International MotherBaby Childbirth Initiative


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10 Steps to Optimal MotherBaby Maternity Services

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  • Goal 3The IMBCI calls for empowering women through education and respectful, caring treatment during pregnancy, birth, and the postpartum period. Goal 4 & 5 The IMBCI calls for skilled birth attendance, effective emergency care, and reserving medical intervention for cases where potential benefits outweigh potential harms to reduce infant and maternal morbidity and mortality, and emphasizes wellness and prevention measures before, during, and after birth to increase maternal and infant survival and health Goal 6 The IMBCI calls for education and prevention measures, and for informed birth and feeding practices that reduce the transmission of HIV from mother to baby.
  • International MotherBaby Childbirth Initiative

    1. 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)
    2. 2. <ul><li>The IMBCI continues at a global level the work begun by the Coalition for Improving Maternity Services (CIMS) Mother-Friendly Childbirth Initiative in the United States, which focuses on facilitating normal birth, avoiding unnecessary interventions, and supporting breastfeeding. </li></ul>
    3. 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
    4. 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
    5. 5. Global Representation at CIMS <ul><li>2005 </li></ul><ul><ul><li>22 people from 11 countries representing 3 regions of the world </li></ul></ul><ul><li>2006 </li></ul><ul><ul><li>50 people from 22 countries representing the 4 regions of the world </li></ul></ul><ul><li>Thanks to a grant from New Hampshire Charitable Foundation </li></ul>
    6. 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. 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. 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. 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
    10. 10. TAG Participants <ul><li>WHO </li></ul><ul><li>UNICEF </li></ul><ul><li>UNFPA </li></ul><ul><li>ICM </li></ul><ul><li>IPA </li></ul><ul><li>ICN </li></ul><ul><li>Partnership for Maternal, Newborn and Child Health </li></ul><ul><li>Childbirth Connection </li></ul><ul><li>CIMS </li></ul><ul><li>Wellstart International </li></ul><ul><li>JHPIEGO </li></ul><ul><li>ILCA </li></ul><ul><li>WABA </li></ul><ul><li>DONA International </li></ul><ul><li>Lamaze International </li></ul><ul><li>LaLeche League </li></ul><ul><li>Academy of Breastfeeding Medicine </li></ul><ul><li>University of North Carolina Women ’s Health Research </li></ul><ul><li>Save the Children * </li></ul><ul><li>White Ribbon Alliance for Safe Motherhood * </li></ul>
    11. 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.
    12. 12. United Nations Millennium Development Goals <ul><li>1.Eradicate extreme poverty and hunger </li></ul><ul><li>2.Achieve universal primary education </li></ul><ul><li>3.Promote gender equality and empower women </li></ul><ul><li>4.Reduce child mortality </li></ul><ul><li>5.Improve maternal health </li></ul><ul><li>6.Combat HIV/AIDS, malaria and other diseases </li></ul><ul><li>7. Ensure environmental sustainability </li></ul><ul><li>8. Develop a global partnership for development </li></ul>
    13. 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. 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. 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. 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.
    17. 17. <ul><li>Step 3—cont ’ d. 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. </li></ul>
    18. 18. Step 4 <ul><li>Provide drug-free comfort and pain-relief methods during labor, explaining their benefits for facilitating normal birth and avoiding unnecessary harm. </li></ul>
    19. 19. <ul><li>Show women (and their companions) how to use drug-free methods, including touch, holding, massage, labouring in water, and coping and/or relaxation techniques. Respect women ’s preferences and choices. </li></ul>
    20. 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. 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. 22. Practices proven to be beneficial include: Offering the mother unrestricted access to food and drink as she wishes during labour.
    23. 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.
    24. 24. <ul><li>Tools supportive of upright positions during labor and birth include birthing balls, birthing chairs, floor mats, wall ladders, and ropes. </li></ul>
    25. 25. Practices proven to be beneficial include: <ul><li>Techniques for turning the baby in utero and for vaginal breech delivery. </li></ul>
    26. 26. Practices proven to be beneficial include: <ul><li>Facilitating immediate and sustained skin-to-skin MotherBaby contact for warmth, attachment, breastfeeding initiation, and developmental stimulation, and ensuring that MotherBaby stay together . </li></ul>
