This is a lovely article with some very helpful information for midwives and other carers of pregnant women who are plus size. It’s so important to remember that larger women are not necessarily less healthy than slimmer women- and even if they do have medical conditions related to their weight, they still need and deserve personalised care.
And of course, labour and birth in water offers huge benefits to women of all sizes, and women should not be denied access to water just because they are “plus size”.
Alongside 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.
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.
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.
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.