Category Archives: Report

Water birth: Is your health service ready to offer this to women?

There is increasing demand for access to water immersion (being in a bath or pool during labour) and water birth (where a baby is born in water) in Australia (Dahlen, 2011). Birthing in water enhances women’s sense of being in control (Clews, 2019) and women’s experience of waterbirth is more positive compared to uncomplicated non-waterbirth (Lathrop, et al., 2018; Ulfsdottir, et al., 2018). Women who use water immersion during labour are less likely to request an epidural (Cluett, 2018).

A recent large retrospective study analysed outcomes for 2,567 water births and 23,201 conventional births, concluding that waterbirth was as safe for the baby and the birthing woman as non-waterbirth (Hodgson, et al., 2020). Previous large studies have shown the same (Bovbjerg et al., 2016). Three particular concerns regarding waterbirth are commonly raised (water aspiration, infection, and issues with thermoregulation), but are not supported by available evidence (Young & Kruske, 2013). These concerns can be managed by  evidence-informed guidelines, knowledgeable maternity care providers, and access and use of appropriate equipment.

Despite growing interest from women in using birth pools during labour and birth, availability is limited. In Queensland, approximately one in every five hospitals that provide maternity care offer waterbirth. Introducing waterbirth is a more complex task than simply installing birth pools. Health services need time to develop guidelines, educate care providers, and to be confident that the facility is ready to offer waterbirth. Women who use hospital birth services have an appropriate expectation that the services provided are safe.

In 2020, a hospital in Queensland installed birth pools to provide access to water immersion and water birth. Before offering waterbirth, health services managers wanted to be sure that they were ready. Our team, Dr Jyai Allen and Professor Jenny Gamble, were commissioned to conduct an independent assessment of the health service’s readiness and preparedness for waterbirth. Our consultants worked closely with health service managers to understand what was needed and co-designed the assessment project with them. They conducted a literature review which determined that no specific tools existed which could be used to accurately determine whether the hospital was ready to provide waterbirth services. A key part of the project, therefore, involved adapting relevant published documents, clinical guidelines, professional position statements and research evidence to develop a readiness and preparedness checklist which we could apply.

The project was conducted in two phases: initial assessment and final assessment. Our consultants conducted an on-site visit to observe the physical environment including birth suite rooms and pool facilities, equipment and supplies, and emergency facilities which might be required. We observed training sessions and interviewed staff members and reviewed key organisational documents and resources. The checklist supported our assessment of the service and ensured that judgements were based on internationally accepted best practice standards. We generated an interim report which provided guidance to the health service and outlined recommended changes prior to final site assessment.

After our final site assessment, our report concluded that the service was ready to offer water immersion and waterbirth for women with uncomplicated pregnancies. It also provided recommendations for further enhancement and quality improvements following the introduction of water immersion and waterbirth. The health service was delighted with the process, and with our rigorous application of the best available evidence to their specific situation. As a result, they had confidence to offer water immersion and water birth to women with uncomplicated pregnancies – a service enhancement that women had been seeking for several years.

We believe that our waterbirth preparedness checklist can be applied by any maternity service as they plan and prepare to introduce waterbirth. Using the checklist makes it clear what progress has been made and what work remains to be done to ensure the service is ready for waterbirth. We believe that the checklist offers a means to help support the expansion of waterbirth options.

References:

Bovbjerg, M. L., Cheyney, M., & Everson, C. (2016, Dec 31). Maternal and newborn outcomes following waterbirth: The Midwives Alliance of North America Statistics Project, 2004 to 2009 Cohort. Journal of Midwifery and Women’s Health, 61(1), 11-20. https://doi.org/10.1111/jmwh.12394

Clews, C., Church, S., & Ekberg, M. (2019). Women and waterbirth: A systematic meta-synthesis of qualitative studies. Women & Birth, in press. https://doi.org/10.1016/j.wombi.2019.11.007

Cluett, E.R., Burns, E., & Cuthbert, A. (2018). Immersion in water during labour and birth. Cochrane Database of Systematic Reviews, 5, CD000111. DOI: 10.1002/14651858.CD000111.pub4

Dahlen, H., Jackson, M., Schmied, V., Tracy, S., & Priddis, H. (2011). Birth Centres and the National Maternity Services Review: Response to consumer demand or compromise?  Women & Birth, 24(4), 165- 72. https://doi.org/doi:10.1016/j.wombi.2010.11.001

