International MotherBaby Childbirth Initiative

10 Steps to Optimal MotherBaby 10 Steps to Optimal MotherBaby Maternity ServicesMaternity Services

10 Steps to Optimal MotherBaby 10 Steps to Optimal MotherBaby Maternity ServicesMaternity Services

An Initiative of the An Initiative of the International MotherBaby Childbirth Organization International MotherBaby Childbirth Organization

(IMBCO)(IMBCO)in partnership with Childbirth Connection and in partnership with Childbirth Connection and

the Coalition for Improving Maternity Services (CIMS)the Coalition for Improving Maternity Services (CIMS)

The The International International MotherBaby MotherBaby Childbirth Childbirth Initiative Initiative (IMBCI)(IMBCI)

The IMBCI continues at a global The IMBCI continues at a global level the work begun by the level the work begun by the Coalition for Improving Maternity Coalition for Improving Maternity Services (CIMS) Mother-Friendly Services (CIMS) Mother-Friendly Childbirth Initiative in the United Childbirth Initiative in the United States, which focuses on States, which focuses on facilitating normal birth, avoiding facilitating normal birth, avoiding unnecessary interventions, and unnecessary interventions, and supporting breastfeeding. supporting breastfeeding.

The Coalition for Improving The Coalition for Improving Maternity Services (CIMS)Maternity Services (CIMS)

is a coalition of national (US) organizations is a coalition of national (US) organizations and individuals with concern for the care and and individuals with concern for the care and wellbeing of mothers, babies, and families. wellbeing of mothers, babies, and families.

In 1995, CIMS created the In 1995, CIMS created the Mother-Friendly Mother-Friendly Childbirth Initiative (MFCI): 10 Steps to Childbirth Initiative (MFCI): 10 Steps to Mother-Friendly Birth Services Mother-Friendly Birth Services

www.motherfriendly.org

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

Development of the Development of the IMBCIIMBCI

Global Representation at Global Representation at CIMSCIMS

20052005 22 people from 11 countries representing 22 people from 11 countries representing

3 regions of the world3 regions of the world

20062006 50 people from 22 countries representing 50 people from 22 countries representing

the 4 regions of the worldthe 4 regions of the world

Thanks to a grant from New Hampshire Thanks to a grant from New Hampshire Charitable FoundationCharitable Foundation


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


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


163 countries participated from 163 countries participated from all 4 regions.all 4 regions.

The ensuing survey of these The ensuing survey of these organizations showed an 85%-organizations showed an 85%-95% level of agreement with the 95% level of agreement with the 10 Steps. This international 10 Steps. This international consensus on the value of the 10 consensus on the value of the 10 Steps formed the backdrop for Steps formed the backdrop for the development of the IMBCI.the development of the IMBCI.

A grant from the New A grant from the New Hampshire Charitable Hampshire Charitable

Trust Foundation Trust Foundation enabled the CIMS enabled the CIMS

International International Committee to bring a Committee to bring a

group of group of representatives of representatives of

international international organizations organizations

together in Geneva in together in Geneva in June 2006. June 2006.


TAG ParticipantsTAG Participants WHOWHO UNICEFUNICEF UNFPA UNFPA ICMICM IPAIPA ICNICN Partnership for Partnership for

Maternal, Newborn Maternal, Newborn and Child Healthand Child Health

Childbirth ConnectionChildbirth Connection CIMSCIMS Wellstart Wellstart

InternationalInternational JHPIEGOJHPIEGO ILCA ILCA

WABAWABA DONA InternationalDONA International Lamaze InternationalLamaze International LaLeche LeagueLaLeche League Academy of Academy of

Breastfeeding Breastfeeding MedicineMedicine

University of North University of North Carolina WomenCarolina Women’’s s Health ResearchHealth Research

Save the Children *Save the Children * White Ribbon White Ribbon

Alliance for Safe Alliance for Safe Motherhood *Motherhood *


We are proud to note that in We are proud to note that in addition to complementing prior addition to complementing prior Initiatives such as Safe Initiatives such as Safe Motherhood and the BFHI, the Motherhood and the BFHI, the IMBCI also contributes to IMBCI also contributes to achieving at least achieving at least fivefive of the of the eighteight UN Millennium UN Millennium Development Goals targeted for Development Goals targeted for 2015.2015.

