The Ten Steps of the Mother-Friendly Childbirth Initiative are all based on practices for which there is solid scientific evidence. Founded by CIMS: “The Coalition for Improving Maternity Services is a coalition of individuals and organizations with concern for the care and well-being of mothers, babies, and families. Our mission is to promote a wellness model of maternity care that will improve birth outcomes and substantially reduce costs.”

The First Consensus Initiative of the Coalition for Improving Maternity Services (CIMS)

Mission, Preamble and
Principles

Mission

The Coalition for Improving Maternity Services (CIMS) is
a coalition of individuals and national organizations with
concern for the care and well-being of mothers, babies, and
families. Our mission is to promote a wellness model of
maternity care that will improve birth outcomes and
substantially reduce costs. This evidence-based mother-, baby-,
and family-friendly model focuses on prevention and wellness as
the alternatives to high-cost screening, diagnosis,
and treatment programs.

Preamble

Whereas:

• In spite of spending far more money per capita on
  maternity and newborn care than any other country, the United
  States falls behind most industrialized countries in perinatal morbidity and mortality,
  and maternal mortality is four times greater for
  African-American women than for Euro-American women;
• Midwives attend the vast majority of births in those
  industrialized countries with the best perinatal outcomes,
  yet in the United States, midwives are the principal
  attendants at only a small percentage of births;
• Current maternity and newborn practices that contribute
  to high costs and inferior outcomes include the inappropriate
  application of technology and routine procedures that are not
  based on scientific evidence;
• Increased dependence on technology has diminished
  confidence in women’s innate ability to give birth without
  intervention;
• The integrity of the mother-child relationship, which
  begins in pregnancy, is compromised by the obstetrical
  treatment of mother and baby as if they were separate units
  with conflicting needs;
• Although breastfeeding has been scientifically shown to
  provide optimum health, nutritional, and developmental
  benefits to newborns and their mothers, only a fraction of
  U.S. mothers are fully breastfeeding their babies by the age
  of six weeks;
• The current maternity care system in the United States
  does not provide equal access to health care resources for
  women from disadvantaged population groups, women without
  insurance, and women whose insurance dictates caregivers or
  place of birth;

Therefore,

We, the undersigned members of CIMS, hereby resolve to
define and promote mother-friendly maternity services in
accordance with the following principles:

Principles

We believe the philosophical cornerstones of mother-friendly
care to be as follows:

Normalcy of the Birthing Process

• Birth is a normal, natural, and healthy process.
• Women and babies have the inherent wisdom necessary for
  birth.
• Babies are aware, sensitive human beings at the time of
  birth, and should be acknowledged and treated as such.
• Breastfeeding provides the optimum nourishment for
  newborns and infants.
• Birth can safely take place in hospitals, birth centers,
  and homes.
• The midwifery model of care, which supports and protects
  the normal birth process, is the most appropriate for the
  majority of women during pregnancy and birth.

Empowerment

• A woman’s confidence and ability to give birth and to
  care for her baby are enhanced or diminished by every person
  who gives her care, and by the environment in which she gives
  birth.
• A mother and baby are distinct yet interdependent during
  pregnancy, birth, and infancy. Their interconnected-ness is
  vital and must be respected.
• Pregnancy, birth, and the postpartum period are milestone
  events in the continuum of life. These experiences profoundly
  affect women, babies, fathers, and families, and have
  important and long-lasting effects on society.

Autonomy

Every woman should have the opportunity to:

• Have a healthy and joyous birth experience for herself
  and her family, regardless of her age or circumstances;
• Give birth as she wishes in an environment in which she
  feels nurtured and secure, and her emotional well-being,
  privacy, and personal preferences are respected;
• Have access to the full range of options for pregnancy,
  birth, and nurturing her baby, and to accurate information on
  all available birthing sites, caregivers, and practices;
• Receive accurate and up-to-date information about the
  benefits and risks of all procedures, drugs, and tests
  suggested for use during pregnancy, birth, and the postpartum
  period, with the rights to informed consent and informed
  refusal;
• Receive support for making informed choices about what is
  best for her and her baby based on her individual values and
  beliefs.

Do No Harm

• Interventions should not be applied routinely during
  pregnancy, birth, or the postpartum period. Many standard
  medical tests, procedures, technologies, and drugs carry
  risks to both mother and baby, and should be avoided in the
  absence of specific scientific indications for their
  use.
• If complications arise during pregnancy, birth, or the
  postpartum period, medical treatments should be
  evidence-based.

