Better Births in Powys – Supporting Women, Improving Care

Powys delivering better births
Ruth Weston of Aquabirths in the new Aquabirths birth pool installed in one of Powys’ birth centres.

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.

Well done Powys – you are an inspiration!

Guest blog by Emma Ashworth

Free Mini Birth Couch Kit with Birthing Pool

Birthing Couch Kit for Smaller Birth Rooms

The SoftBirth birthing couch kit has a new little sis!  A shorter version for smaller rooms at a smaller price.  A HoM asked us to design a smaller birth couch kit for smaller rooms, so we did and will even fit in the back of a small hatchback. Anyway, with all our birth couches we offer very large discounts when more than one of the same couch is bought. So, this is £600+VAT but 3 or more would be at £500 each.  As with the larger SoftBirth couch, this is a kit – the stool and kneeler are included.  The mini is also FREE with Aquabirths’ Canberra, Venus and Heart-shaped birth baths.

Mini birth couch kit

Waterbirth : Part of a World Movement

Revisiting WaterbirthBarbara Harper, founder/director of Waterbirth International reviews the second edition of Dianne Garland’s textbook ‘Revisiting Waterbirth: An Attitude to Care’ in the context of waterbirth practice around the world.

It is no secret that water is healing and that the use of water is an effective medium to facilitate changes in actual brain wiring. It is with excitement and great pleasure that I welcome the publication of the second edition of Revisiting Waterbirth: An Attitude to Care. Dianne Garland has continued to provide waterbirth education and training not only throughout the UK, but around the world. Our mutual passion brought us together for conferences, workshops and presentations many times. It has been my privilege to work closely with Dianne as a teaching partner in China, Spain, the Czech Republic, Israel, India and the United States. Her excitement about demystifying waterbirth is contagious, and the reader, whether midwife, doctor or mother, will experience that enthusiasm within the pages of this book.

There has never been a time in our combined history when the message and knowledge within Revisiting Waterbirth: An Attitude to Care has been more necessary. The misinformation surrounding waterbirth that Dianne and I have witnessed in different parts of the world is sometimes distressing and occasionally humorous. This book gives every practitioner an effective, informative guide to start a waterbirth practice and integrate that practice into any clinical setting. It also provides concrete examples and stories from those with whom Dianne and I have worked. The inclusion of detailed stories from practitioners and parents is a wonderful supplement to the new edition of Revisiting Waterbirth.

The use of water for labour and birth has increased exponentially since Dianne and I first started writing letters to one another in 1989. When we finally met in person 26 years ago in Kobe, Japan, at the International Confederation of Midwives conference, we excitedly shared documentation of the efficacy and safety of waterbirth. The demand for accurate, useful information and descriptions of experiences has also increased. When we first started our collaboration, waterbirth was referred to as a fad or a trend that would soon be gone. Women seeking the ease and comfort of water will continue to increase in every part of the world. Waterbirth is part of a world movement that seeks a more humane and gentler approach to childbearing.

The use of warm water immersion has long been seen as an aid for labour, making it easier for the mother to enter into and remain in a state of hormonal bliss. Today, there are well-designed studies that prove the efficacy of water for labour and the safety of water for the birth of the baby. Dianne’s experience as a hands-on midwife attending waterbirths, as well as her design and documentation of research, makes her the perfect person to lay the foundation of education for those who want to incorporate the use of water into maternity care settings. This book is also a guide for those who have already started waterbirth practice to improve their experience.

The message in this book is simple, straightforward and very hopeful. It is hopeful in the sense that more and more women are asking how to make labour less about ‘enduring the pain’ and more about creating a good, healthy and loving experience of birth for the baby. Women understand that creating a new human being is one of the most important jobs on the planet. The providers who serve those women need the encouragement that this book offers to step out of the routine medical care and become open to the possibilities that water can, indeed, change the course of a labour and should be utilized as a valuable tool for almost all women. The attitude with which professionals view a woman’s ability to give birth can either enhance or detract from her experience.

