In Labor and Birth Care

The International Federation of Gynecology and Obstetrics (FIGO), International Confederation of Midwives (ICM), White Ribbon Alliance (WRA), International Pediatric Association (IPA), and World Health Organization (WHO) have developed guidelines to certify birth facilities as “Mother and Newborn Friendly.” Published in the International Journal of Gynecology & Obstetrics, FIGO’s journal, the guidelines begin by acknowledging that “Evidence collected in a variety of settings has documented that the quality of care is related to the quality of maternal and newborn health outcomes, including mortality.” Additionally, a “review series on quality of maternal and newborn care found that improving access to facilities did not guarantee improved maternal outcomes, and posited that poor quality of care was the most likely explanatory factor.” To remedy this:

“Professional associations and facilities should provide not only the best evidence-based quality of care, but attend to each woman’s inviolable right to dignity, privacy, information, supportive care, pharmacological or nonpharmacological pain relief, and choice of birthing companion(s), without abuse, financial extortion, or differential care based on age, marital status, HIV status, financial status, ethnicity, or other factors.”

Fleshing out this principle, the guidelines detail 10 criteria that define a mother-baby friendly birthing facility. For example, criterion #1 reads as follows, and the other 9 have equal significance to maternity care reform:

“A FIGO, ICM, WRA, IPA, WHO mother-baby friendly birthing facility:

1. Offers all birthing women the opportunity to eat, drink, walk, stand, and move about during the first stage of labor and to assume the position of her choice/comfort during the second and third stages, unless medically contraindicated.”

The criteria are followed by a description of a process by which adherence to those standards could be measured and certification awarded. Finally, the guidelines conclude with strategies for implementing the initiative. For obvious reasons, the potential significance of this initiative for the future of maternity care worldwide cannot be overestimated. 

On a personal note, one source for the guidelines is the International MotherBaby Childbirth Initiative (IMBCI), which was developed by the International MotherBaby Childbirth Organization (IMBCO). This organization spun off from the Coalition for Improving Maternity Services (CIMS), a U.S. grassroots coalition. CIMS was founded in 1996 at a retreat at which representatives of maternity care organizations and individual stakeholders came together to draft by consensus what came to be called the Mother-Friendly Childbirth Initiative (MFCI). The IMBCI was modeled on the MFCI. I was present at that historic gathering and participated in drafting the MFCI, so you may imagine my feelings at seeing what has grown from CIMS’ roots. CIMS intended to designate U.S. birth facilities and home birth providers as “Mother Friendly” but never had the resources to put that plan into action. It is my fervent hope that FIGO, ICM, WRA, IPA, and WHO, with infinitely greater resources, will succeed where CIMS and IMBCO fell short. 

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