January 12, 2004

The Ten Steps of the Mother Baby Friendly Childbirth Initiative

This will be my first Diary entry for the year. For the last three weeks I have been enjoying a holiday in Thailand and Cambodia, and although I wasn’t at all focussed on work, there were a number of times that childbirth and related issues popped up.

In Thailand I had the opportunity to catch up with the other members of the Board of the Childbirth and Breastfeeding Foundation of Thailand at a party to celebrate the year’s achievements (more about this later). The Foundation has begun to be recognised in other South East Asian countries and is leading the movement for the reform of outdated birth practices and in the promotion of breastfeeding.

Using the Better Birth Initiative developed by Justus Hofmeyr in South Africa as a starting point, the Foundation has produced a workbook and program to encourage the adoption of evidence based practices in maternity care. Groups of midwives and doctors, having participated in practical sessions and discussions, fill out the workbook, answering basic questions that reinforce their new skills and provide evidence of their learning. It is an innovative approach that would have broad application in many settings.

Word is already spreading - the Foundation has facilitated programs in several centres in Vietnam and this week are presenting a program in Laos. The Laotian sponsors also wanted a statement they could use as a basis for initiating reform, so putting our heads together last week in Bangkok, the following statement was formulated:

The Mother and Baby Friendly Childbirth Initiative

The health of mothers and babies is of fundamental importance to well-being of the family, the community and society. The ability of a country and its health services to provide optimal care for pregnancy and birth demonstrates their commitment in this area, which can have a profound effect on future health of a population, economic stability and social cohesion of its society.

Given that

Birth is a normal, natural and healthy process
Women and babies have the innate, instinctive knowledge necessary for giving birth, and
Breastfeeding provides the optimum nourishment for newborns and infants,

The best possible care for mothers and babies can be achieved by

1. Basing obstetric, midwifery and nursing practices on proven scientific evidence
2. Developing evidence based educational programs for all maternity care staff
3. Promoting midwifery as the primary model of care for achieving optimal birth outcomes
4. Providing pregnant and labouring women with care that is sensitive and responsive to their specific religious, cultural and ethnic needs
5.Providing appropriate, individualised treatment for women and babies
6. Encouraging women to have a companion of their choice, such as a family member or close friend, to provide emotional and physical support throughout their labour and birth
7. Providing evidence based information to mothers to enable them to make informed decisions about their care
8. Promoting breastfeeding through implementing the WHO-UNICEF “Ten Steps of the Baby-Friendly Hospital Initiative”
9. Setting up systems for collaborative care between hospital and community based services
10. Developing systems for the monitoring and auditing of the implementation of this Initiative, and reporting on progress being made to achieve its objectives.

I believe that this is an easily understood, broad based and simple list of steps that are appropriate for developing as well as western countries. We steered away from setting specific targets (such as caesarean rates) or mentioning specific procedures (such as enemas, episiotomies and lithotomy) because if an evidence based approach is used, these issues will be covered anyway.

I would welcome feedback from others about its usefulness or applicability to the conditions in other countries. Meanwhile, it will be interesting to receive feedback from the Laotian program where this list was first launched.

Posted by andrea at January 12, 2004 03:32 PM