Active labour and birth in Obstetric Units

Hi-Lo active birth chair

The benefits of upright and active labour and birth to women, babies and a healthy labour are uncontroversial and well established – and yet women are still so often confined to the bed in obstetric units.

Women who are welcomed into a midwife led unit, on the other hand, tend to have rooms where the bed is not centre stage, and instead the standard birth support equipment lends itself to upright, kneeling, squatting or forward leaning positions for labour and birth. Access to a birth pool is common, as are slings, birth couches, mats and balls.

Walk into most obstetric units and the untrained eye would have a hard time recognising it from any other hospital room. Machines, cables, bleeps and flashing lights and of course, in the centre, the bed. We spend 1/3 of our lives lying down in bed. When we are admitted to hospital for any other reason than to give birth, we lie down in bed. There is every psychological reason to automatically go to the bed and lie down when we’re admitted in labour – and every physiological reason not to!

By taking away the focus of the room from the bed and towards ways to support active labour and birth we know that we can shorten labours, help with babies’ positioning, reduce the need for pain relief and have more positive births. It is therefore not only a real worry that women who are birthing in the obstetric unit so often don’t have the automatic access to the low cost, high value equipment which supports this, it actively causes harm by reducing and limiting the woman’s ability to move in labour.

We call upon the commissioners and managers of obstetric units to consider the ways that their birth units can have the best of both worlds – the low-tech, high impact equipment which helps women to remain active, and the high-tech, high impact equipment available if necessary, but ideally easily accessible but slightly hidden, eg behind a screen. While, clearly, hospital birth pools can’t be plumbed into every obstetric unit room, there’s no reason why each room can’t benefit from a HiLo Birth Chair, or something similar. This simple piece of equipment is perfect for supporting active birth in every room in the obstetric unit. Fast and easy to clean, small footprint for even the smallest obstetric room, the HiLo Birth Chair provides excellent support for multiple labour and birth positions including upright breech birth. It supports normal human birth physiology and biomechanics while permitting extremely easy access to the woman in order to offer monitoring of all kinds, and all other tests and checks which can be performed without the woman lying down (ie almost everything). The reduction in the use of anaesthesia, caesareans and other expensive interventions1 that are likely to come from using the HiLo Birth Chair in each obstetric room will mean that it will quickly pay for itself. Indeed, just one avoided caesarean covers its cost as well as stopping that woman from possible life-long complications from major surgery.

We need to move away from an either/or situation for women. It shouldn’t be that only women on the MLU can access evidence based equipment that can reduce costs for the Trust, reduce interventions for the mother and baby and increase the chance of each mother having a positive birth. Obstetric units can benefit from this equipment too – saving money and having better outcomes for women and babies.

Reference

  1. Cochrane Review, “Mothers position during the first stage of labour” https://www.cochrane.org/CD003934/PREG_mothers-position-during-the-first-stage-of-labour

 

Waterbirth, GBS and Hospital Birth Pools

Can women who are found to be carrying Group B Strep (GBS) still have a waterbirth (in a hospital birth pool or at a home water birth)? Yes!

Hospital birth pool GBS is very common. It’s thought that around 1 in 4 women carry the bacteria in their vagina, but despite this very few babies become affected by it. However those who are affected can become extremely ill, and tragically some will die. Because of this, prophylactic antibiotics given during labour are offered to women who are found to be carrying GBS, which does reduce the number of affected babies.

Our binary maternity labelling (low/high risk) means that any woman with any additional issue in their pregnancy becomes “high risk”, and many trusts’ guidance on waterbirth states that only “low risk” women may use the birth pool. In many cases this leads to women who would hugely benefit from a birth pool, and who would be far more likely to have a straightforward, drug-free birth by using one, being denied access to them.

Is this reasonable, or should women be supported to have a waterbirth if they wish, if they’re a GBS carrier?

What is the evidence?
Cohain1 states that out of 4432 waterbirths, only one incident of GBS was reported, whereas the rate for dry land births was one in 1450. This implies that waterbirth may significantly lower the rates of GBS infection in babies who are born in a birth pool. Research by Zanetti-Dällenbach R2 et al found that even though the levels of GBS in the birth pool were higher when babies were born into the water compared to labouring in water and birthing on land, the levels of GBS infection in the babies born in water was lower. While no large scale RCTs have yet been done, this data does show that birthing in water may in fact be a hugely important way to reduce the numbers of babies who are contracting GBS after birth and perhaps we should be encouraging women to birth in water as a way to reduce the infection rate! Even the Royal College of Obstetrics and Gynaecology (RCOG) states that waterbirth is not contraindicated for women who are carrying GBS3.

Women who are found to be carrying GBS before labour are offered prophylactic antibiotics which, if she chooses to accept them, will be given via a cannula during birth. This is often considered to be a contraindication for labouring and birthing in water, but in fact it is very simply to protect the cannula during a waterbirth. Women can either keep their hand out of the water, or if they feel they might want to put their hand into the birth pool, the midwife can place a close fitting plastic glove over her hand and seal it with an appropriate skin-safe waterproof tape.

