BIRTH IS NOT AN ILLNESS

BIRTH IS NOT AN ILLNESS
Fortelesa Declaration - Recommendations from the World Health Organization 1985
These recommendations are taken from a report on Appropriate Technology for Birth published by the World
Health Organization in April 1985, and are known as the Fortelesa Declaration.
The recommendations are based on the principle that each woman has a fundamental right to receive proper
prenatal care; that the woman has a central role in all aspects of this care, including participation in the planning,
carrying out, and evaluation of the care; and that social, emotional and psychological factors are decisive in the
understanding and implementation of proper prenatal care.
» The whole community should be informed about the various procedures in birth care, to enable each woman to
choose the type of birth care she prefers.
» The training of professional midwives or birth attendants should be promoted. Care during normal pregnancy
and birth, and following birth should be the duty of this profession.
» Information about birth practices in hospitals (rates of caesarean section &c) should be given to the public
» There is no justification in any specific geographic region to have more than 10-15% caesarean section births.
» There is no evidence that a caesarean section is required after a previous transverse low segment caesarean
section birth. Vaginal deliveries after caesarean should normally be encouraged wherever emergency surgical
» There is no evidence that routine fetal monitoring during labour has a positive effect on the outcome of
» There is no evidence for pubic shaving or pre-delivery enema.
» Pregnant women should not be put in a lithotomy position during labour or delivery. They should be
encouraged to walk during labour and each woman must freely decide which position to adopt during delivery.
» The systematic use of episiotomy is not justified.
» Birth should not be induced for convenience, and the induction of labour should be reserved for specific
medical indications. No geographic region should have rates of induced labour over 10%.
» The routine administration of analgesic or anaesthetic drugs that are not specifically required to correct or
prevent a complication in delivery should be avoided.
» Artificial early rupture of the membranes, as a routine process, is not scientifically justified.
» The healthy newborn must remain with the mother, wherever both their conditions permit it. No process of
observation of the healthy newborn justifies a separation from the mother.
» The immediate beginning of breastfeeding should be promoted, even before the mother leaves the delivery
» Obstetric care services that have critical attitudes towards technology, and that have adopted an attitude of
respect for the emotional, psychological and social aspects of birth should be identified. Such services should be
encouraged and the processes that have led them to their position must be studied so that they can be used as
models to foster similar attitudes in other centres and to influence obstetrical views nation wide.
» Governments should consider developing regulations to permit the use of new birth technology only after
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