In April 1985, the World Health Organization and the Pan American Health Organization They organized a conference on the appropriate technology for childbirth in Fortaleza (Brazil), with the assistance of midwives, obstetricians, pediatricians, epidemiologists, sociologists, psychologists, economists, health administrators and mothers.
From there emerged the known as "Declaration of Strength", with recommendations on birth.
The statement was the result of a careful analysis carried out by experts from all over the world, and has been adapted by many organizations as a role model for a normal and respected birth.
However, 25 years later, these points that every woman should know do not seem to have been assumed in many areas, starting with the hospital that is where most of us give birth. The Declaration of Strength includes aspects that we frequently discuss in our pages.
However, it never hurts to remember and claim them. These are the key points of the Declaration of Strength on how a birth should be and some comments from us about it.
Mothers and their families should be encouraged to practice self-care in the perinatal period, and to recognize when they need help and of what kind to improve the conditions of pregnancy, childbirth and the puerperium.
Mutual help groups among mothers offer valuable social support and a unique opportunity to share information about childbirth. That the mother does not feel alone, that she can share fears and experiences, is fundamental in this delicate period.
Every woman should be informed of the different methods of delivery care, so you can choose the type of delivery you prefer. However, many times we do not know the options, or we are afraid, or we have no financial resources for what we would like. As we have said, sometimes the place where the woman should give birth is not the one she can choose.
"Informal" perinatal care systems (such as midwives, midwives, or traditional midwives) must coexist with the official system. I would add that in contexts where it is possible, more and more, there are professional qualifications for these trades that deserve respect, and should be seen as collaborating agents in childbirth. An example is the valuable work of midwives in Primary Care. Many times midwives may be the best option for pregnant women.
Professionals in the healthcare network must know communication techniques to promote a respectful exchange of information with pregnant women and their families. The relationship between labor professionals and families should be cordial and respectful.
An elected member of the woman's family must have free access during childbirth and throughout the postnatal period. In addition, the health team must also provide emotional support, because it is of little use to have a close person if the rest is "against" or does not contribute to psychic well-being of the parturient.
Women who give birth in an institution must retain their right to decide on clothing (theirs and that of the baby), food, placental destination and other culturally important practices.
The healthy newborn should remain with the mother whenever possible. Immediate breastfeeding should be recommended, as we have seen so many times to build the basis of successful breastfeeding.
It is not recommended to routinely place the pregnant woman in lithotomy position. Each woman must freely decide what position to take during childbirth. Perhaps this point is the one that remains least respected, along with the one that follows. In the absence of information on the different postures to give birth, the rejection of a good part of the medical staff to change habits.
The perineum should be protected whenever possible, so the systematic use of episiotomy is not justified.
There is no evidence that routine fetal monitoring has a positive effect on the outcome of pregnancy. Electronic fetal monitoring should only be performed in cases carefully selected for their high risk of perinatal mortality, and in induced deliveries.
It is recommended to control the fetal heart rate by auscultation during the first phase of labor, and more frequently during the expulsion.
Shaving pubic hair or administering an enema before delivery is not indicated. They are unjustified practices against which many women feel uncomfortable or violent.
Labor induction must be reserved for specific medical indications. No region should have more than 10% of inductions. The convenience of inductions has been called into question on more than one occasion, and it is that a labor induction is not a risk-free act, although sometimes it is necessary and preferable, for example, to a caesarean section.
During the expulsion, the routine administration of analgesics or anesthetics should be avoided (unless specifically needed to correct or prevent any complications).
Precocious artificial rupture of membranes as a routine procedure is not justified.
Some of the countries with the lowest perinatal mortality in the world have less than 10% C-sections. It cannot be justified that no country has more than 10-15%. As we know, this is another of the pending accounts in our environment, with an unreasonably high number of cesarean sections. Occasionally 25% of deliveries by caesarean section are exceeded.
There is no evidence that a new caesarean section is necessary after a previous C-section. Vaginal birth after caesarean section is an increasingly safe option.
After a caesarean section, vaginal delivery should normally be recommended, whenever emergency surgery is possible.
As we can see, these are many aspects related to the period before and after childbirth, and especially during it. Aspects that include not only physical but also emotional care, a global attention to the woman who gives birth and her baby.
Fortunately, more and more hospitals and professionals are aware of the importance of respectful care for a normal delivery. However, there is a long way to go to get you recommendations on the birth of the Declaration of Strength effectively generalize.
Photos | Inferis and dizznbonn on Flickr More information | Ecovisions In Babies and more | Normal delivery care strategy, The industrialization of births, Book "Normal Birth Initiative": the midwifery federation for a more natural birth
