Aquabirths Research Review:
Title: “A systematic meta‐thematic synthesis to examine the views and experiences of women following water immersion during labour and waterbirth.”
Authors: Claire Feeley, Megan Cooper and Ethel Burns
Published in the Journal of Advanced Nursing (Link)
Review by Emma Ashworth
A common complaint about research into midwifery and obstetric interventions is that they seldom include the views and lived experiences of the women and people who have them. The evaluation of outcomes are usually limited to physical outcomes, not psychological ones, which reflects the dominant culture of prioritising physical injury over psychological injury and the common adage, “at least you and your baby are healthy”. There is also often a prioritisation of the physical health of the baby over the physical and psychological health of the mother or birthing person, which can leave them feeling like they are of less or little importance, or simply a vessel to grow a baby.
It is therefore very refreshing to read this paper, which has gathered together what information we do have on how women feel about waterbirth into one place. Waterbirth is safe for babies, as has been shown time and again (see our blog for more research reviews) and now we have a wonderful collation of the data on the psychological safety and benefits of waterbirth to the birthing woman or person: Women’s experience of waterbirth.
What did the paper look at?
This particular piece of research has gathered together women’s experience of waterbirth under three main themes which they describe as: Liberation and Self‐Emancipation, Synergy, transcendence and demarcation and Transformative birth and beyond.
What were their findings?
- Pain relief
Firstly they looked at the effectiveness of water as pain relief. They note that, “While the experience of pain is subjective and influenced by several factors, the provision of adequate pain relief in a timely manner to suit the needs of women is a hallmark of respectful maternity care”. It is also a legal requirement, under the European Convention on Human Rights as well as International Law. No one should be left in pain when suitable pain relief is available, and refusing a large bath but offering opiates is clearly unlikely to be the safest option for many women and people.
The paper discussed the fact that the sense of pain during labour can be increased if a woman feels anxiety or fear. Warm water is a natural relaxant for most people, and this increase in relaxation is thought to be instrumental in reducing anxiety, and therefore pain. The paper states, “Both the water and pool itself facilitated women’s physical and psychological needs during labour and/or birth, including offering effective analgesia.”
While the birth pool may not have taken away all the pain, women explained that it “softened the intensity” of pain, supporting women’s self-belief in their ability to cope with labour.
Key takeaway: Birth pools offer safe and effective pain relief without the side effects that come with pharmaceuticals. Birth pools support the physical and psychological needs of birthing women and people.
- The protection of the birth space
The paper describes the experiences of women who gave laboured and/or gave birth in a birth pool as, “liberating and transformative experiences” and that women felt “empowered, liberated, and satisfied”.
An important benefit to the birthing woman or person was the “demarcation” of their space, creating a “safe haven” and a “cocoon”.
“…the pool itself […] provided a physical demarcation of the women’s space in the birthing environment/room. The birthing pool offered a safe and private enclosure in which women were able to let go of inhibitions, physically and psychologically separate themselves from the outside world while also facilitating their ability to go in – flowing ‘with’ labour rather than fighting against it. In turn, this enabled them to transcend into an altered state of consciousness where time and place lost their meaning, indicative of a deep internal connection to ‘being’ rather than doing.”
Key takeaway: The physical presence of the birth pool meant that women felt safe and protected, and supported them to work with their bodies, facilitating a higher chance of physiological birth.
- The transformative effect of a positive birth
The sense of achievement that women felt was a very strong theme in all of the research that was summarised in this paper. It describes, “… vivid feelings of empowerment, ‘victory’ women ‘claimed’ their birth’, rather than ‘being delivered’ of their baby.”
Catching one’s own baby in the water was hugely empowering for many women, but even when this didn’t happen the sense of achievement was profound, with many women stating that they wanted to do it all again and that a birth pool would be imperative at their next birth.
This sense of achievement went beyond the birth, and led to a transformation that continued into the postnatal period, showing that women’s experience of waterbirth has far more value than ‘a nice birth experience’.
“The next day I was sitting, suckling my daughter, with an oversized aura, super proud of me, my experience, and all that. And I think it’s fundamental to have a positive birth experience.”
“The difference in me mentally was unbelievable; I was definitely a lot mentally safer this time. I honestly believe [the water VBAC] turned me into supermum.”
Key takeaway: A positive birth leads to safer women and babies, both during the birth and afterwards. It can transform how women and people feel about themselves, and their relationship with their babies.
This important paper gives us yet more invaluable information on the importance of ensuring that every woman or person who wants to labour and/or birth in water is supported to do so. It clearly describes the powerful and positive effect of water on physiological birth, and on the psychological well-being of mothers and birthing people. The paper concludes that, “We recommend maternity professionals and services offer water immersion as a standard method of pain relief during labour/birth.” Aquabirths completely agrees!