Checklist for Respectful Maternity Care

10 Steps of the International MotherBaby Childbirth Initiative

Taken from the IMBCI website:

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.

Step 2

Possess and routinely apply midwifery knowledge and skills that enhance and optimize the normal physiology of pregnancy, labor, birth, breastfeeding, and the postpartum period.

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. 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.

Step 4

Provide drug-free comfort and pain-relief methods during labor, explaining their benefits for facilitating normal birth and avoiding unnecessary harm, and showing women (and their companions) how to use these methods, including touch, holding, massage, laboring in water, and coping/relaxation techniques. Respect women’s preferences and choices.

Step 5

Provide specific evidence-based practices proven to be beneficial in supporting the normal physiology of labor, birth, and the postpartum period, including:

• Allowing labor to unfold at its own pace, while refraining from interventions based on fixed time limits and utilizing the partogram to keep track of labor progress.
• Offering the mother unrestricted access to food and drink as she wishes during labor.
• Supporting her 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.
• Techniques for turning the baby in utero and for vaginal breech delivery.
• Facilitating immediate and sustained skin-to-skin motherbaby contact for warmth, attachment, breastfeeding initiation, and developmental stimulation, and ensuring that motherbaby stay together.
• Allowing adequate time for the cord blood to transfer to the baby for the blood volume, oxygen, and nutrients it provides.
• 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.

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.

• shaving
• enema
• sweeping of the membranes
• artificial rupture of membranes
• medical induction and/or augmentation of labor
• repetitive vaginal exams
• withholding food and water
• keeping the mother in bed
• intravenous fluids
• continuous electronic fetal monitoring
• insertion of a bladder catheter
• supine or lithotomy position
• caregiver-directed pushing
• fundal pressure
• episiotomy
• forceps and vacuum extraction
• manual exploration of the uterus
• primary and repeat caesarean section
• suctioning of the newborn
• immediate cord clamping
• separation of mother and baby

Step 7

Implement measures that enhance wellness and prevent emergencies, illness, and death of MotherBaby:

• Provide education about and foster access to good nutrition, clean water, and a clean and safe environment.
• Provide education in and access to methods of disease prevention, including malaria and HIV/AIDS prevention and treatment, and tetanus toxoid immunization.
• Provide education in responsible sexuality, family planning, and women’s reproductive rights, and provide access to family planning options.
• Provide supportive prenatal, intrapartum, postpartum, and newborn care that addresses the physical and emotional health of the motherbaby within the context of family relationships and community environment.

Step 8

Provide access to evidence-based skilled emergency treatment for life-threatening complications. Ensure that all maternal and newborn health care providers have adequate and ongoing training in emergency skills for appropriate and timely treatment of mothers and their newborns.

Step 9

Provide a continuum of collaborative maternal and newborn care with all relevant health care providers, institutions and organizations. Including traditional birth attendants and others who attend births out of hospital in this continuum of care. Specifically, individuals within institutions, agencies and organizations offering maternity-related services should:

• 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 other’s points of view.
• Foster continuity of care during labor and birth for the motherbaby from a small number of caregivers.
• Provide consultations and transfers of care in a timely manner to appropriate institutions and specialists.
• Ensure that the mother is aware of and can access available community services specific to her needs and those of her newborn.

Step 10—Strive to achieve the 10 Steps to Successful Breastfeeding as described in the WHO/UNICEF Baby-friendly Hospital Initiative:

• Have a written breastfeeding policy that is routinely communicated to all health care staff.
• Train all health care staff in skills necessary to implement the policy.
• Inform all pregnant women about the benefits and management of breastfeeding.
• Help mothers initiate breastfeeding within a half-hour of birth. Place babies in skin-to-skin contact with their mothers immediately following birth for at least an hour and encourage mothers to recognize when their babies are ready to breastfeed, offering if needed.
• Show mothers how to breastfeed and how to maintain lactation, even if they should be separated from their infants.
• Give newborn infants no food or drink other than breast milk, unless medically indicated.
• Practice “rooming in”—allow mothers and infants to remain together 24 hours a day.
• Encourage breastfeeding on demand.
• Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants.
• Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.