10 Steps of the International MotherBaby Childbirth Initiative
The 10 Steps of the MotherBaby Childbirth Initiative are based on the results of best available evidence about the safety and effectiveness of specific tests, treatments, and other interventions for mothers and babies. “Safe” means that care is provided through evidence-based practices that minimize the risk of error and harm and support the normal physiology of labour and birth.
“Effective” means that the care provided achieves expected benefits and is appropriate to the needs of the pregnant woman and her baby based on sound evidence. Safe and effective care of the MotherBaby provides the best possible health outcomes and benefits with the most appropriate and conservative use of resources and technology.
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.
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. (3)
Step 3 - Inform the mother of the benefits of continuous support during labour and birth, and affirm her right to receive such support from companions of her choice, such as fathers, partners, family members, doulas (4), or others. Continuous support has been shown to reduce the need for intrapartum analgesia, decrease the rate of operative births and increase mothers’ satisfaction with their birthing experience.
Step 4 - Provide drug-free comfort and pain-relief methods during labour, explaining their benefits for facilitating normal birth and avoiding unnecessary harm, and showing women (and their companions) how to use these methods, including touch, holding, massage, labouring in water, and coping/relaxation techniques. Respect women’s preferences and choices.
Step 5 - Provide specific evidence-based practices proven to be beneficial in supporting the normal physiology of labour, birth, and the postpartum period, including:
The 10 Steps of the MotherBaby Childbirth Initiative are based on the results of best available evidence about the safety and effectiveness of specific tests, treatments, and other interventions for mothers and babies. “Safe” means that care is provided through evidence-based practices that minimize the risk of error and harm and support the normal physiology of labour and birth.
“Effective” means that the care provided achieves expected benefits and is appropriate to the needs of the pregnant woman and her baby based on sound evidence. Safe and effective care of the MotherBaby provides the best possible health outcomes and benefits with the most appropriate and conservative use of resources and technology.
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.
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. (3)
Step 3 - Inform the mother of the benefits of continuous support during labour and birth, and affirm her right to receive such support from companions of her choice, such as fathers, partners, family members, doulas (4), or others. Continuous support has been shown to reduce the need for intrapartum analgesia, decrease the rate of operative births and increase mothers’ satisfaction with their birthing experience.
Step 4 - Provide drug-free comfort and pain-relief methods during labour, explaining their benefits for facilitating normal birth and avoiding unnecessary harm, and showing women (and their companions) how to use these methods, including touch, holding, massage, labouring in water, and coping/relaxation techniques. Respect women’s preferences and choices.
Step 5 - Provide specific evidence-based practices proven to be beneficial in supporting the normal physiology of labour, birth, and the postpartum period, including:
- Allowing labour to unfold at its own pace, while refraining from interventions based on fixed time limits and utilizing the partogram to keep track of labour progress. (5)
- Offering the mother unrestricted access to food and drink as she wishes during labour.
- Supporting her 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. (6)
- Techniques for turning the baby in utero and for vaginal breech delivery.
- Facilitating immediate and sustained skin-to-skin MotherBaby contact for warmth, attachment, breastfeeding initiation, and developmental stimulation, and ensuring that MotherBaby stay together.
- Allowing adequate time for the cord blood to transfer to the baby for the blood volume, oxygen, and nutrients it provides.(7)
- Ensuring the mother’s full access to her ill or premature infant, including kangaroo care, and supporting the mother to provide her own milk (or other human milk) to her baby when breastfeeding is not possible.
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• shaving
• enema • sweeping of the membranes • artificial rupture of membranes • medical induction and/or augmentation of labour • repetitive vaginal exams • withholding food and water • keeping the mother in bed • intravenous fluids (IV) • continuous electronic fetal monitoring (cardiotocography) |
• insertion of a bladder catheter
• supine or lithotomy (legs-in-stirrups) position • caregiver-directed pushing • fundal pressure (Kristeller) • episiotomy • forceps and vacuum extraction • manual exploration of the uterus • primary and repeat caesarean section • suctioning of the newborn • immediate cord clamping • separation of mother and baby |
Step 7 - Implement measures that enhance wellness and prevent emergencies, illness, and death ofMotherBaby:
• Provide education about and foster access to good nutrition, clean water, and a clean
and safe environment.
• Provide education in and access to methods of disease prevention, including malaria
and HIV/AIDS prevention and treatment, and tetanus toxoid immunization.
• Provide education in responsible sexuality, family planning, and women’s reproductive
rights, and provide access to family planning options.
• Provide supportive prenatal, intrapartum, postpartum, and newborn care that addresses
the physical and emotional health of the MotherBaby within the context of family
relationships and community environment.
Step 8 - Provide access to evidence-based skilled emergency treatment for life-threatening complications. Ensure that all maternal and newborn healthcare providers have adequate and ongoing training in emergency skills for appropriate and timely treatment of mothers and their newborns.
Step 9 - Provide a continuum of collaborative maternal and newborn care with all relevant health care providers, institutions and organizations. Including traditional birth attendants and others who attend births out of hospital in this continuum of care. Specifically, individuals within institutions, agencies and organizations offering maternity-related services should:
3. Such skills are most commonly the specialty of midwives. Core midwifery competencies are defined in ICM Essential Competencies for Basic Midwifery Practice (www.internationalmidwives.org) and in Making Pregnancy Safer: The Critical Role of the Skilled Birth Attendant—A Joint Statement by WHO, ICM, and FIGO (www.who.int/reproductive-health/publications/2004/skilled_attendant.pdf).
