Have you decided how to have your
The choice is yours!
First, you should learn as much as you
can about all your choices. There are many different ways of
caring for a mother and her baby during labor and
Birthing care that is better and healthier for mothers and
babies is called “mother-friendly.” Some birth places or
settings are more mother-friendly than others.
A group of experts in birthing care came up with this list
of 10 things to look for and ask about. Medical research
supports all of these things. These are also the best ways to
When you are deciding where to have your baby, you'll
probably be choosing from different places such as:
- • birth center,
- • hospital, or
- • home birth service.
Here's what you should expect, and ask for, in your birth
experience. Be sure to find out how the people you talk with
handle these ten issues about caring for you and your baby. You
may want to ask the questions below to help you learn more.
1. Ask, “Who can be with me during
labor and birth?”
Mother-friendly birth centers, hospitals, and home birth
services will let a birthing mother decide whom she wants to
have with her during the birth. This includes fathers,
partners, children, other family members, or friends.
They will also let a birthing mother have with her a person
who has special training in helping women cope with labor and
birth. This person is called a doula or labor support person.
She never leaves the birthing mother alone. She encourages her,
comforts her, and helps her understand what's happening to
They will have midwives as part of their staff so that a
birthing mother can have a midwife with her if she wants
2. Ask, “What happens during a normal
labor and birth in your setting?”
If they give mother-friendly care, they will tell you how
they handle every part of the birthing process. For example,
how often do they give the mother a drug to speed up the birth?
Or do they let labor and birth usually happen on its own
They will also tell you how often they do certain
procedures. For example, they will have a record of the
percentage of C-sections (Cesarean births) they do every year.
If the number is too high, you'll want to consider having your
baby in another place or with another doctor or midwife.
Here are some numbers we recommend you ask about.
- They should not try to start labor for more than 1
in 10 women (10%).
- They should not do an episiotomy (ee-pee-zee-AH-tummy) on
more than 1 in 5 women (20%). They should be trying to bring
that number down. (An episiotomy is a cut in the opening to
the vagina to make it larger for birth. It is not necessary
most of the time.)
- They should not do C-sections on more than 1 in 10 women
(10%) if it's a community hospital. The rate should be 15% or
less in hospitals which care for many high-risk mothers and
A C-section is a major operation in which a doctor cuts
through the mother's stomach into her womb and removes the baby
through the opening. Mothers who have had a C-section can often
have future babies normally. Look for a birth place in which 6
out of 10 women (60%) or more of the mothers who have had
C-sections go on to have their other babies through the birth
3. Ask, “How do you allow for
differences in culture and beliefs?”
Mother-friendly birth centers, hospitals, and home birth
services are sensitive to the mother's culture. They know that
mothers and families have differing beliefs, values, and
For example, you may have a custom that only women may be
with you during labor and birth. Or perhaps your beliefs
include a religious ritual to be done after birth. There are
many other examples that may be very important to you. If the
place and the people are mother-friendly, they will support you
in doing what you want to do. Before labor starts tell your
doctor or midwife special things you want.
4. Ask, “Can I walk and move around
during labor? What position do you suggest for
In mother-friendly settings, you can
walk around and move about as you choose during labor. You can
choose the positions that are most comfortable and work best
for you during labor and birth. (There may be a medical reason
for you to be in a certain position.) Mother-friendly settings
almost never put a woman flat on her back with her legs up in
stirrups for the birth.
5. Ask, “How do you make sure
everything goes smoothly when my nurse, doctor, midwife, or
agency need to work with each other?”
Ask, “Can my doctor or midwife come with me if I have to be
moved to another place during labor? Can you help me find
people or agencies in my community who can help me before and
after the baby is born?”
Mother-friendly places and people will have a specific plan
for keeping in touch with the other people who are caring for
you. They will talk to others who give you birth care. They
will help you find people or agencies in your community to help
you. For example, they may put you in touch with someone who
can help you with breastfeeding.
6. Ask, “What things do you normally
do to a woman in labor?”
Experts say some methods of care during labor and birth are
better and healthier for mothers and babies. Medical research
shows us which methods of care are better and healthier.
Mother-friendly settings only use methods that have been proven
to be best by scientific evidence.
Sometimes birth centers, hospitals, and home birth services
use methods that are not proven to be best for the mother or
the baby. For example, research has shown it's usually not
helpful to break the bag of waters.
Here is a list of things we recommend you ask about. They do
not help and may hurt healthy mothers and babies. They are not
proven to be best for the mother or baby and are not
- They should not keep track of the baby's heart rate all
the time with a machine (called an electronic fetal monitor).
Instead it is best to have your nurse or midwife listen to
the baby's heart from time to time.
- They should not break your bag of waters early in
- They should not use an IV (a needle put into your vein to
give you fluids).
- They should not tell you that you can't eat or drink
- They should not shave you.
- They should not give you an enema.
A birth center, hospital, or home birth service that does
these things for most of the mothers is not mother-friendly.
Remember, these should not be used without a special medical
7. Ask, “How do you help mothers stay
as comfortable as they can be? Besides drugs, how do you help
mothers relieve the pain of labor?”
The people who care for you should
know how to help you cope with labor. They should know about
ways of dealing with your pain that don't use drugs. They
should suggest such things as changing your position, relaxing
in a warm bath, having a massage, and using music. These are
called comfort measures.
Comfort measures help you handle your
labor more easily and help you feel more in control. The people
who care for you will not try to persuade you to use a drug for
pain unless you need it to take care of a special medical
problem. All drugs affect the baby.
8. Ask, “What if my baby is born
early or has special problems?”
Mother-friendly places and people will
encourage mothers and families to touch, hold, breastfeed, and
care for their babies as much as they can. They will encourage
this even if your baby is born early or has a medical problem
at birth. (However, there may be a special medical reason you
shouldn't hold and care for your baby.)
9. Ask, “Do you circumcise baby
Medical research does not show a need
to circumcise baby boys. It is painful and risky.
Mother-friendly birth places discourage circumcision unless it
is for religious reasons.
10. Ask, “How do you help mothers who
want to breastfeed?”
The World Health Organization made this list of ways birth
services support breastfeeding.
- They tell all pregnant mothers why and how to
- They help you start breastfeeding within
1 hour after your baby is born.
- They show you how to breastfeed. And they show you how to
keep your milk coming in even if you have to be away from
your baby for work or other reasons.
- Newborns should have only breast milk. (However, there
may be a medical reason they cannot have it right away.)
- They encourage you and the baby to stay together all day
and all night. This is called “rooming-in.”
- They encourage you to feed your baby whenever he or she
wants to nurse, rather than at certain times.
- They should not give pacifiers (“dummies” or “soothers”)
to breastfed babies.
- They encourage you to join a group of mothers who
breastfeed. They tell you how to contact a group near
- They have a written policy on breastfeeding. All the
employees know about and use the ideas in the policy.
- They teach employees the skills they need to carry out
Would you like to give this
information (and more) to your doctor, midwife, or
This information is a part of the Mother-Friendly Childbirth
Initiative written for health care providers. You can get a
copy of the Initiative for your doctor, midwife, or nurse by
mail, e-mail, or on the World Wide Web.
To Get a Copy:
- CIMS National Office
- PO Box 2346
- Ponte Vedra Beach, FL 32004
- Fax 904-285-2120
For a copy of both documents by mail, send a stamped
self-addressed envelope with $3 (US) to help cover the costs
($4 Canada or Mexico, $5 all others). Bulk prices
For the Printable PDF Version, click here.
© 2000 by The Coalition for Improving Maternity
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