Pregnancy, labour, birth, and breastfeeding are normal and healthy processes. The mother and baby constitute an integral unit during pregnancy, birth, and infancy (referred to herein as the “MotherBaby”) and should be treated as such, as the care of one significantly impacts the care of the other.

Obstetrical practices can negatively impact a woman’s ability to breastfeed. Birth and breastfeeding cannot be separated—they are part of the motherbaby continuum--and the way birth proceeds can have a major impact on the way breastfeeding will proceed. Any procedure that interrupts the mother’s physiological systems or interferes with her self-esteem can be highly detrimental to breastfeeding, including drugs used during labour and birth, disrespectful care, suctioning the baby at birth, early cord clamping, and separation of motherbaby after birth.

The International MotherBaby Childbirth Initiative (IMBCI): 10 Steps to Optimal Maternity Care promotes a motherbaby model of care that will transform birth and breastfeeding practices around the world. The IMBCI focuses on facilitating normal birth, avoiding unnecessary interventions, and supporting breastfeeding.

An optimal MotherBaby maternity service has written policies, implemented in education and practice, requiring that its health care providers:

• Step 1 Treat every woman with respect and dignity.
  
• Step 2 Possess and routinely apply midwifery knowledge and skills that optimize the normal physiology of birth and breastfeeding.
  
• Step 3 Inform the mother of the benefits of continuous support during labour and birth, and affirm her right to receive such support from companions of her choice.
  
• Step 4 Provide drug-free comfort and pain relief methods during labour, explaining their benefits for facilitating normal birth.
  
• Step 5 Provide evidence-based practices proven to be beneficial.
  
• Step 6 Avoid potentially harmful procedures and practices.
  
• Step 7 Implement measures that enhance wellness and prevent illness and emergencies.
  
• Step 8 Provide access to evidence-based skilled emergency treatment.
  
• Step 9 Provide a continuum of collaborative care with all relevant health care providers, institutions, and organizations.
  
• Step 10 Strive to achieve the BFHI 10 Steps to Successful Breastfeeding.
  

The IMBCI acknowledges the great variation in resources and access to care around the world. The challenge for the 21st century is to increase access to skilled caregivers and emergency care where these are lacking while decreasing the overuse of unnecessary medical interventions, increasing understanding of normal birth and breastfeeding, and improving quality of care in all countries.

Baby-friendly (H)ospital Initiative(BFHI) added the Mother-friendly Care new optional Global Criteria and questions have been added to ensure that practices are in place for mother-friendly labour and delivery. These practices are important, in their own right, for the physical and psychological health of the mothers themselves, and also have been shown to enhance their infants’ start in life, including breastfeeding. Many countries have explored options for including mother-friendly criteria within the Initiative, in some cases re-terming their national initiatives as “mother and baby friendly”. Other countries have adopted full “mother-friendly” initiatives. New self- appraisal and assessment questions on this topic offer a way for countries that have not done so already to add a component focused on the key “mother-friendly” criteria needed for an optimal “continuum of care” for both mother and child from the antenatal to postpartum period.

The 5 steps of the Global Criteria include:

1. Encourage women to have companions of their choice to provide continuous physical and/or emotional support during labour and birth, if desired.
   
2. Allow women to drink and eat light foods during labour, if desired.
   
3. Encourage women to consider the use of non-drug methods of pain relief unless analgesic or anaesthetic drugs are necessary because of complications, respecting the personal preferences of the women
   
4. Encourage women to walk and move about during labour, if desired, and assume positions of their choice while giving birth, unless a restriction is specifically required for a complication and the reason is explained to the mother.
   
5. Care that does not involve invasive procedures such as rupture of the membranes, episiotomies, acceleration or induction of labour, instrumental deliveries, or cesarean sections unless specifically required for a complication and the reason is explained to the mother.
   

Together with the guidelines set by the IMBCI and BFHI Global Criteria there is significant evidence based research to support breastfeeding through improving birth practices.