This essay is a reflection of the pool birth I witnessed whilst out on my practical placement. The elements of my experience in this area that I will be reflecting on are the advantages and disadvantages of birthing in the pool and the communication between the midwife and the expectant mother. I have chosen this area to reflect on because I would like to feel confident in promoting pool birthing and I would like to be able to support and provide correct advice for a woman considering to birth in the pool. The names of the people involved in my reflection, including the trust I experienced my practical placement have been changed to insure confidentiality is obtained. I will be using the Gibb’s Reflective Cycle (Gibbs, 1988) to help me to discuss, analyse and evaluate throughout my reflection. I began my first long night shift on delivery suit in ABC hospital and my mentor and I took over the care of a woman who was in early stages of labour.
This lady had drawn up her birth plan which showed she wanted no pain relief and wanted to birth in the pool. We read through the notes and saw this lady was 41 weeks pregnant and a Multip. Reading this we knew labour might not be long so we saw the expectant mother to the pool birth room settled her in and did a full set of observations and checks on both mum and fetus. The observations and checks were all within the normal range my mentor also performed a V.E which found the woman was 4cm dilated. By this point in time the woman’s contractions were now quite strong and painful and seemed to be coming 3 in 10 and the woman asked to get in the pool as soon as she could, so we began to fill the pool with a water temperature of 37ºc. We stayed in the room once the woman was in the pool but the midwife did not touch the woman once she was in the pool she just encouraged, answered questions, listened in to the baby every 15 minutes and observed.
Once the woman got in to the pool the labour seemed to progress quickly. The woman seemed very calm and relaxed and within 1 hour 30 minutes the woman began pushing and my mentor used a hand held mirror placed in the water to see the progress and began to listen in to the baby every 5 minutes and after a contraction. Within 30 minutes the head was born slowly with my mentor’s calm and low tone of voice guiding the woman and then the body followed on the next contraction and my mentor just helped guide baby up in to mums hands. The woman sustained two grazes which did not need suturing and both mother and baby were well.
This was the first pool birth I had witnessed and I felt on edge and concerned throughout it. Because the woman seemed so calm and relaxed I kept expecting my mentor midwife to ask the woman to leave the pool for a vaginal examination to get an exact idea of progress. The baby’s heart rate was fine and showed no cause for concern throughout but I just could not help feel concerned. Once the baby’s head was born I felt relief, I was amazed and could not stop smiling. The woman clearly knew her pain tolerance level and what she wanted and how she wanted her labour and birth of her new baby to go.
According to Cluett and Burns (2009) water births have become more popular over the last 20 years and is now a popular option in the hospital, birth centre or at home (Coad & Dunstall, 2011). NICE (2007) states there is little evidence to guide and support a midwife in water birth management, so it is necessary for the midwife to determine the risks and benefits for each woman and baby by an assessment of each individual case (Macdonald & Magill-Cuerden, 2011). Birthing in water is becoming a popular choice for women and midwives because the water provides buoyancy and allows the woman to move freely and change positions freely. The birthing pool needs to be deep and water filled to immerse the woman when sitting down up to her breasts and according to NICE (2007) the water temperature needs to be no more than 37.5ºC and to be monitored and checked hourly (Johnson & Taylor, 2011). The immersion in the water helps the woman to relax as her labour progresses.
Being relaxed and in the water can help the pelvic floor muscles relax. The immersion in water is said to minimize pain so no other pain control method is required because the water stimulates the temperature and touch nerve fibers in the skin, this helps block the impulses from the pain fibers. This is known as the Gate Theory of Pain. Warm water can help prevent or minimize vagina, vulva, and perineum tears and grazes (Daniels, 2012). Thoeni et al. (2004) found that studies showed there a reduction in episiotomies and the use of analgesia on women who chose to birth in water (Coad & Dunstall, 2011).The midwife needs to provide verbal gentle support to help the woman control the birth of her baby to help reduce and prevent perineal trauma (Macdonald & Magill-Cuerden) Women who birth in water may experience quicker second stages of labour and feeling the fetus ejection reflex, resulting in the baby being born minutes after pushing (Daniels, 2012).
It is said when a woman delivers her baby awake and in control it enhances her birth experience. As the woman is more relaxed and calm her partner seems to be less afraid to take an active part in seeing to his partners needs throughout her labour. This experience will help with maternal bonding between mother and baby and also father and baby (Daniels, 2012). According to Bodner et al., (2002) and Geissbuehler et al., (2004) although there are concerns over the safety of a water birth with water inhalation, hyponatermia, infection, haemorrhage of a umbilical cord rupture, hypoxia and infant death and these complications are rare, research studies show there is no direct proof showing there is different outcomes for a water birth compared to conventional deliveries (Coad & Dunstall, 2011).
