Past and Future Birth:
The Mother-Friendly Childbirth Initiative

The "Mother Friendly Childbirth Initiative," originally the brain child of visionary leaders of the ASPO/Lamaze organization of childbirth educators, is the consensus document of a sweeping coalition of about 25 organizations and 32 individuals dedicated to writing a new charter for childbirth in the 21st century. Participating were leaders of nearly all organizations of childbirth educators, La Leche League, maternal/child health and obstetrical nurses, associations of midwives, childbirth assistants and doulas, physical therapists, health administrators, and noted physicians and authors. In October 1994 in Chicago, they began drafting an ambitious document not only articulating basic principles for mother-friendly environments for childbirth but a comprehensive action plan including coalition-building, political action, financial reform, education for women and their families, education for providers, and respect for cultural diversity.

Gathering momentum and attracting more participants, the initial work party snowballed through four additional meetings held in Chicago (at the Le Leche International Conference), San Francisco (at the APPPAH Congress), Baltimore (at the BIRTH Conference) and a final weekend at Mt. Madonna (no less) Retreat Center in Watsonville, California. The consensus document, finalized April 24, 1996 by an editorial committee including APPPAH Board member Robbie Davis-Floyd, is a closely reasoned and prophetic declaration which may well mark a line between past and future birth.

APPPAH members who contributed along the way include Jay Hathaway, David Chamberlain, Suzanne Arms, Annette Pfannensteil, Jeannine Parvati Baker, Ray Castellino, Tina Kimmel, Jack Heinowitz, and Phyllis Klaus. Coalition for Improving Maternity Services (CIMS, pronounced "KIMS") is now the official name of this powerful alliance of individual leaders and national and international associations, including APPPAH. The CIMS mission is to promote a wellness model of maternity care in contrast with the current disease model. And to advocate family-friendly, fully cooperative professional support among all who care for birthing families whether the birth is at home, at birth centers, or in hospitals. Of special interest to us: this document is the first in childbirth education to assert that pregnant women and unborn babies are dynamically interdependent, have joint wisdom for birthing, and that "babies are aware, sensitive human beings at the time of birth, and should be acknowledged and treated as such."

"In spite of spending far more money per capita on maternity and newborn care than any other country," the Preamble notes, "the US continues to be far behind most industrialized countries in perinatal morbidity and mortality." The Coalition believes much of the high cost is due to inappropriate application of technology and routine interventions that inspire a cascade of expensive solutions in hospitals. They hope for a vast increase of participation by midwives in American birth and for far greater emphasis on breastfeeding as the optimum in nutrition and psychological care of infants.

Five philosophical cornerstones of mother-friendly care are identified: the normalcy of the birthing process; empowerment of women; the autonomy of women in exercising choice; avoidance of harm by routine procedures that are not evidence-based; and a delineation of responsibilities of parents and their caregivers. Significantly, in each category, mothers and babies are treated as a unit, so that what is called mother-friendly is baby-friendly as well. These principles, fully elaborated, form a basis for what the Coalition calls "The Mother-Friendly Childbirth Initiative: Ten Steps to Mother-Friendly Hospitals, Birth Centers, and Home Birth Services." When all steps are achieved, the institution will win approval as "Mother-Friendly."

Meeting all requirements means offering unrestricted access to birth companions and to continuous emotional and physical support during labor, such as a birth assistant or doula; access to midwifery care; provision of accurate descriptions and statistical information to the public about birth practices, procedures and outcomes; freedom to walk, move about and assume positions of choice during labor and birth; and having policies of cooperation with other caregivers providing maternity services to this family. Other steps to recognition as "Mother-Friendly" involve dropping routine practices not supported by scientific evidence such as withholding nourishment, early rupture of membranes, electronic fetal monitoring, and IV drips; educating staff in non-drug methods of pain relief; breastfeeding encouragement and follow-up support; and discouraging non-religious circumcision of the newborn (Now that is baby friendly!).

The tenth step in the Mother-Friendly recognition process is to strive to achieve another ten-step program designed by the World Health Organization/UNESCO called "The Baby-Friendly Hospital Initiative." Launched in July 1991, this worldwide project is all about promoting breastfeeding--itself a major concern in perinatal psychology and health. However, the authors of the WHO campaign apparently never seriously considered what else a hospital might have to do to be baby-friendly! CIMS makes progress toward this in its Action Plan. Under Political Action, one of the tactics is to "refine and disseminate baby-friendly guidelines that speak to the sensitivity and awareness of babies as well as their need for breastfeeding." Again, under Education for Women and Their Families: "Familiarize children with normal and positive childbirth at home and in birthing centers as well as humanized, normalized birth in hospitals that is both woman, family, and baby-friendly. The complete text of the CIMS Consensus Document was ratified on July 1, 1996 and is picking up a growing number of endorsers.

The four-page document includes the list of organizations and individual endorsers, and a brief glossary of terms and brief bibliography. The signatories invite you to help circulate this document and tell how to obtain both paper and electronic copies. For printed copies, write to CIMS at P.O. Box 2346 Ponto Vedra Beach, FL 32004, or telephone toll free 888-282-CIMS. You can download all CIMS documents free from their website at www.motherfriendly.org. Information is available via email to: info@motherfriendly.org