Forteleza Declaration
Appropriate Technology for Birth

Have you heard of the Forteleza Declaration?

Sadly, we would venture to say your answer is no...and through no fault of your own. Something that every pregnant woman should be made aware of and yet few know it even exists. Why is it so important? What is it? What should it matter to you AND your attendant? We plan on answering all these questions so that you are informed and empowered.

The Forteleza declaration is the nickname of a document which was officially named "Appropriate Technology for Birth" and was first published in the Lancet in 1985 - Lancet. 1985 Aug 24;2(8452):436-7. Yes, it was done over 25 years ago and yet few have heard of it. We aim to change that.

This document was first written in April 1985 at a conference that took place at Forteleza, Brazil by the World Health Organization - WHO - and the Pan American Health Organization - PAHO - who intended to answer this very important question: "what is the appropriate use of technology for birth?" It is important to note that the vote from the attendees on all points was unanimous.

Who were the attendees? There were 50 of them and the fields of expertise they represented were: midwifery, obstetrics, pediatrics, epidemiology, sociology, psychology, economics, health administration and mothers.

Some vital components were taken in consideration while crafting the Fortelesa declaration:

Your right to exercise control over the conditions of your labor and the birth of your baby.

The importance of good communication between you - the laboring mom - your family and your birth team.

The need to make sure that there is a wise use of technologies such as fetal monitoring during your birth.

The WHO and PAHO also pondered the idea that there should be a fair evaluation of all new birth technologies before they are implemented.

The Forteleza Declaration Recommendations
Appropriate Technology for Birth

We must note that very careful review of the knowledge of birth technology was studied and this led to the adoption of these recommendations:

Birth is a natural process.

You have the right to proper prenatal care

You should have a central role in all aspects of this care and this includes participation in the planning, carrying out, and evaluation of said care.

Policies about appropriate birth technology should be implemented.

You should be informed of the various procedures - induction, IVs, episiotomy, c-section, epidural, etc - and their effect in order to enable you to choose the type of care and birth you want.

Your well-being - the new mother - must be ensured through free access of a chosen member of your family during birth and throughout the postnatal period.

There is no justification for any place or country to have a rate of c-section higher than 10-15% - in the USA United States it is almost 33%!

If you choose to give birth in an institution - hospital or birth center - you must retain your rights to decide about:

clothing: when is the last time a hospital allowed you to wear what you wanted?

,

food: when is the last time hospital policies allowed you to eat as you wished while in labor?

disposal of the placenta: were you given a choice?

Your newborn must remain with you - the mother - whenever possible - no routine observation procedures justify the separation of mother and baby.

There is no evidence that "once a c-section always a c-section." Therefore vaginal deliveries after caesarean - VBAC - should be encouraged.

There is no evidence that routine fetal monitoring during labor has a positive effect on the outcome of your pregnancy and birth. Therefore you should have the right to declined to be monitored 24/7.

Pubic shaving or pre-delivery enemas should be discarded since scientific evidence showed they are unnecessary procedures.

You should not be put in a lithotomy position during labor or birth. Rather you should be encouraged to stay active and to birth in whatever position is most comfortable.

Birth should never be induced for convenience but rather it should be reserved only if there is a specific medical indications. The induction rate should not be over 10%.

The routine administration of labor drugs should be avoided unless it is specifically required to correct or prevent a complication.

Routine artificial early rupture of the membranes - AROM - is not scientifically justified and can be detrimental.

Breastfeeding should be promoted and encouraged.

So if your birth attendant does not adhere to the Fortelesa declaration - appropriate technology in birth - or worse if she/he has never heard of it, you may want to consider finding a new attendant. Pregnancy is not a disease and birth is not an emergency. YOU should be an active participant in all aspect of your care not because you are "allowed" or by force because you are a "pushy mother" or "one of those" but simply because it is your God given RIGHT.

When all is said and done this is your pregnancy. The birth will be yours and that of your child's and something you will NEVER forget. If interventions are necessary - and they sometimes are - don't you want to KNOW that you have made all the right choices and therefore there can be no regrets or what ifs. You - and your baby - deserve the right information and infallible support.

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