United Nations MillenniumUnited Nations Millennium Development Goals Development Goals

1.Eradicate extreme 1.Eradicate extreme poverty and hunger poverty and hunger

2.Achieve universal 2.Achieve universal primary educationprimary education

3.Promote gender 3.Promote gender equality and equality and empower womenempower women

4.Reduce child 4.Reduce child mortalitymortality

5.Improve maternal 5.Improve maternal healthhealth

6.Combat HIV/AIDS, 6.Combat HIV/AIDS, malaria and other malaria and other diseasesdiseases

7. Ensure 7. Ensure environmental environmental sustainabilitysustainability

8. Develop a global 8. Develop a global partnership for partnership for developmentdevelopment

10 Steps of the 10 Steps of the International MotherBaby International MotherBaby

Childbirth Initiative Childbirth Initiative (IMBCI)(IMBCI)

An optimal MotherBaby An optimal MotherBaby maternity service has written maternity service has written policies, implemented in policies, implemented in education and practice, education and practice, requiring that its health care requiring that its health care providers:providers:

An optimal MotherBaby An optimal MotherBaby maternity service has written maternity service has written policies, implemented in policies, implemented in education and practice, education and practice, requiring that its health care requiring that its health care providers:providers:

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

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

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

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

Step 3—cont’d.Step 3—cont’d. Continuous support has Continuous support has been shown to reduce the need for been shown to reduce the need for intrapartum analgesia, decrease the intrapartum analgesia, decrease the rate of operative births, and increase rate of operative births, and increase mothers’ satisfaction with their mothers’ satisfaction with their

birthing experience. birthing experience.

Step 4Step 4 Provide drug-Provide drug-

free comfort free comfort and pain-relief and pain-relief methods during methods during labor, labor, explaining their explaining their benefits for benefits for facilitating facilitating normal birth normal birth and avoiding and avoiding unnecessary unnecessary harm. harm.

Show women (and Show women (and their companions) their companions)

how to use drug-how to use drug-free methods, free methods,

including touch, including touch, holding, massage, holding, massage,

labouring in labouring in water, and coping water, and coping and/or relaxation and/or relaxation

techniques. techniques. Respect womenRespect women’’s s preferences and preferences and

choices. choices.

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

Practices proven to be beneficial Practices proven to be beneficial include:include:

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


Offering the Offering the mother mother unrestricted unrestricted access to food access to food and drink as and drink as she wishes she wishes during labour.during labour.


Supporting the Supporting the mother to walk mother to walk and move about and move about freely and freely and assisting her to assisting her to assume the assume the positions of her positions of her choice, choice, including including squatting, squatting, sitting, and sitting, and hands-and-hands-and-knees, and knees, and providing tools providing tools supportive of supportive of upright upright positions. positions.

Tools supportive of upright positions Tools supportive of upright positions during labor and birth include during labor and birth include birthing balls, birthing chairs, floor birthing balls, birthing chairs, floor mats, wall ladders, and ropes.mats, wall ladders, and ropes.


Techniques for turning the baby in Techniques for turning the baby in utero and for vaginal breech delivery. utero and for vaginal breech delivery.

Facilitating Facilitating immediate and immediate and

sustained skin-to-sustained skin-to-skin MotherBaby skin MotherBaby

contact for contact for warmth, warmth,

attachment, attachment, breastfeeding breastfeeding initiation, and initiation, and

developmental developmental stimulation, and stimulation, and

ensuring that ensuring that MotherBaby stay MotherBaby stay

together . together .


Allowing Allowing adequate time adequate time for the cord for the cord blood to blood to transfer to the transfer to the baby for the baby for the blood volume, blood volume, oxygen, and oxygen, and nutrients it nutrients it provides. provides.


Ensuring the Ensuring the mothermother’’s full s full access to her ill or access to her ill or premature infant, premature infant, including kangaroo including kangaroo care, and care, and supporting the supporting the mother to provide mother to provide her own milk (or her own milk (or other human milk) other human milk) to her baby when to her baby when breastfeeding is breastfeeding is not possible.not possible.


Step 6Step 6 - Avoid potentially - Avoid potentially harmful procedures and harmful procedures and practices that have no practices that have no scientific support for scientific support for routineroutine or frequentor frequent use in use in normal labor and birth. normal labor and birth.

When considered for a When considered for a specific situation, their use specific situation, their use should be supported by should be supported by best available evidence best available evidence that the benefits are likely that the benefits are likely to outweigh the potential to outweigh the potential harms and should be fully harms and should be fully discussed with the mother discussed with the mother to ensure her informed to ensure her informed consentconsent..

