April is Cesarean Awareness Month. An opportunity to showcase a model of care that lowers the odds for cesarean section for healthy women and leads to optimal health outcomes for mothers and babies.

Research shows that the following birth practices lead to optimal maternal and newborn outcomes:

• Provide women with evidence-based information regarding benefits and risks of tests and procedures so they can make informed decisions about their care.

• Encourage continuous support (doula care) for labor and birth.

• Provide options for midwifery care.

• Provide options for home birth and birth centers.

• Provide integrated, collaborative, multidisciplinary care.

• Provide care that respects women’s cultural, social and religious preference.

• Allow women to walk freely and choose positions of their choice for labor and birth.

• Discourage flat-on-the-back position for labor and birth.

• Allow women to eat and drink during labor.

• Provide mothers with the option of non-drug methods of pain relief such as massage, use of a birth ball, use of a shower, bath and hypnotherapy.

• Do not use the following interventions routinely, and if needed their use should be evidence-based:

• Amniotomy (breaking the bag of waters)

• Induction of labor

• Continuous electronic fetal monitoring

• Use of I.V.s

• Encourage mothers to touch, hold and breastfeed their newborns at birth.

• Encourage skin-to-skin contact for all mothers as soon as medically safe.

• Strive to achieve the WHO/UNICEF, Ten Steps of the Baby-Friendly Hospital Initiative.

• Strive to achieve a 5% induction rate, a 10% or less cesarean rate in community hospitals and 15% or less in tertiary hospitals, a VBAC rate of 60% or more and a 5% or less episiotomy rate.

These are the recommendations of the Mother-Friendly Childbirth Initiative (MFCI) an evidence-based mother-, baby-, and family-friendly model of care which focuses on prevention and wellness as the alternatives to high-cost screening, diagnosis, and treatment programs.

In California maternal and newborn health professionals have formed the Mother-Friendly Childbirth Initiative Consortium of Los Angeles and are using the MFCI as a practice and policy tool to improve outcomes in their communities. You can download powerpoint presentations on the MFCI from the website.

 Resource:

Scientific evidence that supports the Ten Steps of the Mother-Friendly Childbirth Initiative can be downloaded at no cost from the Journal of Perinatal Education: Promoting Normal Birth, Winter 2007 Issue, Supplement, Coalition for Improving Maternity Services: Evidence Basis for the Ten Steps of Mother-Friendly Care.