10 Steps to Optimal MotherBaby Maternity Services

1. 10 Steps to Optimal MotherBaby Maternity Services An Initiative of the International MotherBaby Childbirth Organization (IMBCO) in partnership with Childbirth Connection and the Coalition for Improving Maternity Services (CIMS) The International MotherBaby Childbirth Initiative (IMBCI)

3. The Coalition for Improving Maternity Services (CIMS) is a coalition of national (US) organizations and individuals with concern for the care and wellbeing of mothers, babies, and families. In 1995, CIMS created the Mother-Friendly Childbirth Initiative (MFCI): 10 Steps to Mother-Friendly Birth Services www.motherfriendly.org

4. Increasing numbers of birth activists from other countries began attending the CIMS annual meetings in the U.S. At their urging, in 2005 CIMS formed an International Committee, which quickly selected regional international representatives and created a strong international grassroots network. Development of the IMBCI

6. Development of the IMBCI With support from this network, the CIMS International Committee worked with the University of North Carolina Women ’s Health and Research Group to conduct an international survey to determine the level of agreement of the organizations surveyed with each of the MFCI 10 Steps.

7. Development of the IMBCI For this survey, the CIMS International Committee compiled the largest database in existence on birth- and breastfeeding-related organizations worldwide.

8. Development of the IMBCI 163 countries participated from all 4 regions. The ensuing survey of these organizations showed an 85%-95% level of agreement with the 10 Steps. This international consensus on the value of the 10 Steps formed the backdrop for the development of the IMBCI.

9. A grant from the New Hampshire Charitable Trust Foundation enabled the CIMS International Committee to bring a group of representatives of international organizations together in Geneva in June 2006. Development of the IMBCI

11. Development of the IMBCI We are proud to note that in addition to complementing prior Initiatives such as Safe Motherhood and the BFHI, the IMBCI also contributes to achieving at least five of the eight UN Millennium Development Goals targeted for 2015.

13. 10 Steps of the International MotherBaby Childbirth Initiative (IMBCI) An optimal MotherBaby maternity service has written policies, implemented in education and practice, requiring that its health care providers:

14. Step 1 - Treat every woman with respect and dignity, fully informing and involving her in decision making about care for herself and her baby in language that she understands, and providing her the right to informed consent and refusal.

15. Step 2 - Possess and routinely apply midwifery knowledge and skills that enhance and optimize the normal physiology of pregnancy, labour, birth, breastfeeding, and the postpartum period

16. Step 3 - Inform the mother of the benefits of continuous support during labor and birth and affirm her right to receive such support from companions of her choice, such as fathers, partners, family members, doulas, or others.

20. Step 5 - Provide specific evidence-based practices proven to be beneficial in supporting the normal physiology of labor, birth, and the postpartum period.

21. Practices proven to be beneficial include: Allowing labor to unfold at its own pace while refraining from interventions based on standardized time limits, and utilizing the partogram to keep track of labour progess.

22. Practices proven to be beneficial include: Offering the mother unrestricted access to food and drink as she wishes during labour.

23. Practices proven to be beneficial include: Supporting the mother to walk and move about freely and assisting her to assume the positions of her choice, including squatting, sitting, and hands-and-knees, and providing tools supportive of upright positions.

29. Step 6 - Avoid potentially harmful procedures and practices that have no scientific support for routine or frequent use in normal labor and birth. When considered for a specific situation, their use should be supported by best available evidence that the benefits are likely to outweigh the potential harms and should be fully discussed with the mother to ensure her informed consent .

43. Step 7 - Implement measures that enhance wellness and prevent emergencies, illness, and death of MotherBaby.

48. Measures that enhance wellness and prevent illness Ensure timely identification of complications and collaborative, evidence-based referral and treatment.

49. Step 8 - Provide access to evidence-based skilled emergency treatment for life-threatening complications. Ensure that all maternal and newborn health providers have adequate and ongoing training in emergency skills for appropriate and timely treatment of mothers and their newborns.

50. Step 9 - Provide a continuum of collaborative maternal and newborn care with all relevant health care providers, institutions and organizations. Include traditional birth attendants and others who attend births out of hospital in this continuum of care.

54. Step 10 – Strive to achieve the WHO/UNICEF Baby-friendly Hospital Initiative with the 10 Steps to Successful Breastfeeding

56. Sign on as a supporter! www.imbci .org

57. The Optimal MotherBaby Model of Care The optimal MotherBaby model of care implemented in this Initiative promotes the health and wellbeing of all women and babies during pregnancy, birth, and breastfeeding, setting the gold standard for excellence and superior outcomes in maternity care.