Although research has not found any significant differences with birthing in air or water, risk of infection has to be considered because women sometimes open there bowels in labour and in the water it introduces infection (Author A, 2009). There is a risk the baby may inhale their first breath whilst under water, although babies have a dive reflex and can instinctively close their airways, preventing them from breathing in water it is still a risk to be considered. Experts believe this is only a risk if the baby’s head reaches the surface of the water before the rest of its body overriding the dive reflex, the oxygen supply via the placenta is compromised or the baby is startled as it is born and takes a breathe before its brought to the surface. There is a possibility the cord can snap due to the quick process of the baby being brought to the surface quickly and not giving the cord time to follow (Author A, 2009).
It also needs to be taken in to consideration that if there are complications requiring you have to leave the pool and birth on the bed or you find the water is making little or no difference to the painful contractions you are feeling you may need a pain relief which may make you dizzy so you will have to leave the pool for yours and your baby’s safety, these points need to be considered because it may leave you feeling upset or effect how feel about your birth experience especially if it does not go as planned (Author, A 2009). According to NICE (2007) there is not enough high quality evidence to support or discourage having a water birth (Macdonald & Magill-Cuerden, 2011). More research is needed according to Cluett et al (2002) in to clinical outcomes and the physiological effects of the use of water in labour (Macdonald & Magill-Cuerden, 2011). From two national surveys Gilbert & Tookey (1999) and Alderdice et al. (1995) found there was no evidence to support or show there is a link between neonatal morbidity and mortality with the use of water during labour (RCM, 2008).
The midwife has a role and responsibility to help provide safe labour care with the added consideration to the safety of the woman, baby and the midwife providing the care when using water for the analgesia for birth. The midwife needs to provide clear contemporaneous records of everything from when the woman arrives in to the midwives care up to the time the midwife hands her care over or the woman is discharged (Johnson & Taylor, 20 At the moment the research shows the pros out way the cons for deciding on whether or not to have a water birth. The research shows that a water birth is an option for those women who are low risk and want to try to go through their labour without the help of medical pain relief methods for example analgesia, epidural and morphine. When u have a bath especially a deep bath its relaxing so you can see how this can be used to help relax a woman in labour. If a woman is relaxed she may be more willing to let it go through the changes it needs to during labour without her tensing her body and trying to fight it.
Looking at my research and going over my reflection of my witness of a home birth everything I saw and witnessed was how the research expects a water birth to be. I can now see and understand why the woman I saw labouring in the pool did not look like the contractions were bothering her too much because once in the pool she seemed really relaxed and was able to breathe through the contractions calmly. This also helped speed up labour I believe and know now because the woman was relaxed, calm and in control and with the help of my mentors calm and low voice the baby’s head delivered slowly and then the body not long after. I can see now how this may have helped considerably with the woman only sustaining two superficial grazes and no further or more serious injuries that nay of needed suturing.
I feel more confident now and hope with this research knowledge I can attend the next water birth with confidence and faith in the process of labouring in water. I do feel though that more research needs to be conducted because maybe it could be available to more women not just those who are totally low risk cases. The research shows how just the fact of a woman being relaxed can make a difference to a woman in labour and make her feel in control of her labour.
There is also the fact being immersed in water can help with pain relief and I feel this could a positive effect on many labouring women, especially those women who plan to go through their labour with no medical pain relief. I am really gutted now I have had my four children and never tried a water birth but I have had all my children now so hopefully I can gain knowledge and experience and hopefully help future women have pleasant and memorable labours.
Author, A. (2009). Baby Centre : The Pros and Cons of Water Birth. Retrieved May, 8th, 2012, from http://www.babycentre.co.uk/pregnancy/labourandbirth/waterbirth/benefitsandhazards/ Coad, J & Dunstall, M. (2011). Anatomy and Physiology for Midwives. (3rd ed). Churchill Livingstone Elsevier Ltd. Daniels, K. (2012). The Benefits of Water for Labor and/or Birth. Retrieved May, 8th, 2012, from http://www.waterbirthinfo.com/benefits.html Gibbs, G. (1998). Learning by doing: a guide to teaching and learning methods. Oxford: Further Education Unit, Oxford Polytechnic. Johnson, R & Taylor, W. (2011). Skills for Midwifery Practice. (3rd ed). Churchill Livingstone Elsevier Ltd. Macdonald, S & Magill-Cuerden, J. (2011) Mayes Midwifery. (14th ed). Baillere Tindall Elsevier Ltd. RCM. (2008). RCM Evidence based Guidelines for Midwifery-led care in Labour. (4th ed). Royal College of Midwives Trust.