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A spurt in Unneeded Medical Interventions for Healthy Pregnant Women: WHO Study

WHO’s new guidelines include 56 evidence-based recommendations on the best care for mother and baby during labour and immediately after

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WHO chief Tedros Adhanom Ghebreyesus paid homage to his predecessor, Margaret Chan, saying the reforms begun under her leadership to make the World Health Organization more responsive and better able to tackle emergencies were now paying off.
The World Health Assembly, the decision-making body of the WHO, passed a number of resolutions aimed at improving global health. Wikimedia Common
  • WHO is launching new recommendations aimed at reducing potentially harmful interventions
  • WHO says health providers tend to intervene medically when the rate of labour appears to be slower than what is considered normal
  • WHO warns unnecessary labour and potentially harmful routine medical interventions are rampant in all parts of the world – in poor and rich countries alike

The World Health Organization (WHO) warns healthy pregnant women are undergoing unnecessary medical interventions at an alarming rate. Given the trend, WHO is launching new recommendations aimed at reducing potentially harmful interventions.

The organization reports most of the estimated 140 million annual births occur without complications. Yet, it says over the past 20 years there has been a significant rise in medical interventions previously used to avoid risks. These include oxytocin infusion to speed up labour and caesarean sections.

WHO says health providers tend to intervene medically when the rate of labour appears to be slower than what is considered normal. This is based on a long-held benchmark for cervical dilation to occur at a rate of one centimetre per hour.

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Olufemi Oladapo, a medical officer in WHO’s Department of Reproductive Health and Research, says every labour and childbirth is unique, and it is perfectly normal for some women to be slower than the prescribed rate of cervical dilation.

The World Health Organization (WHO) warns healthy pregnant women are undergoing unnecessary medical interventions at an alarming rate. Pixabay
The World Health Organization (WHO) warns healthy pregnant women are undergoing unnecessary medical interventions at an alarming rate. Pixabay

He says WHO has set another boundary for cervical dilation of up to five centimetres per hour during the first stage of labour until the woman is ready to push out the baby.

“It should not be longer than 12 hours for first-time mothers. And it should not be longer than 10 hours in subsequent labours…. So, as long as a woman is making some progress within that time frame, and the condition of the mother as well as the baby are reassuring, then there should be no reason for intervening,” Oladapo said.

WHO warns unnecessary labour and potentially harmful routine medical interventions are rampant in all parts of the world – in poor and rich countries alike. WHO’s new guidelines include 56 evidence-based recommendations on the best care for mother and baby during labour and immediately after.

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These include permitting a woman to have a companion of choice present during labour and childbirth; ensuring good communication between women and health providers; and allowing women to make decisions about their pain management, labour and birth positions. (VOA)

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As Venezuela’s Healthcare Collapses, Women and Girls Dying Needlessly

The surgeon is one of only three left at the Concepcion Palacios hospital in the Venezuelan capital

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Venezuela, Healthcare, Pregnant Women
Venezuelan girls beg for change where Venezuelans cross illegally into Colombia near the Simon Bolivar International Bridge, April 14, 2019. VOA

In Caracas’s main maternity hospital the blood banks and medicine cabinets are empty, the power and water regularly cut out — and women and girls are dying needlessly, according to one of the few remaining doctors, Luisangela Correa.

The surgeon is one of only three left at the Concepcion Palacios hospital in the Venezuelan capital, where the lifts and most toilets are closed and there are no bandages, sterilizers or X-ray services.

“We are like trapped, kept hostage by this situation … hope is what keeps us here,” Correa, 45, told the Thomson Reuters Foundation.

“If we haven’t left the hospital, it’s because we hope that things will improve.”

Venezuela, Healthcare, Pregnant Women
A Venezuelan migrant woman holds a baby outside an immigration processing office on the Rumichaca bridge after crossing the border from Colombia to Rumichaca, Ecuador, June 12, 2019. VOA

One in four have left

Millions of Venezuelans have fled the country to escape an economic and political crisis that has left about seven million — one in four — in need of humanitarian aid, according to the United Nations.

Its human rights chief Michelle Bachelet said last week after a three-day mission in March to the troubled South American country that Venezuela’s healthcare sector was in “critical condition.”

A lack of basic medicine and equipment was “causing preventable deaths,” she said — something Correa is witnessing at first hand.

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Infection rates at the maternity hospital are high because cleaners do not have disinfectants to wash away bacteria and there are no sterilizers for doctors to clean their equipment, she said.

“Currently, maternity is a risk for Venezuelan women, as it is for babies … many give birth at home, in the street,” Correa said.

“And there are no blood banks. Any complications from heavy bleeding is a very big risk of death for a patient.”

Correa, the U.N. and women’s rights groups all said unsanitary hospital conditions along with food and medical shortages had led to a rise in maternal mortality rates.

Venezuela, Healthcare, Pregnant Women
In Caracas’s main maternity hospital the blood banks and medicine cabinets are empty. VOA

U.N. findings disputed

The Venezuelan government disputed the findings of the U.N. report and said in a written response that maternal mortality rates had decreased by nearly 14% between 2016 and 2018.

Venezuela’s national healthcare system, once considered a model for Latin America, is now plagued by shortages of imported drugs and thousands of doctors and nurses no longer show up for work, their salaries ravaged by inflation.

Venezuelan President Nicolas Maduro has said there is little need for humanitarian aid, blaming U.S. sanctions for the oil-rich country’s economic problems.

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The United States imposed tough sanctions on Venezuela’s oil industry in January in an effort to oust Maduro in favor of opposition leader Juan Guaido, who is recognized as Venezuela’s rightful leader by more than 50 governments.

‘100% shortage’

CEPAZ, a coalition of women’s rights groups, has said Venezuela’s maternal mortality rates have increased by 65% from 2013 to 2016, with nearly 800 women dying.

Bachelet’s report cited a national survey that showed 1,557 people died due to lack of supplies in hospitals between November 2018 and February 2019.

Correa said she was seeing more pregnant teenage girls seeking care because they cannot find or afford contraception and do not receive sex education in schools.

According to the U.N. report, teenage pregnancies have risen by 65% since 2015, and several cities in Venezuela face a “100% shortage” of all types of contraception.

Strict abortion law

Due to Venezuela’s strict abortion law, which only allows the procedure under limited circumstances, some women and girls resort to unsafe abortions.

This has contributed to a rise in preventable maternal mortality, with about 20% of maternal deaths reportedly linked to unsafe abortions, the U.N. said in its report.

Correa says she is determined to continue to speak out about the dire conditions in public hospitals and help women in need. “The only thing we have are the outcries and hope that this will change,” she said. “My people, my country need me at this moment.” (VOA)