Each birthing room at the Auckland based “Birthcare” birthing centre in New Zealand has been upgraded to take the bed away from the focus of the room, and instead create a harmonious birth space with the pool and couch as the main furniture items.
Including mood lighting (choose the colour that you like best), sound systems, bean bags and birth balls, these stunning birth rooms provide a secure and comfortable space for women to birth their babies safely.
The Birthcare centre offers services seldom seen in even the best UK birth centres, such as an onsite paediatrician to avoid unnecessary transfers to hospital for non-emergency treatment, and an in-house lactation consultant service which women can self-refer back to after discharge should they need more assistance with breastfeeding.
Many of our own UK birth centres have these wonderful facilities, including our own Aquabirths birth pools and Softbirths birth couches, mood lighting, sound and the obstetric bed either absent or hidden. We urge more trusts to follow this route, support birth centres and also support these facilities within the obstetric unit, to help more women to have physiological births.
In Part 1 of this blog I discussed how companies need to build innovative products together with clinicians, in order to work out what helps them and their patients, rather than companies making assumptions about medical needs which may not actually be valid, which can create barriers to innovation.
Another barrier to innovation in the NHS which was raised in the Nuffield Trust’s report (link) was that, “Products are sought which lead to short-term savings, rather than transforming care pathways leading to more efficient services”.
Stories of NHS managers introducing cheaper versions of products which turn out to be more expensive overall are rife: examination gloves which split, and two or three are wasted before a useful pair is found. Paper towels which don’t come out of the dispensers properly, and end up being wasted on the floor. But far more worryingly – spending money on areas which do not improve care, and can actually hinder it.
Far cheaper investments, such as birth pools, also leads to significant cost savings. Labouring in water increases the rate of spontaneous vaginal births, reduces the need for instrumental delivery, reduces the numbers of 3rd and 4th degree tears, lowers the chance of a woman wanting opiate pain relief or an epidural, and increases women’s positive experiences of birth which might lead to lower levels of PND. (1) ALL of these mean that the NHS spends less money on fixing the consequences of these interventions, as well as the cost of the intervention itself.
Let’s see the NHS looking at the wider picture with every new innovation or investment. We call upon commissioners to look past the cost of installing new equipment which supports women to birth more easily, and instead see the full spectrum of ways that an investment in a birth pool, or other normal birth promoting products, can save the cash-strapped NHS money, while leading to better outcomes for women and their babies.
While many barriers to new innovation in the NHS are well documented, the Nuffield Trust has released a report which looks at areas which have received less focus, and yet which are key to change.
Two of the main barriers listed were:
Lack of clinician time to identify problems, and to work with companies to provide solutions
Products are sought which lead to short-term savings, rather than transforming care pathways leading to more efficient services – I will discuss this in the next blog.
Lack of clinician time to identify problems and to help to work with innovators to find solutions is a problem which is certainly not limited to the NHS. All industries provide insufficient resources to allow staff the time, space and training to sit back and look at where problems are, and to work on solutions to those problems. In the NHS this leads to solutions being offered by companies which have not always been designed together with the clinicians, or the users of those products.
Sometimes a problem is identified and the solution put forward does resolve a problem, but causes another because the designer doesn’t work within the care setting. Although this isn’t a clinical product example, it underlines the problem well: In the 80s, some female nurses still wore starched fabric caps (male nurses were not required to as the fashion followed nurses originally being primarily nuns, and then the Victorian era of women needing a head covering). I well remember my own mother spending hours over the ironing board spraying starch onto her nursing caps. One day she told us that they were moving from the fabric cap to a disposable cardboard version (at a daily cost of 2p per cap to the NHS). Rather than working out whether the cap was a relic from the past which interfered with clinical care and should be removed from the uniform, the solution to the complaints of female nurses that they spent hours getting their caps stiff and sturdy was resolved with an expensive and pointless alternative product.
Aquabirths is lucky to have worked with midwives right from the start of the design of all of our birth pools. Pictured is our heart shaped birth pool which was designed together with midwives from Leeds, Yorkshire, UK. They requested featured such as:
A freestanding pool to enable midwives and birth companions to be able to easily support the birthing woman from any side of the birth pool.
A larger birth pool to offer comfort and support to even the tallest women.
Smoothed edges to ensure comfort for women and midwives leaning over the edge of the birth pool, often for long periods of time.
A single surface birth pool to ensure that it can easily and thoroughly be cleaned.
Aquabirths continues to work with midwives and birthing women to ensure that our birth pools are designed just how the users of our pools need them to be, and we hope to see more of a trend across the NHS to working this way with product manufacturers.
Oldham, in Greater Manchester, UK, has created the most stunning, supportive and effective birth centre which is family-centred and woman friendly. Designed to nurture women and birth, creating a safe, positive and caring space for the whole family – including other children, who can be present at the birth of their sibling.
Designed to support the physiology of birth from the ground up, the Birth Centre rooms do not centre around an obstetric bed. Instead, they feature slings, balls, mats, Softbirth couches, adjustable lighting and the stunning Aquabirths birth pool, with a large family bed available for parents and baby to rest in after their little one is born.
