Disposable Birth Pool Plugs? No!

Last week we had a request to supply a box of single-use, disposable birth pool plugs for a hospital birth pool.   We were surprised to hear that any Trusts were using conventional bath plugs in their birth pools. Here’s why. 

Cleaning a bath plug and chain

Birth pool plugs are not permitted to have chains on them (HTM64 Health Technical Memorandum). This is because you can’t attach the other end of the chain to anything because of the cleaning challenges, and the chain itself is also just another crevice where bacteria may breed. In theory, the plug chains are also a ligature risk.

Access to the birth pool plug by midwives

After I bath my children, I ask them to pull the plug out as I’m not keen on dirty bath suds up to my elbow! A hospital birth pool is MUCH deeper than even my children insist on. Leaning in to pull out the plug, probably right up to the midwife’s shoulder, through water which is likely to be contaminated with faeces and blood, isn’t ideal. While the midwife has already had their hands in the water, it’s not the same as trying to reach all the way down and not contaminate their uniform sleeves. Some Trusts have proposed providing the midwives with gauntlet gloves, but then there is the rigmarole of cleaning them, finding them, having pairs that fit everyone’s arm length… Far better to avoid the situation at all and not have disposable birth pool plugs!

Finding the plugs!

We still travel with a travellers’ emergency bath plug as many’s the time that we’ve ended up in a hotel or holiday home with no bath plug in sight. Imagine the challenge of trying to track plugs through the cleaning process and back again! So the obvious answer appears to be the disposable birth pool plugs that we at Aquabirths were asked to supply, but who will keep an eye on how many are left and when they need to be re-ordered? And of course, with a disposable item, there is always the…

Eco considerations

Every Little Counts and all that, and everything we can do to try to reduce the impact on our environment makes an impact. If we can move away from disposable items. Generally, disposable items in the NHS are incinerated, with serious ecological impacts. Disposable birth pool plugs are not necessary. There’s a much better solution…

Aquabirths’ Birth Pool Plug Solution!

Aquabirths do not supply hospital birth pools with disposable plugs. Our birth pools come with built in grated wastes and an integrated valve to stop water flowing out, or to release it after the birth. To “plug” or “unplug” the birth pool the midwife simply needs to open the valve!

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?

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.

Proper Installation of Birthing Pools and False Economies.

I doubt if there is a maternity unit in the UK that isn’t strapped for funds.  Savings always need to be found!  But please don’t scrimp on the installation of the birthing bath – this is a job for a qualified plumber and not a general fitter.   This is not a way of pushing our installation service but simply because we’ve just had to tidy up a mess left by a contractor who didn’t install the bath properly.

It is very important that the bath you have bought, paid to be delivered and installed is put in properly to avoid extra costs and problems down the line.  Make sure Estates or someone ensures the contractor follows the instructions.  If you have queries, ring us.  You could have a site visit before hand so that we can discuss installation; you can also  book for our plumber to be present at installation to offer guidance, at the very least, you could arrange for him to be present to give phone support.  The cost of a site visit (which is only for mileage and time) is discounted from the purchase price (up to a maximum of £200) in any case.

We understand that hospitals will want to make saving where they can but, as we know with a local hospital, the installer put the bath in wrongly and with no consideration of the midwives who will have to use it.  This has caused extra expense, hassle and time-wastage trying to sort it.  Othertimes, the incorrect trap has been used so that Infection Control are unhappy.