Introductory Chapter: Childbirth Challenges

1. Introduction

Childbirth is one of the most important moments in life. Since the beginning, birth has always been surrounded by a fascination mixed with happiness and fear.

In medieval times, childbirth was a risky situation for both mother and baby. At that time, one in three women were victims of maternal mortality [1]. Infection, postpartum hemorrhage, obstructed labor, and poor knowledge of obstetrics were common causes of death [2].

Development of medicine and more detailed knowledge of the physiological process of childbirth brought safety. These aspects were essential to provide safer childbirth care by reducing maternal and perinatal mortality. The word Obstetrics derives from the Latin term “obstetrix”, which is derived from the verb “obstare” (to be beside). This is the main mission of health professionals who embrace this specialty and accompany pregnant women at birth. Be at her side, fully supporting the parturient throughout the process and identifying risk situations that require intervention. “Obstare” (to be beside) is the motto that guides the specialty, and any act that opposes it can result in an avoidable error.

That is why the issue of childbirth care is so lively and current. Centuries passed, new knowledge was acquired, and behaviors were modified over time because they proved to be inefficient, and others were incorporated. Despite all development, we know that we live in a globalized world where different scenarios are presented, different socio-economic and cultural aspects that make birth a concern and several measures have been taken to reduce this distortion.

The United Nations among the goals for sustainable development stipulated, in 2016, some global strategies for the health of women, children, and adolescents. They listed three premises: survive, prosper, and transform [3].

One of the main strategies is the reduction of preventable deaths, among which are: reducing global maternal mortality to less than 70 deaths per 100,000 live births and reducing neonatal mortality to at least 12 per 1000 live births in all countries [3].

In addition, a very intense debate seeks to minimize obstetric care by dividing natural childbirth and cesarean section into two opposing groups. To relegate the importance of obstetrics to this dichotomy is to belittle the specialty. Obstetrics is much bigger than that. It involves the birth of a baby, a mother and a father.

Obstetrics is the specialty that receives the most complaints, as society considers childbirth a purely physiological event, without major complications. Thus, the pass away of a mother or a child represents, for the lay population, a disastrous performance of the assistance team, a situation in which technical knowledge is immediately questioned and, subsequently, it is considered malpractice and will be investigated by the medical board.

Childbirth care is a major challenge today. Safety in childbirth care to avoid maternal-fetal morbidity and mortality is especially important. However, there are still 810 maternal deaths per day from complications in pregnancy and childbirth, mostly from preventable or treatable causes such as infectious diseases, hemorrhage, pre-eclampsia, and complications during or after pregnancy and childbirth [4, 5].

It is essential to avoid, on the one hand, excessive medicalization with early and unnecessary interventions and, on the other hand, the lack of care that can lead to delays in decision-making. In this delicate balance, it is also important to consider the expectations of the parturient with her desires related to how the delivery she idealized will take place. Respecting their wishes without jeopardizing the maternal-fetal unit is a great challenge for the obstetrician. The scenario where the birth will take place must be prepared by a sensitive, respectful, and kind team. It is important to avoid interventions such as uterine pressure, routine episiotomy, and excess unnecessary cesarean sections. Cultural, socioeconomic aspects and the choice of delivery mode are part of a big puzzle.

This book aims to assess the best childbirth care within the scientific evidence. Good quality care is essential for maternal and fetal safety. The book will cover the following topics: intrapartum care, episiotomy, uterotonics, induction of labor, new technologies to date pregnancy at birth, skin-to-skin contact, and contraception.

The contribution of this book is to present the reader with scientific evidence on the topic of Childbirth. We believe that with initiatives like this we will be contributing to sustainable development with a reduction in maternal and neonatal mortality. The progress of a society is linked to conditions that provide women with safe motherhood and that culminate in the birth of a child with the right to physical and mental health.

The purpose of obstetrics is to preserve the integrity of maternal health and provide the unborn with all the promising potential for their full somatic, neurological, and psychological development, in order to become a healthy citizen physically and psychically. Thus, it will have the necessary conditions to be useful to society, and to the family, and will be able to dazzle a happy future.