The Oldham Birth Centre’s philosophy of care is key to the success of this midwife-led maternity unit. Midwives are trained in hypnobirthing techniques, aromatherapy, acupuncture and using water to support positive, safe, physiological birth. Minimising adrenaline is key to maximising oxytocin, and maximising oxytocin is key to birth progressing well, so the whole room is designed to be calm and to help everyone to relax. An aromatherapy diffuser by the door greets the birthing family as they arrive, and the scents in the air, the dimmed lights offset by coloured bubble lamps and the Aquabirths birth pool gives a sense of walking into a spa.
Midwives describe seeing women sitting in a chair and looking around, and visibly relaxing. A kitchen is available for all to use, so birth partners can help themselves to drinks, and they can make their own snacks. Midwives make it quite clear that this space is for them to use, which is an important part of helping everyone to relax and continue to reduce any adrenaline levels.
The Oldham Birth Centre is not an extension of the labour ward, but instead is designed as a birth centre for the families of the city. While there are strict criteria for straightforward access to the unit, if a woman wants to birth there she can attend a Birth Options Clinic where their choice of place of birth is discussed, and the woman will be supported by the midwives.
The unit itself is nothing without its midwives, and the midwives at Oldham are hand picked for their inbuilt nurturing nature – not a trait which can be taught. Diane watches the student midwives who show an interest in physiological birth and support women’s choices. Those who wish to become part of the community/birth centre team are encouraged to apply.
Oldham Birth Centre is not unique, but it is unusual and it is beautiful. The women and families of Greater Manchester are extremely lucky to have this wonderful facility with its fabulous midwives.
The unit has a video on You Tube which showcases the birth pool and other facilities: https://www.youtube.com/watch?v=2wOHqJfLhGg
There is no mystery to installing a birthing bath. In may ways they are simpler than domestic baths because our baths are one-piece Single -Surface baths. Midwives designed the bath from the top down, and plumbers designed it from the bottom up!
Usually, the bath arrives into a near-finished room. Plumbing should already been in place behind an IPS panel. All that should be visible is a small piece of 40mm solvent weld pipe protruding from the very bottom of the IPS (or no more than 25mm from the floor). Taps are in place by this stage too.
Looking in through the hatch, the finished pipe work should look like this. The valve should be as close to the hatch door as possible so that the midwives are not having to reach right in under the bath. The valve is supplied with the bath. The pipe either side of the valve must be clamped to support the valve and to stop the pipework being twisted by the constant use of the valve.
Anyway, first things first. This is a 2-3 person job – you’ll see why. When we install a bath, we put down lots of padding and tip the bath on its side onto the padding. This way, we can, using a long level or straight edge, adjust the feet to match the base of the pool. The bath is designed to sit both on the basal rim of the bath and on the feet. This is why our baths are so good at spreading the load. If you don’t think you can put the pool on its side without scratching it, don’t – the warranty doesn’t cover it.
It is also easier to silicone in place the waste and, if ordered, the LED lights. The latter are fitted in the same way as a waste – a backnut and a lot of silicone! Once all that’s done, carefully turn the bath back onto its base.
Offer up the end of the bath to the IPS. This way, you’ll see where the waste pipe will come through the end of the bath. mark and drill it out.
First to go on the tail of the waste is an elbow and the waterless trap. The Hepworth vO is a good choice but other versions are now available. Do not use a U-bend or shower trap. They hold water which will just become a source of infection issues.
Next comes the valve and the remaining piperun to join on to the piece of 40mm pipe protruding through the base of the IPS (and through the end of the bath you’ve just drilled!). Don’t glue the pipework before you’ve tried it all in place. You may want to mark where the clamps either side of the valve are to go. It is easier to pull the bath back, drill and then put it in place. Finish the pipework.
Screw the bath to the IPS and, through flanges on the base in the hatch area, to the floor. Silicone round.
Powys: Supporting women and supporting Better Births.
In the heart of Wales, in one of the most rural areas of the United Kingdom, lies the beautiful county of Powys. In this stunning region the recommendations of The Birthplace Study and Better Births are being wholeheartedly implemented. In extraordinary contrast to some areas of the UK, Powys has determined to ensure that Midwife Led Units are recommended as the optimal birth place for healthy women and babies, provided they are happy to birth there – supporting women in their decisions and supporting Better Births. 20% of women give birth in a midwife led unit in this area, compared to 14% for the rest of the UK.
Powys has 6 midwife led units across the county, limiting the distance that women need to travel in labour, increasing safety for women and babies and reducing the stress on families at a time where the birthing woman needs to be able to focus on her job at hand. In addition, Newtown, one of Powys’ towns with a birth centre, has recently celebrated the huge achievement of obtaining funding to run sonographer services local to where women are, reducing the travelling distances for women by 3000 miles a year!
Newtown has also used its funding to add in a permanent Aquabirths birth pool, and a double bed so that new parents can snuggle up together with their baby after the birth, rather than being separated at one of the most profound times of their lives.
Aquabirths birthing baths have been installed in several hospitals across the Netherlands such as the Saint Lucas Andreas in Amsterdam. Now we have an agent/distributor in the Netherlands. We’ve partnered with the established Dutch company VAB so that customers in the Netherlands can discuss the baths and get support locally. Their Mobypool range is here. You can contact Maks and Hans here.
Also, we now price our baths in Euros and pounds so that customers in the rest of the EU can choose the currency that suits them.