There has been increasing focus among international and national organisations examining quality of care, abuse/neglect of women in facilities during childbirth, and the lack of professional and social accountability among facility-based providers of care.
Every woman has the right to a positive birth experience, to compassionate care from knowledgeable, skilled providers who recognise that each woman, family and newborn are unique.
The published evidence of violations of women’s human rights during childbirth is shocking and distressing, but can also serve as an impetus for action. Professional associations and facilities should provide not only the best evidence-based quality of care, but also attend to each women’s inviolable right to dignity, privacy, information, supportive care, pharmacological or non-pharmacological pain relief, and choice of birthing companion(s).
For these reasons, the International Confederation of Midwives, International Federation of Gynecologists and Obstetricians, International Pediatric Association and World Health Organization have co-designed a Guideline on Mother-Baby Friendly Birthing Facilities, with ten-steps and associated indicators:
- Offers all birthing women the opportunity to eat, drink, walk, stand and move about during the first stage of labour and to assume the position of her choice / comfort during the second and third stages, unless medically contraindicated.
- Has clear, non-discriminatory policies and guidelines for the treatment and care of HIV-positive mothers and their newborns, as well as policies for counselling and provision of postpartum family planning, and youth-friendly services.
- Provides all mothers with privacy during labour and birth.
- Allows all birthing women the comfort of at least one person of her choice (e.g. father, partner, family member, friend, and traditional birth attendant, as culturally appropriate) to be with her throughout labour and birth.
- Provides culturally competent care that respects the individual’s customs, nonharmful practices, and values around birth, including those women who experience perinatal loss.
- Does not allow physical, verbal, emotional or financial abuse of labouring, birthing and postnatal women and their families.
- Provides care at affordable costs in line with national guidelines and assures financial accountability and transparency. Families will be informed about what charges can be anticipated and how they might plan to pay for services. Families must be informed if any additional charges apply for complications. Health facilities should have a process for payment that does not include detention of the woman or baby. Refusal of care for the mother or the baby because of inability to pay should not be permitted.
- Does not routinely employ practises or procedures that are not evidence-based, such as routing episiotomy, induction of labour, or separating mother and baby care, etc., consistent with international guidelines and action plans. Each birthing facility should have the capacity, staff, policy, and equipment to provide neonatal and maternal resuscitation, minimise the risk of infection, provide prompt recognition and prevention/treatment of emergent maternal and neonatal needs, have established links for consultation and prospectively planned arrangements for the stabilisation and/or transport of sick mothers or sick/premature infants.
- Educates, counsels, and encourages staff to provide both non-pharmacological and pharmacological pain relief as necessary.
- Promotes immediate skin-to-skin and mother/baby contact and actively supports all mothers to hold and exclusively breastfeed their babies as often as possible and provides combined care for mother and baby as appropriate.