Appropriate Intervention in Childbirth

Statement of belief

The International Confederation of Midwives supports the belief that childbearing for the great majority of women throughout the world is a normal, physiological process influenced by culture, traditions, religion, and psychosocial factors. The Confederation further believes that childbearing is a family event and requires a health-oriented rather than a disease-oriented model of care from providers.

The Confederation also believes that for many women in the resource poor nations of the world, pregnancy and birth can be life-threatening and every attempt should be made to reduce the risk of death or illness through the use of evidence-based, low cost technological interventions when needed.

In keeping with the ICM International Code of Ethics for Midwives, the Confederation also believes that women are active participants in decisions that affect their health services. Making informed decisions about the use or non-use of technology in childbirth requires that women have up-to-date, complete and understandable information on the risks and benefits of each technological intervention proposed in their care.

Proposed policy

In keeping with the basic premise that childbirth is a normal, life cycle event for the majority of women in the world, the midwives of the world will use technology during childbirth only when indicated to enhance the well being of mothers and babies and improve outcomes. In keeping with this premise, the midwife will:

· provide information to women and their families that promotes the understanding of birth as a normal life process and enables women to make informed choices during health care;

· promote childbirth practices that enhance the normal physiological processes of labor and birth as well as the psychological, spiritual and cultural aspects;

· advocate for the fair allocation of health resources that support the basic needs of women and their babies as priority;

· participate in the design and evaluation of interventions during childbirth, including the ethical use of technology according to the following criteria:

· when there is a clear and present danger to the health of mother or baby that can be removed by using technology;

· when the benefits of its use outweigh the risks to mother or baby or both;

· when both the midwife and the woman/family fully understand how the technology works and why it is indicated;

· when the woman has been given complete and understandable information about the proposed technological intervention and can therefore give fully informed consent to proceed;

A midwife will:

· take measures to avoid unnecessary interference in the progress of

normal labor and birth;

· understand and implement life saving skills, including the use of

technology, in a timely and appropriate manner when there is a clear and present danger to the health of pregnant women and/or their babies.

Guiding statement to Member Associations

Member Associations are urged to use this statement or draft a similar one that highlights the midwife's role in both the use and evaluation of any technological intervention during their care of women and newborn.

References

- ICM International Code of Ethics for Midwives (1993)

- ICM Global Vision for Women (1996)

- ICM Essential Competencies for Midwifery Practice (1998 draft)

Supersedes ICM Statement:

Intervention in Childbirth 93/5

Adopted by the International Confederation of Midwives Council, Manila, May 1999.

Date for review: 2005