A New Midwifery Regulator? Bedside re-sus on the cord, Hungary jails Midwife Agnes, Birth Trauma feedback through theatre, Worldwide Midwifery News
A New Midwifery Regulator? Bedside re-sus on the cord, Hungary jails Midwife Agnes, Birth Trauma feedback through theatre, Worldwide Midwifery News
One of the Moby birthing pools bound for Utrecht. http://vab.nl/vab-introduceert-mobypool-bevallen-bad-2
Contact VAB http://vab.nl/contact
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.
In terms of taps, we don’t recommend any, but have a short guide sheet (pdf). We know taps from the Ideal Bluebook range are commonly used. For example, one Trust repeatedly favoured using two of the following so that there was a double supply of mixed supply hot water. The reason being that 22mm taps that are HTM compliant are very difficult to source and a 15mm tap would take too long to fill the bath. http://www.idealspec.co.uk/catalogue/bluebook/brassware/contract/contour-21/contour-21-single-control-mixer-and-15-23cm-spout_p351.html
Rada Sensor taps are also very popular.
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.
Well done Powys – you are an inspiration!
Guest blog by Emma Ashworth
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.
Softbirth Birth Couches – How Trusts are using them in Midwifery Led Units and Obstetric Units
Warrington and Halton NHS Trust have thrown out some of the traditional mechanical beds in both the Midwifery Led Unit (MLU) AND the obstetric unit and replaced them with Softbirth Birth Couches! Knowing that women have the best chance of a positive birth in an environment which best supports a birthing woman’s biological need to move and change position, MLU Manager Carys Hammond, Head of Midwifery Dr Tracey Cooper and their teams have created a hugely positive change in their Trust.
Carys said, “We realised that not every woman needs the mechanical obstetric beds. We wanted to change the rooms, make them physically different, so that midwives would offer the birthing couch room to women. They use pieces of the couch to adapt to different birthing positions and be upright and mobile. It totally changes the ambiance of the room. It’s not right for everyone, and women’s needs are evaluated individually in partnership between the woman and the staff, but the birth environment is really important. Midwives are excited about them!”
Carys reported that the Trust was supportive of the changes. Senior management helped the midwifery team to work through the infection control and governance procedures and getting their support was key to this project.
The Trust midwives are ensuring that women are aware of the options of the birth couch in both the obstetric unit and the MLU. This is done in a variety of ways, including their monthly “Maternity Voices” meetings, their Facebook page (link: https://www.facebook.com/WarringtonAndHaltonHospitalsNhsFoundationTrust/) and on the tours around the wards which are offered to pregnant parents.
“These changes are evidence based,” said Carys, “and it’s what women are asking for. Remember who is important – the women.”
To find more about introducing SoftBirth birth couches into obstetric units or midwifery led units, please get in touch.
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.
Barbara 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
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.
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.
Dianne Garland’s book, “Revisiting Waterbirth” is due out in April or May 2017