Potentially harmful practices Potentially harmful practices include:include:

Sweeping of the Sweeping of the membranesmembranes

Artificial rupture Artificial rupture of of

membranesmembranes

ShavingShaving

Enema Enema


Medical induction Medical induction and/or and/or augmentation of augmentation of labourlabour

Repetitive vaginal Repetitive vaginal examsexams


Withholding food and Withholding food and waterwater

Keeping the mother in Keeping the mother in bed bed

Intravenous fluids (IV)Intravenous fluids (IV)


Continuous electronic fetal Continuous electronic fetal monitoring monitoring (cardiotocography)(cardiotocography)


Pharmacological pain Pharmacological pain controlcontrol Insertion of a bladder Insertion of a bladder cathetercatheter


Supine or lithotomy position Supine or lithotomy position (legs-in-stirrups) (legs-in-stirrups)


Caregiver-directed pushingCaregiver-directed pushing

Fundal pressure (Kristeller)Fundal pressure (Kristeller)



EpisiotomyEpisiotomy Forceps and Forceps and vacuumvacuum

extractionextraction


Manual exploration of the uterusManual exploration of the uterus

Potentially harmful practices Potentially harmful practices include:include: Primary and repeat cesarean sectionPrimary and repeat cesarean section


Immediate cord Immediate cord clampingclamping

Suctioning of the Suctioning of the newbornnewborn


Separation of mother and Separation of mother and babybaby

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

Measures that enhance wellness Measures that enhance wellness and prevent illnessand prevent illness

Provide education about and foster Provide education about and foster access to good nutrition, clean water, access to good nutrition, clean water, and a clean and safe environmentand a clean and safe environment


Provide Provide education in and education in and access to access to methods of methods of disease disease prevention, prevention, including malaria including malaria and HIV/AIDS and HIV/AIDS prevention and prevention and treatment, and treatment, and tetanus toxoid tetanus toxoid immunization. immunization.


Provide education in Provide education in responsible sexuality, responsible sexuality, family planning, and family planning, and womenwomen’’s reproductive s reproductive rights, and provide access rights, and provide access to family planning options.to family planning options.


Provide Provide supportive supportive

prenatal, prenatal, postpartum, and postpartum, and

newborn care that newborn care that addresses the addresses the

physical and physical and emotional health emotional health the MotherBaby the MotherBaby

within the context within the context of family of family

relationships and relationships and community community

environment. environment.


Ensure timely Ensure timely identification identification of of complications complications and and collaborative, collaborative, evidence-evidence-based referral based referral and and treatment.treatment.

Step 8Step 8 - Provide access to evidence-based - Provide access to evidence-based skilled emergency treatment for life-skilled emergency treatment for life-threatening complications. threatening complications.

Ensure that all maternal and newborn Ensure that all maternal and newborn health providers have adequate and health providers have adequate and ongoing training in emergency skills for ongoing training in emergency skills for appropriate and timely treatment of appropriate and timely treatment of mothers and their newborns.mothers and their newborns.

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

Step 9 (contStep 9 (cont’’d)d) Specifically, individuals Specifically, individuals within institutions, agencies, and within institutions, agencies, and organizations offering maternity-organizations offering maternity-related services should:related services should:

Collaborate across Collaborate across disciplinary, cultural, disciplinary, cultural, and institutional and institutional boundaries to provide boundaries to provide the MotherBaby with the MotherBaby with the best possible care, the best possible care, recognizing each recognizing each other’s particular other’s particular competencies and competencies and respecting each others’ respecting each others’ points of viewpoints of view


Foster continuity of Foster continuity of care during labour care during labour and birth from a and birth from a small number of small number of caregiverscaregivers


Provide consultations and transfers of Provide consultations and transfers of care in a timely manner to appropriate care in a timely manner to appropriate institutions and specialists.institutions and specialists.

Ensure that the mother is aware of and Ensure that the mother is aware of and can access available community can access available community services specific to her needs and services specific to her needs and those of her newborn.those of her newborn.

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

Compiling the EvidenceCompiling the Evidence

The International MotherBaby The International MotherBaby Childbirth Organization, in Childbirth Organization, in collaboration with other collaboration with other organizations, is developing a organizations, is developing a companion document detailing the companion document detailing the extensive scientific evidence extensive scientific evidence supporting the 10 Steps of the IMBCI, supporting the 10 Steps of the IMBCI, and will update this document over and will update this document over time as needed to reflect the best time as needed to reflect the best available research evidence.available research evidence.

Sign on as a supporter!Sign on as a supporter!

www.imbci.org

The Optimal MotherBaby The Optimal MotherBaby Model of CareModel of Care

The optimal MotherBaby The optimal MotherBaby model of care model of care

implemented in this implemented in this Initiative promotes the Initiative promotes the health and wellbeing of health and wellbeing of

all women and babies all women and babies during pregnancy, birth, during pregnancy, birth,

and breastfeeding, and breastfeeding, setting the gold setting the gold

standardstandard for excellence for excellence and superior outcomes in and superior outcomes in

maternity care. maternity care.

All maternity All maternity service service providers providers should be should be educated in, educated in, provide, and provide, and support the support the Optimal Optimal MotherBaby MotherBaby Model of Model of Care!Care!

International MotherBaby Childbirth Initiative

Health & Medicine

Transcript of International MotherBaby Childbirth Initiative