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The Coalition for Improving Maternity Services (CIMS) was formed in 1996. It is made up of midwives, physicians, hospital associations, public health workers, doulas, scientists, and many others. As a group they meet to review scientific reports and make recommendations for evidence-based obstetric practices in birth centers and hospitals.

To qualify for CIMS designation, a birth center, hospital, or home birth service must fulfill these Ten Steps of Mother-Friendly Care:

1. Offers all birthing mothers unrestricted access to: birth companions of her choice, continuous emotional and physical support, and professional midwifery care.

2. Provides to the public accurate descriptive and statistical information about its birth care practices and procedures.

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.

4. Provides the birthing woman freedom of movement and discourages the lithotomy (flat-on-your-back) birth position.

5. Has clearly defined policies regarding: continuity of care, follow-up well-baby care, and breastfeeding support.

6. Does not routinely employ procedures unsupported by scientific evidence, including but not limited to: shaving, enemas, IV, withholding nourishment, early rupture of membranes, and electronic fetal monitoring. Other interventions are limited as follows: oxytocin (a chemical used to make labor start or speed up) induction rate of 10% or less, episiotomy rate of less than 20%, with a goal of 5%, cesarean rate of less than 10% and VBAC (vaginal birth after cesarean) rate of 60% or more, with a goal of 75% or more.

7. Educates staff in non-drug pain relief and does not promote the use of analgesic or anesthetic drugs.

8. Encourages touching, holding, and breastfeeding of all babies.

9. Discourages non-religious circumcision of the newborn.

10. Strives to achieve the WHO/UNICEF "Baby-Friendly Hospital Initiative" to encourage breastfeedingsee more on this in Chapter Nine).

When considering a certain hospital or birthing center, ask if they have been designated by CIMS as a Mother-Friendly institution. This will assure you that you are receiving the best care. If they are not designated it does not necessarily mean they don’t follow these standards. You will just have to ask, point by point, about the specifics.