Current maternity and newborn practices that contribute to high costs and inferior outcomes include inappropriate application of technology and routine procedures that are not based on scientific evidence. The Mother Friendly Childbirth Initiative, 1997 Coalition for Improving Maternity Services (CIMS) <www.healthy.net>

The integrity of the mother-child relationship, which begins in pregnancy, is compromised by the obstetrical treatment of mother and baby as if they were separate units with conflicting needs The Mother Friendly Childbirth Initiative, Coalition for Improving Maternity Services

(CIMS) (202) 478-6138

World Health Organization publication entitled "Care in Normal Birth: A Practical Guide" lists obstetrical procedures in four categories, based on a scientific examination of the practice to determine benefit, harm or lack of evidence:

Category B -- Practices Which are clearly harmful or ineffective and should be eliminated: (partial list)

Routine use of enema, pubic shaving, IV fluids in labor

Routine insertion of intravenous cannula (Heparin lock)

Routine use of the supine position (mother lying on her back) during labor

Routine use of lithotomy position with or without stirrups during second stage of labor

Sustained, directed bearing down efforts (Valsalva maneuver) during second stage of labor

Massaging and stretching the perineum during second or pushing stage of labor

Manual exploration of the uterus after delivery

Category D -- Practices which are frequently used inappropriately (partial list)

Restriction of food and fluids during labor

Pain control by systemic agents (narcotic drugs or anesthetics)

Pain control by epidural analgesia

Electronic fetal monitoring

Wearing masks and sterile gowns during labor attendance

Repeated or frequent vaginal exams, especially by more than one caregiver

Oxytocin (Pitocin) augmentation during labor

Routinely moving the laboring women to a different room for delivery

Encouraging women to push when full dilation or almost full dilation of the cervix has been diagnosed, before the women feels the usage to bear down herself

Rigid adherence to a stipulated duration of the second stage (pushing stage) of labor if maternal and fetal conditions are good and there is progress in labor

Operative delivery (Cesarean, forceps or vacuum extraction)

Liberal or routine use of episiotomy

Manual exploration of the uterus after delivery

Maternal & Newborn Health / Safe Motherhood Unit, Family & Reproductive Health
World Health Organization, 1211 Geneva 27, Switerland ~ Tel 41 22 791 21 11

SB 1479 ~California Citizens for Health Freedom 888 / 557-8092