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The Mother-Friendly Childbirth Initiative

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

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:

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

Empowerment

Autonomy

Every woman should have the opportunity to:

Do No Harm

Responsibility

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.
       
  2. Provides accurate descriptive and statistical information to the public about its practices and procedures for birth care, including measures of interventions and outcomes.
  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.
  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.
  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.
       
  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 oxytocin use rate of 10% or less for induction and augmentation;
    • 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.
       
  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.
  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.
  9. Discourages non-religious circumcision of the newborn.
  10. Strives to achieve the WHO-UNICEF "Ten Steps of the Baby-Friendly Hospital Initiative" to promote successful breastfeeding.
Copyright 1996 by the Coalition for Improving Maternity Services (CIMS) c/o ASPO/Lamaze, 1200 19th Street, NW, S-300, Washington, DC 20036. Permission granted to freely reproduce in whole or in part with complete attribution.
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