1. WABA Birthing Practices and Breastfeeding Action Plan WABA Global Forum II - Arusha, Tanzania September 27, 2002 Childbirth practices have a direct impact and influence on mother’s health and well-being, newborn health, and breastfeeding and must be addressed as part of WABA’s global action plan for the next decade.

2. The issues of care for the mother in labour, birth, and immediately after birth are included in the 1989 WHO/UNICEF Joint Statement which formed the foundation for the Ten Steps to Successful Breastfeeding. Therefore….

3. 1. The Baby Friendly Hospital Initiative (BFHI) should be expanded to the Mother-Baby Friendly Hospital Initiative. (targeting childbirth care in maternity facilities, along with newborn and breastfeeding care).

4. Specifically :  Expand BFHI Steps 1 and 2 to include childbirth care in the maternity facility’s policies and in staff training.  Expand BFHI Step 3 to include information to pregnant mothers on humane and evidenced-based childbirth practices.  Expand BFHI Step 4 to include labor and childbirth management as it influences breastfeeding, newborn health, and mother’s health and wellbeing.

5. 2. Specific evidenced-based childbirth practices which should be encouraged are:  Continuous support in labour, birth and immediately after with companion of mother’s choice  Oral hydration and nourishment that is locally available and appropriate (juices, soups, porridge, coconut water, teas, etc.)  Non-pharmacologic methods of pain management including: touch and therapeutic massage, walking and position changes, hydrotherapy, music, presence of companion

6. 3. Routine (non-medically indicated) use of invasive and painful procedures should be discouraged. Such non-evidence based interventions include: enemas perineal shaving frequent vaginal exams AROM (artificial rupture of membranes) continuous electronic fetal monitoring episiotomy, instrumental deliveries cesarean delivery

7. 4. Beyond Facility to Community: Expansion of M-BFHI must consider home and community-based childbirth care. Traditional midwives, and homebirth attendants are uniquely poised to promote, protect and support BOTH humanized birth and optimal breastfeeding. Training and follow-up support for these community-based health providers should be a priority.

8. 5. Global Mother-Baby Friendly Programming Global health programs historically have often separated the mother-baby dyad. WABA should support current programs and new initiatives which include maternal care, newborn care, and breastfeeding care as a package. Gaps in the current monitoring and evaluation indicators should be identified and new indicators developed which will link pregnancy, childbirth, and breastfeeding.

9. Thank You