Hodgson, Z. G., Comfort, L. R., & Albert, A. A. Y. (2020). Water Birth and Perinatal Outcomes in British Columbia: A Retrospective Cohort Study. Journal of Obstetrics and Gynaecology Canada, 42(2), 150-155. https://doi.org/https://doi.org/10.1016/j.jogc.2019.07.007 

Lathrop, A., Bonsack, C.F., & Haas, D.M. (2018). Women’s experiences with water birth: A matched groups prospective study. Birth, 45(4), 416-23. https://doi.org/10.1111/birt.12362

Ulfsdottir, H., Saltvedt, S., Georgsson, S. (2019). Women’s experiences of waterbirth compared with conventional uncomplicated births. Midwifery, 79, 102547. https://doi.org/10.1016/j.midw.2019.102547

Young K, Kruske S. How valid are the common concerns raised against water birth? A focused review of the literature. Women Birth. 2013;26(2):105-109. doi:10.1016/j.wombi.2012.10.006

Meet Associate Professor Kathleen Baird – TMCC collaborator and researcher

Kathleen Baird
Associate Professor Kathleen Baird – Board Member of Queensland Domestic Violence Implementation Council 2015-2019

“Midwives have an important role to play in addressing domestic and family violence.”

I wear a range of hats that inform my perspective on Queensland’s domestic and family violence reform program. I have been a midwife for over two decades, and most days, you will find me working as an academic in the field of midwifery at Griffith University or as the Director of Midwifery and Nursing Education, for the Women Newborn & Children’s Services at the Gold Coast University Hospital. As a member of the Council and Deputy Chair of Queensland’s Domestic and Family Violence Death Review and Advisory Board, I have been particularly interested in reforms directed at comprehensive and integrated services with a special interest in the role of midwives and the health services to identify, empower and effectively support those experiencing domestic and family violence to escape violence and safely rebuild their lives.

These reforms include the integrated service response trials in Beenleigh, Mount Isa and Cherbourg that aim to ensure the safety of victims and manage the risk posed by perpetrators through a collaborative multiagency process. Fundamentally, this approach is about breaking down the silos which have so often been identified as a barrier to protecting victims of domestic violence. But identifying those experiencing domestic and family violence is the first critical step in engaging the service responses necessary to help them to safety. As a midwife, I have long been passionate about improving the health response to domestic and family violence and advocated for routine screening by midwives. The trusting relationship women form with their midwives throughout pregnancy, labour and after her child is born makes midwives ideally placed to enquire about the nature of a woman’s relationship, her sense of safety and available support and to provide appropriate support and referrals if domestic violence is disclosed.

Hospitals are often the first point contact for those experiencing domestic and family violence and are uniquely placed to identify victims and survivors and then offer appropriate support and referrals. In October this year, I was incredibly proud that the Council had the opportunity to see firsthand the response we have developed at the Gold Coast University Hospital. We have worked hard to embed a culture that domestic and family violence is everyone’s business and all hospital staff have a role in identifying and supporting victims and perpetrators of domestic and family violence whether they are pregnant women, patients, children or fellow staff members. Gold Coast Health was the first public health service in Queensland to appoint a specialist and dedicated Domestic and Family Violence Coordinator. The Coordinator ensures that all hospital staff understand their roles, and that our frontline health workers are well trained and supported to sensitively ask the right questions to identify potential domestic and family violence victims, and then to open pathways towards assistance for them.

Experienced social workers work across the health services’ emergency and maternity departments and with the Homeless Health Outreach Team. The Emergency Department is supported by an in-house forensic unit, an active elder abuse support worker, improved platforms for information sharing and a multidisciplinary team to support patients affected by domestic and family violence. Midwives are trained to not only ask the right questions, but to look out for particular signs of domestic and family violence, and to respond and refer accordingly. A partnership with the Women’s Legal Service Queensland has made free and confidential onsite legal services available for women experiencing domestic and family violence who present to the hospital.

It took a great deal of hard work by many dedicated people, supported by strong commitment from our health service executive and managers and a broader integrated service network across the Gold Coast, to deliver a responsive, compassionate and integrated support system for patients and staff affected by domestic and family violence. The hospital continues to refine its systems and processes, but I hope that our experience will encourage and support other health services to develop integrated services that focus on the safety of those experiencing domestic and family violence.

Access the November 2019 Full Council Report here