In 2014, the American Congress of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatricians (AAP) launched a campaign to put doubt about the usefulness of waterbirth into the minds of nurses, doctors, midwives and the public. Some US hospitals paid attention to the published and widely distributed ACOG opinion paper and halted their successful and incident-free waterbirth programs. Dianne and I travelled together to hospitals in Cleveland, Ohio, and Minneapolis, Minnesota, shortly after the article was published, to educate hospital staff and help reinstate waterbirth policies in these facilities. We were welcomed in these places and our efforts were rewarded when the practices were put back into place.

It is my sincere hope and desire that practitioners throughout the world are guided by the message in Revisiting Waterbirth: An Attitude to Care and start implementing protocols in more hospitals. All women should be offered the choice and opportunity to labor in water and birth their babies with the ease, safety and pleasure that water so beautifully provides. I also hope that our tandem careers continue to bring this message to every corner of the globe. As founder and director of Waterbirth International, I have relied on Dianne Garland to provide a multitude of research and documentation from the UK and have used this book in its earlier editions as a teaching tool and recommended reading for nurses, midwives and doctors.

Barbara Harper, RN, CLD, CCCE, CKC, Midwife
Founder/Director of Waterbirth International

Follow Ruth Weston’s BornStroppy Blog

ABOUT RUTH AND ‘BORNSTROPPY’

Ruth Weston, BornstroppyBiog:

Ruth Weston mother, business woman, lactivist. Ruth is the mother of five children, four born at home and in water. She liked her waterbirths so much she took over Aquabirths as a small Yorkshire birth pool hire firm 15 years ago.

Since then she and her husband have grown the business, now, with midwives and doulas, designing pools and soft furniture for the NHS and around the world.

Ruth is passionate about women having good care and a good birth: she set up  ‘Choices in Childbirth’ childbirth group in her home 14 years ago which became a network of similar groups across Yorkshire and beyond with a regular monthly E-newsletter which you can subscribe to.

Ruth helped set up the MSLC in Bradford and Airedale and became its first chair. Ruth is now turning her considerable determination and energy to the delivery of continuity of midwifery carer and the reform of regulation for midwives – structural reforms she believes necessary for the delivery of humane maternity care for women.

For 25 years now I’ve been campaigning along side others to improve women’s experience of childbirth. Part of my work has been to provide the means and equipment for better birthing experiences: that may be knowledge and training or it may birth room equipment.
If you would like to sign up the monthly newsletter ‘Choices in Childbirth’ or ‘Choices in Childbirth for Midwives’, fill in the form below. Or click on the image below.

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Bornstroppy RuthWeston

I’m Group B Strep (GBS) Positive. Can I have a Waterbirth?

GBS testing is not routinely offered to women in the UK.  This is because it is considered that the high rate of carriage compared to the low rate of infection means that the harm done to women and babies in offering antibiotics to every woman who is carrying GBS would outweigh the benefits.

However, some women do end up being tested for one reason or another, and those who find that they are carrying GBS are often then denied access to water during their birth (unless they’re at home, in which case it’s always the woman’s own decision). Aquabirths asks, “Is this a reasonable position for trusts to take?”.

Many trusts are open to women birthing in water and some are not, and within trusts some midwives or obstetricians will deny women access to the trust’s pools, and others will be completely happy to support women who want to use a pool for their birth. What’s going on?

There is limited data on the impact of waterbirth on how many babies born to women who are carrying GBS, but what data there is shows either a reduction in the numbers of babies born underwater who are infected with GBS, or no statistical difference, but with a trend towards a reduction in affected babies who are born underwater. This is despite the fact that the water in a pool birth could have high levels of GBS in it, and therefore the theory is that the water is essentially washing the baby and mother, providing some increased level of protection compared to babies born on dry land. (1)

An article by JS Cohain (2) states that infection with GBS was 1/4432 in babies born underwater v 1/1450 in babies born on land – that’s three times as many babies becoming infected with GBS when they’re born on land than babies born underwater! The article discusses the reasons for this, including considering whether it might be “a massively successful international campaign has covered up the reporting of all deaths and disease from GBS after waterbirths.” There’s nothing like covering all bases!