In conclusion, the evidence we have – limited as it is – shows that giving birth in water is actually protective against the baby contracting GBS, and as such we shouldn’t be asking whether women should be supported to birth in water if they are carrying GBS. Instead we should be asking why are they so often told that they must birth on dry land?

Further reading:

AIMS: Group B Strep Explained by Sara Wickham https://www.aims.org.uk/shop/item/group-b-strep-explained

References:

1)  Cohain, JS, Midwifery Today, “Waterbirth and GBS”: https://www.ncbi.nlm.nih.gov/pubmed/21322437

2)  Zanetti-Dällenbach R, “Water birth: is the water an additional reservoir for group B streptococcus?“ https://www.ncbi.nlm.nih.gov/pubmed/16208480

3) RCOG on GBS and waterbirth: https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/1471-0528.14821 (point 7.5)

Topic Summary: Hospital birth pools and GBS: what is the evidence and what is best practise?

Organising safe and sustainable care in Alongside Midwifery Units: A Review

Oldham Midwifery Unit with Aquabirths birth poolAlongside midwifery units are defined as midwife-led units which are on the same premises as an obstetric unit (OU). They are usually next to the OU and may have come about following restructuring of the OU.

 

A follow on study from Birthplace 2011 investigated the way that alongside midwifery units are organised, staffed and managed, as well as the experiences of the women who use them and the staff who work in them.

 

The researchers looked at 4 different alongside midwifery units. They interviewed midwifery staff and service users, and also those in a management and organisational role. What became clear from the study was the fact that midwives working in alongside midwifery units were able to practice more autonomously, using their own clinical judgement. This is how all midwives, who are all autonomous practitioners, should be able to work, but obstetric units often discourage or reject this aspect of the midwifery role. Midwives also reported how they valued the work environment and culture, although the study did acknowledge that there was a need to ensure that midwives were supported to continue to develop their confidence, which is not a surprise as so many would have been trained in a far more repressive environment.

 

Another challenge for the sustainability of the alongside midwifery units was the fact that of all of the women who were considered to be good candidates to birth there, only a third ended up doing so. This study does not look at why this might be, but we know from feedback from women that very often they are simply not made aware of the midwife led unit in their area, so they did not have the opportunity to consider it for their baby’s birth.

 

Ultimately, Aquabirths would like to see the facilities which are commonplace within a midwife led unit such as birth pools, birth couches, mats and birthing balls, as well as the environment which is designed for calm, and to promote oxytocin, available as standard within all types of units, including obstetric units. There is no reason why these facilities could not be used by far more women, and we strongly believe that if a better birth environment was available to all, that more women would birth their babies with fewer unnecessary interventions. We hope that more research like this will encourage designers of all types of maternity units to create spaces which support both women and midwives to work together for better births.

 

Where’s the bed? Kiwi birth unit refurbished to include birth couches and pools in every room.

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.

Installing a Birthing Bath

professionally installed birthing pool

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.

ideal pipe bends
Avoid sudden 90 degree corners in the pipe run.

 

 

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.

Birth Baths in the Netherlands – Geboortebaden in Nederland

 

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.

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

Corner Baths

We’ve had a bit of a flurry of requests for corner baths, mainly from export customers, so we thought we’d better write a short blog on them.

The short answer is, ‘yes, we do make them.’ They are an excellent option where space is a bit tight but the hospital still want to give a birthing mum the option of a water birth.  Sometimes, corner baths are avoided as the midwives want to be able to access the woman from as many parts of the bath as possible.

Our Dunoon model birthing bath is ideally suited to being used in a corner.  It is already designed specifically to be compact and fit in smaller rooms but to still give a labouring woman plenty of room to move and keep active during birth.  It does this by virtue of its rounded rectangular shape and by using space wisely so that it still has the capacity of a birth.

The Dunoon can be fitted in any position and doesn’t have to go in a corner but if you let us know when ordering, we can include an extra piece of trim (at no cost) so that you can have a neat finish against the corner walls.

Dunoon compact birth pool

Compact Birth Bath for Labour and Post-partum Bathing

Bathing for labour and post-partum bathingAnother of our compact birthing baths for labour and post-partum bathing, the York model, is ready to go off to the Isle of Man.  With its verycompact birth bath modern  look, the York gives birth centres that luxury spa feel.  As with all Aquabirths pools, it is a one-piece construction for maximum strength and infection control as well as for ease of installation.

Midwives and waterbirth mums had a direct hand in this bath’s design, hence the broad rims and curves.  An additional feature they designed in was the excellent lumbar support.

Contact us for drawings, photos and offers for this birthing bath.

Fantastic Looking Birthing Pool

 

We had an email that came via the midwives of the Morecambe Bay Trust in response to our installation of a Canberra birth bath at Barrow (Furness General)

To whom it may concern,

I have seen pictures of the new birth pool in Furness Hospital on your website it looks fantastic. We are looking at developing  a water birth service in our hospital in Limerick in the Republic of Ireland.

We would like to get some information and details of the birthing pool.

I would be delighted if you could supply some information in relation to the birthing pool company and specification that was used.

Regards

Best birth bath ever