    27. 27. Practices proven to be beneficial include: <ul><ul><li>Allowing adequate time for the cord blood to transfer to the baby for the blood volume, oxygen, and nutrients it provides. </li></ul></ul>
    28. 28. Practices proven to be beneficial include: <ul><li>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. </li></ul>
    29. 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 .
    30. 30. Potentially harmful practices include: <ul><li>Sweeping of the membranes </li></ul><ul><li>Artificial rupture of membranes </li></ul><ul><li>Shaving </li></ul><ul><li>Enema </li></ul>
    31. 31. Potentially harmful practices include: <ul><li>Medical induction and/or </li></ul><ul><li>augmentation of labour </li></ul><ul><li>Repetitive vaginal exams </li></ul>Pitocin
    32. 32. Potentially harmful practices include: <ul><li>Withholding food and water </li></ul><ul><li>Keeping the mother in bed </li></ul><ul><li>Intravenous fluids (IV) </li></ul>
    33. 33. Potentially harmful practices include: <ul><li>Continuous electronic fetal monitoring (cardiotocography) </li></ul>
    34. 34. Potentially harmful practices include: <ul><li>Pharmacological pain control </li></ul><ul><li>Insertion of a bladder catheter </li></ul>
    35. 35. Potentially harmful practices include: <ul><li>Supine or lithotomy position (legs-in-stirrups) </li></ul>
    36. 36. Potentially harmful practices include: <ul><li>Caregiver-directed pushing </li></ul>
    37. 37. <ul><li>Fundal pressure (Kristeller) </li></ul>Potentially harmful practices include:
    38. 38. Potentially harmful practices include: <ul><li>Episiotomy </li></ul><ul><li>Forceps and vacuum </li></ul><ul><li>extraction </li></ul>
    39. 39. Potentially harmful practices include: <ul><li>Manual exploration of the uterus </li></ul>
    40. 40. Potentially harmful practices include: <ul><li>Primary and repeat cesarean section </li></ul>
    41. 41. Potentially harmful practices include: <ul><li>Immediate cord clamping </li></ul><ul><li>Suctioning of the newborn </li></ul>
    42. 42. Potentially harmful practices include: <ul><li>Separation of mother and baby </li></ul>
    43. 43. Step 7 - Implement measures that enhance wellness and prevent emergencies, illness, and death of MotherBaby.
    44. 44. Measures that enhance wellness and prevent illness <ul><ul><li>Provide education about and foster access to good nutrition, clean water, and a clean and safe environment </li></ul></ul>
    45. 45. Measures that enhance wellness and prevent illness <ul><ul><li>Provide education in and access to methods of disease prevention, including malaria and HIV/AIDS prevention and treatment, and tetanus toxoid immunization. </li></ul></ul>
    46. 46. Measures that enhance wellness and prevent illness <ul><ul><li>Provide education in responsible sexuality, family planning, and women ’s reproductive rights, and provide access to family planning options. </li></ul></ul>
    47. 47. Measures that enhance wellness and prevent illness <ul><li>Provide supportive prenatal, postpartum, and newborn care that addresses the physical and emotional health the MotherBaby within the context of family relationships and community environment. </li></ul>
    48. 48. Measures that enhance wellness and prevent illness Ensure timely identification of complications and collaborative, evidence-based referral and treatment.
    49. 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. 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.
    51. 51. Step 9 (cont ’d) Specifically, individuals within institutions, agencies, and organizations offering maternity-related services should: <ul><li>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 others ’ points of view </li></ul>
    52. 52. Step 9 (cont ’d) Specifically, individuals within institutions, agencies, and organizations offering maternity-related services should: <ul><li>Foster continuity of care during labour and birth from a small number of caregivers </li></ul>
    53. 53. Step 9 (cont ’d) Specifically, individuals within institutions, agencies, and organizations offering maternity-related services should: <ul><li>Provide consultations and transfers of care in a timely manner to appropriate institutions and specialists. </li></ul><ul><li>Ensure that the mother is aware of and can access available community services specific to her needs and those of her newborn. </li></ul>
    54. 54. Step 10 – Strive to achieve the WHO/UNICEF Baby-friendly Hospital Initiative with the 10 Steps to Successful Breastfeeding
    55. 55. Compiling the Evidence <ul><li>The International MotherBaby Childbirth Organization, in collaboration with other organizations, is developing a companion document detailing the extensive scientific evidence supporting the 10 Steps of the IMBCI, and will update this document over time as needed to reflect the best available research evidence. </li></ul>
    56. 56. Sign on as a supporter! www.imbci .org
    57. 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.
    58. 58. <ul><li>All maternity service providers should be educated in, provide, and support the Optimal MotherBaby Model of Care! </li></ul>