Even though the evidence on GBS and waterbirth is limited and more studies are needed, if the trend was the other way – that more babies seemed to be infected with GBS when born in water – there would be no doubt that there would be a huge push to try to ban birth in water! Given that the opposite is true, and the best data that we have shows a trend towards fewer babies being infected with GBS when they’re born under water, opening up water birth to women who have found that they’re carrying GBS is something that every birth centre and obstetric unit should support.

Article by Emma Ashworth.

Many thanks to Dianne Garland for her help with this article.

References:

(1) Springer Link, “Water birth: is the water an additional reservoir for group B streptococcus?” 

(2) Pubmed, “Waterbirth and GBS”

Further Reading:

AIMS GBS book, “Group B Strep Explained”

RCOG “Group B Strep and Waterbirth”

Practicing Midwife for the GBSS, “Waterbirth for women with GBS: a pipe dream?”

Dianne Garland’s book, “Revisiting Waterbirth” is due out in April or May 2017

AIMS Conference, York: What’s So Difficult About Continuity of Carer?

Ruth will be giving a speech at the AIMS Conference in York University  on the afternoon of Saturday 21st.  The text of it will be posted here but in the meantime…

 

 

Waterbirth Conference 2015

A packed-out conference on waterbirth and normality held in Shipley, with such speakers as Dianne Garland and consultant midwife Alison Brown.  A fuller report to follow but here are some of the tweets…

 

 

 

There was also the launch of BirthSoft for reasonably priced birth couches, mats, etc.

 

Water birth conference comes to Bradford

We’re very proud to be sponsoring the water birth conference in November. Come along and have an inspirational day with like minded people, we’ll all be learning lots, too, because the agenda is filled with fantastic speakers!

Hosted by Dianne Garland, whose amazing training days regularly sell out, we also have sessions by Alison Brown, Emma Ashworth and free birther Jo Whistler.

There’ll be more details near the time, but get in touch for your tickets… info@aquabirths.co.uk

Nice to see Nice guidelines… and still a way to go!

Today, a guest blog from my Aquabirths colleague, Lucy Sangster, who’s been looking into the guidelines.

It’s been good to see that the new Nice guidelines – for care during low risk births – reflects more of the research that so many birth activists have been jumping up and down about for so long.

For example, it says “Do not clamp the cord earlier than 1 minute from the birth of the baby” unless there are serious concerns, and “If the woman requests that the cord is clamped and cut later than 5 minutes, support her in her choice”. That feels like some well needed progress.

The admission that hospital care can create harms seems obvious if you’ve been in the business for years, but the media reaction shows that there’s still a long way to go until everyone takes that on board. Positively, the guidelines have been taken seriously and presented as thoroughly researched. Interestingly, the general media reaction has been complete surprise and inevitably, the counter voices have concentrated on “risk” and “danger”.

The killer quote has to be Cathy Warwick, Chief Executive of the Royal College of Midwives, who said on Radio Four’s Today programme, that midwife led units didn’t work in isolation, that transfer to hospitals was safe and effective if needed, and that outcomes were still better for women who transferred to hospital care than for those who started out in hospital. Considering these transfers are the sudden emergencies and potentially dangerous situations, it is striking that they still do better than women starting out in hospital! (Listen here, from 1:34:30)

In the same feature, Sarah Fishburn, the lay member of the group that worked on the guidelines said that the evidence doesn’t make clear why hospitals lead to worse outcomes, but that other settings tend to be more relaxing, comfortable and with fewer interventions.

Given that the guidelines concentrate on “good communication, support and compassion”, it is however a real shortcoming that the evidence on team midwifery and on continuity of care is not covered. Cathy Warwick said “The guidance as it stands suggests that team midwifery may not be the best model of care. However, recent research shows that team midwifery can help to ensure continuity of carer whilst also delivering other high quality outcomes,” in the Nursing times article.

