All members of Alaska Birth Collective agree to uphold the following principles and guidelines for Mother-Friendly Care.

 

Principles:

We believe the philosophical cornerstones of Mother-Friendly care to be as follows:

Normalcy of the Birthing Process
Birth is a normal, natural, and healthy process.
Women and babies have the inherent wisdom necessary for birth.
Birth can safely take place in hospitals, birth centers, and homes.
The midwifery model of care, which supports and protects the normal birth process, is the most appropriate for the majority of women during pregnancy and birth.
Babies are aware, sensitive human beings at the time of birth, and should be acknowledged and treated as such.
Breastfeeding provides the optimum nourishment for newborns and infants.
Empowerment
A woman’s confidence and ability to give birth and to care for her baby are enhanced or diminished by every person who cares for her, and by the environment in which she gives birth.
A mother and baby are distinct yet interdependent during pregnancy, birth and infancy. Their interconnectedness is vital and must be respected.
Pregnancy, birth, and the postpartum period are milestone events in the continuum of life. These experiences profoundly affect women, babies, fathers, and families, and have important and long-lasting effects on society.
Autonomy
Every woman should have the opportunity to:

Have a healthy and joyous birth experience for herself and her family, regardless of her age or circumstances;
Give birth as she wishes in an environment in which she feels nurtured and secure, and her emotional well-being, privacy and personal preferences are respected;
Have access to the full range of options for pregnancy, birth, and nurturing her baby, and to accurate information on all available birthing sites, caregivers and practices;
Receive accurate and up-to-date information about the benefits and risks of all procedures, drugs and tests suggested for use during pregnancy, birth and the postpartum period, with the rights to informed consent and informed refusal;
Receive support for making informed choices about what is best for her and her baby based on her individual values and beliefs.
Do No Harm

Interventions should not be applied routinely during pregnancy, birth or the postpartum period. Many standard medical tests, procedures, technologies, and drugs carry risks to both mother and baby and should be avoided in the absence of specific scientific or medical indications for their use.
If complications arise during pregnancy, birth or the postpartum period, medical treatments should be evidence-based.
Responsibility

Each caregiver is responsible for the quality of care she or he provides.
Maternity care practice should be based not on the needs of the caregiver or provider, but solely on the needs of the mother and child.
Each hospital and birth center is responsible for periodic review and evaluation according to current scientific evidence, of the effectiveness, risks and rates of use of its medical procedures for mothers and babies.
Society, through both its government and the public health establishment, is responsible for ensuring access to maternity services for all women and for monitoring the quality of those services.
Individuals are ultimately responsible for making informed choices about the health care they and their babies receive.

Postpartum Care

There is no more vulnerable time for mothers, fathers, and children than during pregnancy and postpartum, when psychiatric admissions rise higher than any other time in a woman’s life. Postpartum depression is the most under-diagnosed obstetric complication in the U.S. (Earls, 2010) Because the burden of depression and other mental health distress is so high for mothers and their children, and because it is often overlooked, Postpartum Support International believes that there is a tremendous need for universal screening of all pregnant and postpartum women. Emotional stress and perinatal mental health disorders, such as prenatal and postpartum depression and anxiety, are clinically defined, treatable, and amenable to support, education and intervention. Although there is increasing awareness of the rates of perinatal mental health disorders and the potential negative impact on mothers, babies, and families, perinatal mental health is far too often undiagnosed, under-treated or not treated at all.

Postpartum Support International (PSI) recommends universal screening for the presence of prenatal or postpartum mood and anxiety disorders, using an evidence-based tool such as the Edinburgh Postnatal Depression Screen (EPDS) or Patient Health Questionnaire (PHQ-9).

Both the EPDS and the PHQ-9 are validated for use in the perinatal population, and there is no fee. The benefits are that they are self-administered, translated into many languages, and easy to complete. The EPDS addresses the anxiety component of PMADs as well as depressive symptoms and suicidal thoughts. The PHQ-9 does not have the anxiety component but includes suicidal ideation. The PHQ-9 also incorporates the categories that define depression in the Diagnostic and Statistical Manual (DSM), which helps with diagnostic criteria. With anxiety being recognized as one of the presenting symptoms of PMADs it becomes important that it be assessed in the screening tool, making the EPDS the most widely used tool (“Screening for Perinatal Depression – ACOG,” 2015).

Understanding that healthcare settings are often very busy and providers feel pressured to complete appointments, we recommend that providers learn efficient ways to screen patients and work toward these ideal practices:

Timing:

First prenatal visit
At least once in second trimester
At least once in third trimester
Six-week postpartum obstetrical visit (or at first postpartum visit)
Repeated screening at 6 and/or 12 months in OB and primary care settings
3, 9, and 12 month pediatric visits.

The recommended cut-off score for a positive screen using either tool is 10.
The EPDS is a reliable and valid measure of mood in fathers. Screening for depression or anxiety disorders in fathers requires a two-point lower cut-off than screening for depression or anxiety in mothers, and we recommend this cut-off to be 5/6. (Matthey, 2001)