Undisturbed Labour and Birth Index
The Undisturbed Labour and Birth (ULaB) index is a facility level quality measure comprised of indicators that either support or detract from the physiology of labour and birth; birth that begins, progresses and concludes spontaneously. Following an environmental scan for evidence-based indicators, we convened a multi-disciplinary Delphi panel of experts to develop this tool. This process illuminated 18 domains across environmental, experiential, and structural conditions that are crucial to supporting physiologic labour and birth. These domains were operationalized into a set of measurable indicators within a composite index, including a weighted scoring system. This tool is intended to aid facilities to identify focused quality improvement initiatives and provision of cost-effective services. The ULaB provides facilities and their employees a road map to measure and demonstrate success.
The ULaB is a tool that can aid facilities in lowering intervention rates and costs, while increasing quality and safety for all. The index is informed by current evidence-based practices endorsed by the WHO, ACOG, ACNM, ICI, and AWHONN.
The domains that the index measure are informed by current evidence-based practices endorsed by the World Health Organization (WHO), Society of Obstetricians and Gynaecologists of Canada (SOGC), American College of Obstetricians and Gynaecologists (ACOG), the American College of Nurse Midwives (ACNM), the National Association of Certified Nurse Midwives (NACPM), The Royal College of Midwives, the National Institute for Health and Care Excellence (NICE), the Canadian Association of Perinatal and Women’s Health Nurses (CAPWHN), the Association of Women’s Health, Obstetric, and Neonatal Nurses (AWHONN), and the International Childbirth Initiative of the International Federation of Gynecology and Obstetrics (ICI-FIGO).
- Supportive physical environment1,2
- Respectful Maternity Care and Freedom from Mistreatment1–7
- Culturally Safe Care2,3,6,8,9
- Access to Midwifery Care1,3,4,6–8,10–13
- Integration of Care Across Birth Settings1,4,8,9,12,13
- Admission to Hospital in Active Labour4,6–10,14
- Informed Choice and Person-Centred Decision Making1,3–11,13,14
- Continuous Emotional Support2,4–10,15
- Non-pharmacological Pain Management1–4,6–13,15
- Induction and Augmentation of Labour2,3,6–9,11,15
- Freedom to Eat and Drink During Labour1–4,6
- Freedom of Movement and Choice of Birth Position1–4,6,7,10–13,15
- Fetal Monitoring3,4,6,9–11,15
- Self-directed/spontaneous Pushing During Second Stage of Labour1,3,4,6,7,10,11,15
- Cord Clamping3–5
- Immediate Postpartum Togetherness2,6–8,10
- Undisturbed Birth Rate
- Breastfeeding Support3–5,11
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- International Federation of Gynecology and Obstetrics, International Confederation of Midwives, White Ribbon Alliance, International Pediatric Association, World Health Organization. Mother-baby friendly birthing facilities. Int J Gynaecol Obstet. 2015;128(2):95-99. doi:10.1016/j.ijgo.2014.10.013
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- American College of Obstetricians and Gynecologists. Approaches to Limit Intervention During Labor and Birth. Committee Opinion No. 687. Obstet Gynecol. 2017;129(2):403-404. doi:10.1097/AOG.0000000000001904