working
for the World Health Organization (WHO) in Geneva, updated their 1985 report
with a new publication, "Care in Normal Birth: A Practical Guide"
Publication 9624, 1996.
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For the benefit of mankind, a board of international medical experts
Normal birth is defined as "spontaneous in onset, low-risk at the start of
labor and remaining so throughout labor and delivery. The infant is born
spontaneously in the head first position between 37 and 42 completed weeks.
As the labor and delivery of many high-risk women have a normal course, a
number of the recommendations in this paper also apply to the care of these
women."
Current Israeli practice incorporates some of the recommendations, for
example using gloves during delivery, sterility in cutting the cord, and
routine exam of the placenta.
The following recommendations, based on accepted medical knowledge, are not
adhered to in Israeli hospitals as a rule:
Practices listed as "Clearly Harmful or Ineffective and Should be
Eliminated":
Routine Intravenous infusion in labor
Routine use of supine position during labor
Routine use of lithotomy position during delivery
Sustained, directed bearing down efforts during pushing (PUSH PUSH PUSH!!)
Massaging and stretching the perineum during pushing.
"Practices which are to be used with caution until further research
clarifies the issues":
Routine breaking the water
Routine shot of pitocin after birth
Clamping the cord right away after birth
"Practices which are frequently used inappropriately":
EFM- Electronic Fetal Monitoring
Fasting
Oxytocin augmentation in labor
Epidurals
Repeated or frequent vaginal exams, especially by more than one caregiver
Episiotomy for first births
Changes are happening. For example for the past 5 years, routine enema,
listed in the category of practices that are clearly harmful or ineffective
is slowly being phased out in many hospitals. The already excellent outcomes
of Israeli hospitals would improve if they adhered to the WHO
recommendations based on years of research outcomes.
Source: Care in Normal Birth: a practical guide.
Maternal and Newborn Health, World Health Organization 1996
Document 96.24. Available free of charge from: W.H.O., 1211 Geneva 27,
Switzerland. Fax 41 22 791 0746
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