Implementing The 2018 Who Intrapartum Care Guidelines: A Narrative Review of Challenges and Opportunities

Abstract

Background: Maternal and neonatal health remain a global priority, with efforts focused on reducing mortality and ensuring a positive childbirth experience. This review critically examines the 2018 WHO Intrapartum Care Guidelines (IPGs) and identified the challenges of its implementation.

Method: The search was conducted on PubMed, Scopus, Web of Science, and Google Scholar to identify appropriate literature and involved the use of keywords: “WHO intrapartum guidelines”, “Labour Care Guide (LCG)”, and “positive childbirth experience”, among others. Pertinent articles were reviewed, examined, and grouped according to specified themes. Findings were narratively synthesised, with attention to new evidence and relevance for global health equity.

Findings: The guidelines offer 56 evidence-based recommendations for respectful, intervention-limited care during labour. Modifications included the extension of the active phase of labour to 5 cm and the replacement of the partograph with the LCG in order to facilitate close monitoring of labour. Recommendations included allowing companions in labour and delivery in a position convenient for the patient and the use of some pain relief techniques. Barriers to action are related to personnel, resources, and resistance, especially in underserved and over-medicalised settings.

Conclusion: The 2018 WHO IPGs have greatly advanced the development of woman-centred intrapartum care. For effectiveness, the guidelines require reforms of systems, including infrastructure, improving human resources, and adaptation to the local context.