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

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.

Caseloading Community Midwifery

A very useful paper according to none other than Beverley Beech.  More evidence (as if more were needed!) for the need for caseloading community midwifery.  The link below is to the article of the same name as the title of this blog post.

BMJ Qual Saf-2013-Rance-bmjqs-2012-001295

It can also be found on the blog Bornstroppy.