2 Monitoring and evaluating the impact of the guideline 174
8. Updating of the guideline 175
9. References 176
CONTENTS
iii
