Statewide Clinical guidelines for women requesting immersion in water for pain management during labour and /or birth.
This operational directive is to inform all health care workers in Western Australian hospitals, health services and non governmental facilities providing care for mothers and their newborn(s) of the revised statewide Guideline for the use of water during labour and/or birth.
The statewide policy endorses the Women’s and Newborns’ Health Network clinical guidelines for women requesting immersion in water for pain management during labour and/or birth (October 2012) and replaces the statewide guideline for the use of water during Labour and/or birth on WA Health Hospitals and health services (April 2009). The clinical guidelines inform midwives and medical practitioners enabling them to provide care that is as safe as possible for healthy pregnant women who choose to use immersion in water as a pain management strategy during labour and/or for birth.
STATEWIDE GUIDELINE FOR THE USE OF WATER DURING
LABOUR AND/OR BIRTH IN WA HEALTH HOSPITALS AND HEALTH SERVICES
“Water birth means where a baby is born fully submerged into water. The baby’s head must remain submerged under water until after the body is born, then the baby is brought to the surface immediately. The baby’s head must not be submerged again”.2 Water births are associated with low risks for both the woman and baby when best practice guidelines are followed.3 4
Water immersion for first and second stage of labour
“Water immersion during the first stage of labour significantly reduces epidural/spinal analgesia requirements and reported maternal pain, without adversely affecting labour duration, operative delivery rates, or neonatal wellbeing. Immersion in water during the second stage of labour increased women's reported satisfaction with pushing”1.
The development of a statewide policy for the use of water during labour and/or birth was initiated following a response to increasing consumer demand in Western Australia. The clinical guideline is intended to ensure the safety, as far as possible, for women choosing the option of immersion in water for labour and / or birth for themselves and their unborn/newborn babies.
Note: The Women’s and Newborns Health Network does not necessarily advocate 'water birth' but recognises that women have a right to choose to labour and/or birth in water.
To assist, educate and enable midwives and medical practitioners in WA Health hospital and health services to care safely for healthy pregnant women who choose to use the bath and/or pool during all stages of their labour and birth.2
Requirements for all WA Health hospitals and health services providing care for women that choose to use water during labour and/or birth
WA Health staff are required to follow the Women’s and Newborns’ Health Network clinical guidelines for women requesting immersion in water for pain management during labour and/or birth when healthy women choose to use water immersion during labour and/or birth;
If a woman is considering the use of immersion in water during labour and/or for birth, it should be discussed by the health professional with the woman and her support people during pregnancy to enable the woman to make a fully informed decision 5;
Each maternity service must consider workforce issues such as the availability of appropriate maternity staffing levels and the presence of staff who are suitably prepared in the use of water for labour and/or birth before to ensure the service can be safely provided.
A consent form must be completed and documented after discussion with the woman preferably during the antenatal period of her choice to use water during labour and/or birth 6 2, 7;
The midwife or medical practitioner must be confident and competent to facilitate a woman’s labour and/or birth in water 7 2;
The midwife or support person must remain with the woman at all times to maintain safety whilst she is immersed in water;
Staff must be trained in, and have practiced emergency drills in the correct procedure to assist the woman leave the water in an emergency situation; and
Each maternity service that offers immersion in water for labour and/or birth should undertake ongoing audit and evaluation to ensure adherence to the guidelines and monitor outcomes using the supplied audit tool.
Statewide information on the use of water immersion for pain relief during labour and/or birth will be recorded and monitored using the Stork database.
In addition, it is recommended that the planning for new and/or improved maternity facilities in WA Health should take account of the Women’s and Newborns’ Health Network clinical guidelines for women requesting immersion in water for pain management during labour and/or birth (2012) when considering the ergonomics of suitable bath and/or pool options.
Education and the provision information for parents on the use of water during labour and/or birth
All women who request immersion in water during labour should be provided with written information on the use of water during labour and/or birth. This policy endorses the use of the Women and Newborn Health Service parent brochure for use of water during labour and/or birth (2012) as the appropriate resource to provide parents with evidence based information and education for the use of water during labour and/or birth
Staff Education, Training and Regular Support
Each Area Health Service is responsible for ensuring that health professionals receive appropriate and timely education in the safe use of immersion in water during labour and/or birth. This Guideline supersedes the Women’s and Newborns’ Health Network clinical guidelines for women requesting immersion in water for pain management during labour and/or birth (2012) as an educational resource for health professionals in WA Health hospitals and health services. Recommendations for appropriate education and practical experience are included in the guidelines. In addition, the Women’s and Newborns’ Health Service, King Edward Memorial Hospital, Department of Nursing & Midwifery Education & Research provides study days related to the use of immersion in water for labour and birth for midwives. The WA Branch of the Australian College of Midwives also provides study sessions on this topic. Midwives with prior experience are encouraged to support and mentor colleagues to enable them to gain appropriate supervised clinical experience.
Mr Kim Snowball
DEPARTMENT OF HEALTH WA
BIBLIOGRAPHY / REFERENCES:
||Cluett ER, Nikodem VC, McCandlish RE, Burns EE. Immersion in water in pregnancy, labour and birth. The Cochrane Database Systematic Review 2004;2(CD000111).
||Government of South Australia. Guideline - Birth in Water. Department of Health; 2005.
||Gilbert RE, Tookey PA. Perinatal mortality and morbidity among babies delivered in water: surveillance study and postal survey. British Medical Journal 1999;319:483-7.
||Geissbuehler V, Stein S, Eberhard J. Waterbirths compared with landbirths - an observational study of nine years. Journal Perinatal Medicine 2004;32:308-14.
||Burns E, Kitzinger S. Midwifery Guidelines for Use of Water in Labour: Oxford Centre for Health Care Research and Development. Oxford Brookes University; 2001.
||Government of South Australia. Guideline - First Stage of Labour in Water. Department of Health; 2005.
||Royal College of Obstetricians and Gynaecologists / Royal College of Midwives. Immersion in Water during Labour and Birth (Joint statement No.1). 2006.