Responsibility

• Each caregiver is responsible for the quality of care she
  or he provides.
• Maternity care practice should be based not on the needs
  of the caregiver or provider, but solely on the needs of the
  mother and child.
• Each hospital and birth center is responsible for the
  periodic review and evaluation, according to current
  scientific evidence, of the effectiveness, risks, and rates
  of use of its medical procedures for mothers and babies.
• Society, through both its government and the public
  health establishment, is responsible for ensuring access to
  maternity services for all women, and for monitoring the
  quality of those services.
• Individuals are ultimately responsible for making
  informed choices about the health care they and their babies
  receive.

These principles give rise to the following ten steps,
which support, protect, and promote mother-friendly
maternity services:

To receive CIMS designation as “mother-friendly,” a
hospital, birth
center, or home birth service must carry out our
philosophical principles by fulfilling the Ten Steps of
Mother-Friendly Care:

A mother-friendly hospital, birth center, or home
birth service:

1. Offers all birthing mothers:

   • Unrestricted access to the birth companions of her
     choice, including fathers, partners, children, family
     members, and friends;
   • Unrestricted access to continuous emotional and
     physical support from a skilled woman-for example, a doula or labor-support
     professional:
   • Access to professional midwifery care. (References) 
2. Provides accurate descriptive and statistical information
   to the public about its practices and procedures for birth
   care, including measures of interventions and outcomes.(References)
3. Provides culturally competent care — that is, care that is
   sensitive and responsive to the specific beliefs, values, and
   customs of the mother’s ethnicity and religion.(References)
4. Provides the birthing woman with the freedom to walk,
   move about, and assume the positions of her choice during
   labor and birth (unless restriction is specifically required
   to correct a complication), and discourages the use of the
   lithotomy (flat on back with legs elevated) position.(References)
5. Has clearly defined policies and procedures for:
   • collaborating and consulting throughout the perinatal
     period with other maternity services, including
     communicating with the original caregiver when transfer
     from one birth site to another is necessary;
   • linking the mother and baby to appropriate community
     resources, including prenatal and post-discharge
     follow-up and breastfeeding support.(References)
6. Does not routinely employ practices and procedures that are
   unsupported by scientific evidence, including but not
   limited to the following:
   • shaving;
   • enemas;
   • IVs (intravenous drip);
   • withholding nourishment;
   • early rupture of
     membranes;
   • electronic fetal monitoring;

   Other interventions are limited as follows:

   • Has an induction rate of 10%
     or less;
   • Has an episiotomy rate of
     20% or less, with a goal of 5% or less;
   • Has a total cesarean rate of 10% or less in community
     hospitals, and 15% or less in tertiary care (high-risk)
     hospitals;
   • Has a VBAC (vaginal birth after cesarean) rate of 60%
     or more with a goal of 75% or more.(References)
7. Educates staff in non-drug methods of pain relief and
   does not promote the use of analgesic or anesthetic drugs not
   specifically required to correct a complication. (References)
8. Encourages all mothers and families, including those with
   sick or premature newborns or infants with congenital
   problems, to touch, hold, breastfeed, and care for their
   babies to the extent compatible with their conditions.(References)
9. Discourages non-religious circumcision of the newborn.(References)
10. Strives to achieve the WHO-UNICEF “Ten Steps of the
    Baby-Friendly Hospital Initiative” to promote successful
    breastfeeding:
    1. Have a written breastfeeding policy that is
       routinely communicated to all health care staff;
    2. Train all health care staff in skills necessary to
       implement this policy;
    3. Inform all pregnant women about the benefits and
       management of breastfeeding;
    4. Help mothers initiate breastfeeding within a
       half-hour of birth;
    5. Show mothers how to breast feed and how to
       maintain lactation even if they should be separated from
       their infants;
    6. Give newborn infants no food or drink other than
       breast milk unless medically indicated;
    7. Practice rooming in: allow mothers and infants to
       remain together 24 hours a day;
    8. Encourage breastfeeding on demand;
    9. Give no artificial teat or pacifiers (also called
       dummies or soothers) to breastfeeding infants;
    10. Foster the establishment of breastfeeding support
        groups and refer mothers to them on discharge from
        hospitals or clinics.

©1996 by The Coalition for Improving Maternity Services(CIMS). Reproduced for my blog solely with the intent to educate & advocate.

Posted in activism, birthing & written by Niki —