4. Doulas are birth companions trained in the provision of continuous labour support whose care is shown to increase satisfaction with the birth experience and to reduce women’s use of analgesia, anesthesia and interventions such as caesareans, forceps, and vacuum extraction.
5. The use of a partogram is recommended by WHO/UNFPA as part of basic, safe obstetric/midwifery practice in all labours, especially in settings with high maternal mortality. (See Integrated Management of Pregnancy and Childbirth: Pregnancy, childbirth, postpartum and newborn care: A guide for essential practice,” 2nd ed, 2006.) There are two kinds of partograms. The one used primarily in Europe tracks maternal heart rate; blood pressure; length, frequency and strength of contractions; rupture of membranes; cervical dilation; drugs administered; and the baby’s heart rate. The Latin American partogram developed by CLAP also takes into consideration maternal parity and position during labour and thus is more tailored to the individual woman. PAHO/CLAP recommend use of the latter. (www.colmed5.org.ar/Tramites/HCGOpartograma.pdf, www.clap.ops-oms.org/web_2005/TECHNOLOGIAS/technologias%20perinatales.htm#partograma, http://medicina.udea.edu.co/nacer/PDF/BIA.pdf).
6. Tools supportive of upright positions during labour and birth include birthing balls, birthing chairs, floor mats, wall ladders, and ropes.
7. While a package of interventions called “active management of the third stage of labour” is currently recommended in the belief that it may reduce the incidence of life-threatening postpartum haemorrhage, immediate cord clamping has been dropped from the package since accumulating research has shown its harmful effects on the baby
• Provide education about and foster access to good nutrition, clean water, and a clean
and safe environment.
• Provide education in and access to methods of disease prevention, including malaria
and HIV/AIDS prevention and treatment, and tetanus toxoid immunization.
• Provide education in responsible sexuality, family planning, and women’s reproductive
rights, and provide access to family planning options.
• Provide supportive prenatal, intrapartum, postpartum, and newborn care that addresses
the physical and emotional health of the MotherBaby within the context of family
relationships and community environment.
Step 8 - Provide access to evidence-based skilled emergency treatment for life-threatening complications. Ensure that all maternal and newborn healthcare providers have adequate and ongoing training in emergency skills for appropriate and timely treatment of mothers and their newborns.
Step 9 - Provide a continuum of collaborative maternal and newborn care with all relevant health care providers, institutions and organizations. Including traditional birth attendants and others who attend births out of hospital in this continuum of care. Specifically, individuals within institutions, agencies and organizations offering maternity-related services should:
- Collaborate across disciplinary, cultural, and institutional boundaries to provide the MotherBaby with the best possible care, recognizing each other’s particular competencies and respecting each other’s points of view.
- Foster continuity of care during labour and birth for the MotherBaby from a small number of caregivers.
- Provide consultations and transfers of care in a timely manner to appropriate institutions and specialists.
- Ensure that the mother is aware of and can access available community services specific to her needs and those of her newborn.
- Have a written breastfeeding policy that is routinely communicated to all health care staff.
- Train all health care staff in skills necessary to implement the policy.
- Inform all pregnant women about the benefits and management of breastfeeding.
- Help mothers initiate breastfeeding within a half-hour of birth. Place babies in skin-to-skin contact with their mothers immediately following birth for at least an hour and encourage mothers to recognize when their babies are ready to breastfeed, offering if needed.
- Show mothers how to breastfeed and how to maintain lactation, even if they should be separated from their infants.
- Give newborn infants no food or drink other than breastmilk, unless medically indicated.
- Practice “rooming in”-- allow mothers and infants to remain together 24 hours a day.
- Encourage breastfeeding on demand.
- Give no artificial teats 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 the hospital or clinic.
3. Such skills are most commonly the specialty of midwives. Core midwifery competencies are defined in ICM Essential Competencies for Basic Midwifery Practice (www.internationalmidwives.org) and in Making Pregnancy Safer: The Critical Role of the Skilled Birth Attendant—A Joint Statement by WHO, ICM, and FIGO (www.who.int/reproductive-health/publications/2004/skilled_attendant.pdf).
4. Doulas are birth companions trained in the provision of continuous labour support whose care is shown to increase satisfaction with the birth experience and to reduce women’s use of analgesia, anesthesia and interventions such as caesareans, forceps, and vacuum extraction.
5. The use of a partogram is recommended by WHO/UNFPA as part of basic, safe obstetric/midwifery practice in all labours, especially in settings with high maternal mortality. (See Integrated Management of Pregnancy and Childbirth: Pregnancy, childbirth, postpartum and newborn care: A guide for essential practice,” 2nd ed, 2006.) There are two kinds of partograms. The one used primarily in Europe tracks maternal heart rate; blood pressure; length, frequency and strength of contractions; rupture of membranes; cervical dilation; drugs administered; and the baby’s heart rate. The Latin American partogram developed by CLAP also takes into consideration maternal parity and position during labour and thus is more tailored to the individual woman. PAHO/CLAP recommend use of the latter. (www.colmed5.org.ar/Tramites/HCGOpartograma.pdf, www.clap.ops-oms.org/web_2005/TECHNOLOGIAS/technologias%20perinatales.htm#partograma, http://medicina.udea.edu.co/nacer/PDF/BIA.pdf).
6. Tools supportive of upright positions during labour and birth include birthing balls, birthing chairs, floor mats, wall ladders, and ropes.
7. While a package of interventions called “active management of the third stage of labour” is currently recommended in the belief that it may reduce the incidence of life-threatening postpartum haemorrhage, immediate cord clamping has been dropped from the package since accumulating research has shown its harmful effects on the baby
Adminstrative Director, Rae Davies. Email: [email protected] Phone (USA EST): 904-285-0028