So will it lead to changes? It’s refreshing to see front pages of the papers talking about the evidence instead of scare stories, but the research on general views about birth has suggested that many women still aren’t aware of this evidence and that it will take more work to change birth culture. Whether the money will follow to create midwife led units in the areas where there isn’t that choice now remains to be seen. Germaine Greer spoke about it this week and said that there’s been a lack of follow through from Government and society on women’s issues that have been ongoing for years…

With thanks to the BBC for use of the image of the Mirror front page. There’s also a lovely article from the Telegraph here.

Legionnaires Disease and Water Birth – An Update.

Please be clear this alert is NOT for baths and birthing pools filled from domestic or hospital hot water systems which are then emptied or pumped out when cooled or used.

This IS for heater filter units which re-circulate warm water.

This is not about these circulatory systems being innately dangerous either – just that the sanitization and effectiveness of all units now have to be checked to ensure safety before being hired out or used.

There is a potential for contamination if the unit is not fully disinfected, or the unit is not working properly or the users do not follow the strict instructions.

Investigation is under way. So, if you have one, lend one, or hire one, then contact your local Health and Safety Dept at your local authority to get advice on ensuring this awful situation does not happen to you, a loved one, or a customer.
Every good wish
Ruth@Aquabirths

https://www.gov.uk/government/news/alert-after-legionnaires-disease-case-in-baby
Press Release Text:
Public Health England (PHE) and NHS England have temporarily advised against the home use of birthing pools with built-in heaters and recirculation pumps, potentially filled up to 2 weeks in advance of the birth. This follows a single case of Legionnaires’ disease identified in a baby born in this specific type of birthing pool at home. The baby is currently receiving intensive care treatment in hospital.
Samples taken from the heated birthing pool used have confirmed the presence of legionella bacteria, which cause Legionnaires’ disease. Tests are ongoing to establish if it is the same strain which infected the baby. This is the first reported case of Legionnaires’ disease linked to a birthing pool in England, although there have been 2 cases reported internationally some years ago.
NHS England has today issued a Patient Safety Alert rapidly notifying the healthcare system – and specifically midwives – to the possible risks associated with the use of these heated birthing pools at home. The alert recommends that heated birthing pools, filled in advance of labour and where the temperature is maintained by use of a heater and pump, are not used for labour or birth. In the meantime, a full risk assessment into their use is being carried out.
The majority of birthing pools used at home are filled from domestic hot water systems at the time of labour – these birthing pools do not pose the same risk and are excluded from this alert. There are no concerns about these types of pools as long as pumps are used solely to empty the pool and not for recirculation of warm water.
Professor Nick Phin, PHE’s head of Legionnaires’ disease, said:
This is an extremely unusual situation, which we are taking very seriously. As a precaution, we advise that heated birthing pools, filled in advance of labour and where the temperature is then maintained by use of a heater and pump, are not used in the home setting, while we investigate further and until definitive advice on disinfection and safety is available.
We do not have concerns about purchased or hired pools that are filled from domestic hot water supplies at the onset of labour, provided that any pumps are used solely for pool emptying.
PHE and relevant local authorities are investigating the infection control measures required for this type of birthing pool and local authorities will be working with the small number of companies who supply these heated birthing pools for use at home.
Louise Silverton, director for midwifery at the Royal College of Midwives, said:
Women planning birth at home using a traditional pool that is filled when the woman is in labour or using a fixed pool in an NHS unit are not affected by this alert and should not be concerned. Birthing pools in hospitals are subject to stringent infection control procedures and monitoring. Home birthing pools filled during labour come with disposable liners and are only in place for a relatively short time period, reducing opportunity for bacterial growth.  Any women with concerns about using home birthing pools should contact their midwife or local maternity unit.
Legionnaires’ disease is extremely rare in childhood, with only 1 case in children aged 0 to 9 years reported in England between 1990 to 2011.The infection does not spread from person-to-person – people become infected with the bacteria through inhalation of contaminated water droplets.