From "Care in Normal Birth" to "Intrapartum care for a positive childbirth experience": How was the WHO guideline on normal birth changed?

Purpose The World Health Organization (WHO) released "WHO recommendations: Intrapartum care for a positive childbirth experience" in 2018. The guideline is considered the revised edition of the "Care in Normal Birth: a practical guide" issued in 1996 dedicated to childbirth in healthy pregnant women. This study aimed to compare the old and new WHO guidelines, and to describe the changes that have been made. Methods First, the basic characteristics of both the guidelines were compared. Second, subheadings were created in Japanese to describe the contents of both the old and new guidelines. A comparable list of subheadings of the old and new guidelines was made, and the categories of recommendation were shown in the same table. Finally, we analyzed the following details: "newly added items in the new guideline", "items that were present in the old guideline but were not included in the new guideline", and "items in the new guideline for which the recommended levels have shifted". Then, the overall changes in the WHO recommendations for normal childbirth were described. Results The old and new WHO guidelines were similar with regard to promoting the respectful maternity care. The major points that were revised included the respect for diversity of the progress of labor and modification of the definitions and standard duration of the first and second stages of labor. Additionally, the new guideline included recommendations on the care for women who have undergone epidural anesthesia, and for newborns. Recommendations considered to have been widely accepted in several birth settings, such as the use of clean instruments was not included in the new guideline. The category levels that elevated from the old guideline were the items related to oxytocin administration at the third stage of labor, umbilical cord traction, and care for women who underwent epidural anesthesia. The new guideline emphasized the midwifery cares which promote women's positive childbirth experience. However, the contents of midwifery cares were consistently unchanged in the new and old guidelines, although there were differences in expressions. [ABSTRACT FROM AUTHOR]