International MotherBaby Childbirth Initiative

By Denise Hynd

In 2006 an international gathering of childbirth experts, including representatives of consumer groups such as La Leche League, refined the first draft of the International MotherBaby Childbirth Initiative (IMBCI) as an acknowledgement that 2 challenges for the 21st century are;

• Increasing understanding of normal birth and breastfeeding,
• Decreasing the overuse of unnecessary medical interventions.

The IMBCI aims to highlight both the importance of a woman’s birth experience and the scientific evidence showing the benefits of care based on normal physiology.  Additionally the 10 Steps of the IMBCI aim to implement woman-centered and low intervention practices which promote optimal health and wellbeing of a woman and her baby through-out the childbearing continuum. The name, the International MotherBaby Childbirth Initiative reflects the importance of the mother and baby as one integral unit that should not be separated, as well as the impact of birth practices on breastfeeding.

The 10 Steps of IMBCI are based on best available evidence about the safety and effectiveness of 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, 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. Safe and effective care of the MotherBaby dyad provides the best possible health outcomes and benefits with the most appropriate and conservative use of resources and technology.

Thus optimal MotherBaby maternity services have written policies, implemented in education and practice, requiring that its health care providers:

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 with 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.

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, or others.

Step 4 Provide drug-free comfort and pain-relief methods during labour including touch, holding, massage, labouring in water, and coping/relaxation techniques, explaining their benefits for facilitating normal birth and avoiding unnecessary harm, as well as showing women (and their companions) how to use these methods. 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; allowing adequate time for the cord blood to transfer to the baby for the blood volume, oxygen,  and nutrients it provides (see www.imbci.org  for further examples).

Step 6 Avoid potentially harmful procedures and practices that have no scientific support for routine or frequent use in normal labour 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. These include: sweeping of the membranes, artificial rupture of membranes, medical induction and/or augmentation of labour, (see www.imbci.org for further examples).

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

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

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. Specifically, individuals within institutions, agencies and organizations offering maternity-related services should:

Step 10 Strive to achieve the 10 Steps to Successful Breastfeeding as described in the WHO/UNICEF Baby-friendly Hospital Initiative.

All of these steps are an expression of underlying IMBCI principles, many of which are supported by New Zealand’s unique midwifery-based maternity services.  However others are inadequately met as reflected in national rates of childbirth intervention such as 23.8% caesarean section in 2005. International evidence indicates that overuse of medical interventions in childbirth result in both short and long term increased health care costs and strain health resources without improving outcomes. The IMBCI principles include; Pregnancy, labour, birth, and breastfeeding are normal and healthy processes that in most cases need only attention and support from caregivers. Many women can safely give birth outside of hospitals in clinics, birth centers, and homes when skilled care and effective referral are available.  Thus New Zealand maternity services and the nation would benefit from adoption of the 10 Steps of the MotherBaby Childbirth Initiative!

It is hoped that representatives of concerned New Zealand groups including Homebirth Aoteroa, will eventually form a board and trust for the ongoing management of this initiative in New Zealand. Initial public promotion of the initiative is aimed to occur through screenings of films such as Orgasmic Birth (www.orgasmicbirth.org) followed by a panel discussion involving local supporters, as well as IMBCI presentations at conferences or other maternity care provider and consumer gatherings. Interested New Zealand individuals or groups, willing to help launch, promote or contribute to this initiative are asked to sign up as a supporter on the IMBCI website.

Denise Hynd (Midwife)
(09) 832 3467
midwifedenise@vodafone.co.nz

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Last updated: 6 October 2009.