Step 1: Offers all birthing mothers unrestricted access to birth companions, labor support, professional midwifery care.
Step 2: Provides accurate descriptive and statistical information to the public about its practices and procedures for birth care, including measures of
interventions and outcomes.
Step 3: Provides culturally competent care – that is, care that is sensitive and responsive to the specific beliefs, values, and customs of the mother’s
ethnicity and religion.
Karen Miles Sheffield
Step 4: Provides the birthing woman with the freedom to walk, move about, and assume the positions of her choice during labor and birth (unless restriction
is specifically required to correct a complication), and discourages the use of the lithotomy (flat on back with legs elevated) position.
Step 5: Has clearly defined policies and procedures for:
• Collaborating and consulting throughout the perinatal period with other maternity services, including communicating with the original caregiver when
transfer from one birth site to another is necessary;
• Linking the mother and baby to appropriate community resources, including prenatal and post-discharge follow-up and breastfeeding support.
Judith A. Lothian
Step 6: Does not routinely employ practices and procedures that are unsupported by scientific evidence,
Barbara A. Hotelling
Step 7: Educates staff in non-drug methods of pain relief, and does not promote the use of analgesic or anesthetic drugs not specifically required to
correct a complication.
Step 8: Encourages all mothers and families, including those with sick or premature newborns or infants with congenital problems, to touch, hold,
breastfeed, and care for their babies to the extent compatible with their conditions.
Step 9: Discourages non-religious circumcision of the newborn.
Step 10: Strives to achieve the WHO-UNICEF “Ten Steps of the Baby-Friendly Hospital Initiative” to promote successful breastfeeding:
Eileen A. DiFrisco and Jessica Deeb
• Mother-Friendly self-assessment tool for hospitals, birth centers, and home birth practices.
• Having a Baby?: Ten Questions to Ask
• Is Your Perinatal Practice Mother-Friendly?
• Is Your Doula Practice Mother-Friendly?
• Are Your Childbirth Classes Mother-Friendly?
• Additional Policy: Nitrous Oxide Use in the Intrapartum/Immediate Post-Partum Period
• Additional Policy: Birth Can Safely Take Place at Home and in Birthing Centers