12. Recommendations• Delivery facil

12. Recommendations
• Delivery facilities must offer every woman privacy and allow her to be
accompanied by her choice of a supportive person (husband, friend,
mother, relative, TBA); all women must be treated with respect.
• Psychosocial support, education, communication, choice of position,
and pharmacological methods appropriately used during the first
stage are all useful in relieving pain and distress in the second stage
of labor.
• There should be at least 2 people assisting at every birth, whether it is
another health professional, family member, TBA, or village health
worker. Arrangements for having another person besides the primary
skilled attendant should be planned during the pregnancy.
• Monitoring of the fetal heart beat must be continued during the second
stage to allow early detection of bradycardia.
• Routine episiotomy is harmful and should not be practiced.
• Women should not be forced or encouraged to push until they feel an
urge to push.
• Health facilities and skilled attendants should be provided with
handheld battery powered or hand-cranked Dopplers for fetal heart
auscultation after every contraction. These should be added to lists
of essential commodities.
• Local anesthetic should always be given for any episiotomy, episiotomy/laceration
repair, or forceps delivery.
• Provision of critical skills for second stage management needs to be
supported by policies as well as training, simulations (drills), and
linkage with a functioning referral system.
• Lack of access to instrumental delivery is a major deficit in obstetric
care in many facilities; skills necessary for safe instrumental delivery
must be emphasized in preservice and in-service education for all
skilled attendants