This article addresses a recent advisory issued by the Union Health Ministry in India, asking states to adopt a non-interventional approach during the final stages of labour, in line with the Gujarat model. This recommendation has drawn criticism from obstetricians who suggest it contradicts existing World Health Organization (WHO) guidelines. The matter is pertinent as it directly affects efforts to mitigate Post-Partum Haemorrhage (PPH), a leading cause of maternal mortality in India.
Understanding Post-Partum Haemorrhage
Postpartum haemorrhage (PPH) is clinically defined as a blood loss exceeding 500 ml within 24 hours post childbirth. PPH constitutes the foremost cause of maternal deaths in economically challenged countries and accounts for nearly a quarter of all global maternal fatalities.
The primary cause of PPH is the uterus failing to contract adequately after the baby is delivered and the placenta is expelled. Normally, these contractions act to suppress the bleeding from the vessels in the region where the placenta was attached. In cases where contraction is weak, vessel bleeding becomes uncontrolled.
Recommendations from WHO
World Health Organization emphasizes the strategy known as “active management of third stage of labour” (AMTSL). The third stage refers to the period between the baby’s delivery and the eventual expulsion of the placenta, which typically lasts from six to thirty minutes. The volume of blood lost throughout this stage depends on the time taken for placental separation from the uterine wall and the subsequent efficiency of uterine muscle contractions.
As per WHO recommendations, the use of uterotonic drugs, intended to induce uterine contractions and minimize bleeding, stands as the best critical measure.
New Government’s Advisory
The latest advisory put forth by the Union Health Ministry advocates for a physiological management approach, or a “hands-off” practice during the third stage of labour. This advisory suggests delaying the clamping and cutting of the umbilical cord until the placenta naturally separates and is expelled from the uterus, advising that the uterotonic oxytocin be administered only after this process.
Comparison of Maternal Mortality Facts
| Country | Maternal Mortality Rate (per 100,000 live births) |
|---|---|
| India | 145 |
| United States | 19 |
| United Kingdom | 7 |
| Australia | 6 |
| Germany | 6 |
Opposition to the Advisory
The aforementioned advisory has faced opposition from obstetricians who argue that it contradicts the WHO recommendations for managing PPH. Their primary concern is that this can potentially hinder existing efforts aimed at reducing PPH cases and preventing maternal fatalities due to bleeding.
