The First Consensus
Initiative of the Coalition for Improving Maternity Services (CIMS)
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.
- 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
- 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
- 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
- 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;
We, the undersigned members of CIMS, hereby resolve to define and
promote mother-friendly maternity services in accordance with the
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
- 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.
- 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.
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
- 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
- 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
- Individuals are ultimately responsible for
making informed choices about the health care they and their babies
These principles give rise to the following
ten steps which support, protect, and promote mother-friendly maternity
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
- 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
- Access to professional midwifery care.
- Provides accurate descriptive and statistical
information to the public about its practices and procedures for
birth care, including measures of interventions and outcomes.
- 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.
- 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.
- Has clearly defined policies and procedures
- 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.
- Does not routinely employ practices and
procedures that are unsupported by scientific evidence, including
but not limited to the following:
- 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
- Has a VBAC (vaginal birth after cesarean)
rate of 60% or more with a goal of 75% or more.
- 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.
- 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.
- Discourages non-religious circumcision of the
- Strives to achieve the WHO-UNICEF
"Ten Steps of
the Baby-Friendly Hospital Initiative" to promote
Copyright 1996 by the Coalition for
Improving Maternity Services (CIMS) c/o ASPO/Lamaze, 1200 19th Street,
NW, S-300, Washington, DC 20036. Email CIMS at
Permission granted to freely reproduce in whole or in part with