Helen Cahill
The Mother-Friendly Childbirth Initiative
Ten Steps of the Mother-Friendly Childbirth Initiative for Mother-Friendly
Hospitals, Birth Centers, and Home Birth 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:
- 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)
- Provides accurate descriptive and statistical information to the public
about its practices and procedures for birth care, including measures of
interventions and outcomes.(References)
- 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)
- 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)
- 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)
- 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)
- 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)
- 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)
- Discourages non-religious circumcision of the newborn.(References)
- Strives to achieve the WHO-UNICEF "Ten Steps of the Baby-Friendly Hospital
Initiative" to promote successful breastfeeding:
- Have a written breastfeeding policy that is routinely communicated to
all health care staff;
- Train all health care staff in skills necessary to implement this
policy;
- Inform all pregnant women about the benefits and management of
breastfeeding;
- Help mothers initiate breastfeeding within a half-hour of birth;
- Show mothers how to breast feed and how to maintain lactation even if
they should be separated from their infants;
- Give newborn infants no food or drink other than breast milk unless
medically indicated;
- Practice rooming in: allow mothers and infants to remain together 24
hours a day;
- Encourage breastfeeding on demand;
- Give no artificial teat or pacifiers (also called dummies or
soothers) to breastfeeding infants;
- Foster the establishment of breastfeeding support groups and refer
mothers to them on discharge from hospitals or
clinics.(References)
