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?

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.

 

Waterbirth : Part of a World Movement

Revisiting WaterbirthBarbara Harper, founder/director of Waterbirth International reviews the second edition of Dianne Garland’s textbook ‘Revisiting Waterbirth: An Attitude to Care’ in the context of waterbirth practice around the world.

It is no secret that water is healing and that the use of water is an effective medium to facilitate changes in actual brain wiring. It is with excitement and great pleasure that I welcome the publication of the second edition of Revisiting Waterbirth: An Attitude to Care. Dianne Garland has continued to provide waterbirth education and training not only throughout the UK, but around the world. Our mutual passion brought us together for conferences, workshops and presentations many times. It has been my privilege to work closely with Dianne as a teaching partner in China, Spain, the Czech Republic, Israel, India and the United States. Her excitement about demystifying waterbirth is contagious, and the reader, whether midwife, doctor or mother, will experience that enthusiasm within the pages of this book.

There has never been a time in our combined history when the message and knowledge within Revisiting Waterbirth: An Attitude to Care has been more necessary. The misinformation surrounding waterbirth that Dianne and I have witnessed in different parts of the world is sometimes distressing and occasionally humorous. This book gives every practitioner an effective, informative guide to start a waterbirth practice and integrate that practice into any clinical setting. It also provides concrete examples and stories from those with whom Dianne and I have worked. The inclusion of detailed stories from practitioners and parents is a wonderful supplement to the new edition of Revisiting Waterbirth.

The use of water for labour and birth has increased exponentially since Dianne and I first started writing letters to one another in 1989. When we finally met in person 26 years ago in Kobe, Japan, at the International Confederation of Midwives conference, we excitedly shared documentation of the efficacy and safety of waterbirth. The demand for accurate, useful information and descriptions of experiences has also increased. When we first started our collaboration, waterbirth was referred to as a fad or a trend that would soon be gone. Women seeking the ease and comfort of water will continue to increase in every part of the world. Waterbirth is part of a world movement that seeks a more humane and gentler approach to childbearing.

The use of warm water immersion has long been seen as an aid for labour, making it easier for the mother to enter into and remain in a state of hormonal bliss. Today, there are well-designed studies that prove the efficacy of water for labour and the safety of water for the birth of the baby. Dianne’s experience as a hands-on midwife attending waterbirths, as well as her design and documentation of research, makes her the perfect person to lay the foundation of education for those who want to incorporate the use of water into maternity care settings. This book is also a guide for those who have already started waterbirth practice to improve their experience.

The message in this book is simple, straightforward and very hopeful. It is hopeful in the sense that more and more women are asking how to make labour less about ‘enduring the pain’ and more about creating a good, healthy and loving experience of birth for the baby. Women understand that creating a new human being is one of the most important jobs on the planet. The providers who serve those women need the encouragement that this book offers to step out of the routine medical care and become open to the possibilities that water can, indeed, change the course of a labour and should be utilized as a valuable tool for almost all women. The attitude with which professionals view a woman’s ability to give birth can either enhance or detract from her experience.

In 2014, the American Congress of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatricians (AAP) launched a campaign to put doubt about the usefulness of waterbirth into the minds of nurses, doctors, midwives and the public. Some US hospitals paid attention to the published and widely distributed ACOG opinion paper and halted their successful and incident-free waterbirth programs. Dianne and I travelled together to hospitals in Cleveland, Ohio, and Minneapolis, Minnesota, shortly after the article was published, to educate hospital staff and help reinstate waterbirth policies in these facilities. We were welcomed in these places and our efforts were rewarded when the practices were put back into place.

It is my sincere hope and desire that practitioners throughout the world are guided by the message in Revisiting Waterbirth: An Attitude to Care and start implementing protocols in more hospitals. All women should be offered the choice and opportunity to labor in water and birth their babies with the ease, safety and pleasure that water so beautifully provides. I also hope that our tandem careers continue to bring this message to every corner of the globe. As founder and director of Waterbirth International, I have relied on Dianne Garland to provide a multitude of research and documentation from the UK and have used this book in its earlier editions as a teaching tool and recommended reading for nurses, midwives and doctors.

Barbara Harper, RN, CLD, CCCE, CKC, Midwife
Founder/Director of Waterbirth International

Comments please – canvassing ideas for birth baths

At a recent conference attended by Ruth, a German midwife recounted how she used a much deeper container as a waterbirth pool .  With this in mind, what do you, midwives and birth practitioners, think.  It is not the bath that Ruth is stood in, rather its something to indicate depth.  We have a design but there’s no point going into production if there is no call.  Alternatively, we might start making it for the export market.  Do let us know you thoughts.

ruth new deep bath2 ruth new deep bath

Things to consider before buying and installing a birthing pool

Things you need to consider when installing a birthing pool – a Midwife’s guide.

 

As the demand for active birth – and water births in particular – increases, more and more trusts and birthing units are installing birthing pools. Here, David Weston, owner of Aquabirths in West Yorkshire shares his expertise and experience and gives guidance on “where to start”.

 

As with many things in midwifery, you have to start with the plumbing.  Is there already a bath in the room where you plan to put your pool?  Or at least a sink?  If the plumbing is in place to begin with, it makes life a lot easier and the job a lot cheaper.  One critical thing is the height of the existing waste water pipe. 

 

Ideally, the waste water will leave the room either at, or very close to, floor level so that pipe-work from plughole to waste drain is at a steep enough gradient to enable the water to empty quickly.  A valve and a trap need to be fitted in under the bath and it’s a case of getting them in before you run out of height. If the waste pipe is a few inches up the wall, then the bath will probably need to be raised, which can add to the overall cost of the build.

 

Space. When putting a pool into a birthing room, you might also want to consider what else you want in the room.  Other room uses may impinge on the bath – for example, plug sockets for CD-players need to be at least 3m from the bath. It’s always a good idea to make contact with an experienced Birth Pool specialist very early in the process. Any company worth their salt will be willing to chat through your options with you, or be prepared to visit you, even before you have engaged an architect or project manager.

 

I have seen rooms with birthing pools left unused or – worse still – used as storage rooms! Allowing time to properly consider how best to equip the room with other equipment can avoid this. If you want a bed in the room with the birth pool, will you want to be able to move the bed in and out also? Will there be enough room to do so. You don’t want to find yourself in a position of not being able to offer the birth pool to women who want it because someone rammed it with a bed and the estates office have told you it can’t be used.   

 

Colours and features.  Gone are the days of “it comes in white…or white” A birthing bath can be any colour and any shape you want and many of the baths we have installed have been adapted to suit the needs of individual midwifery teams. If you have a “dream” birthing pool in mind, don’t be afraid to ask. Modern moulding techniques mean that bespoke baths are much more affordable than they were ten years ago.

 

When it comes to taps, choice can be a little more limited because of the various regulations that apply to hospitals. Any good birth pool company will know their way round these regulations and should still be able to offer you a number of alternatives. It is probable that this is something that can be sorted by the hospital’s Estates Department.  You can also request additional features and modifications such as LED lights inside the bath, a choice on the position of the waste outlet and even the addition of an anti-bacterial gel coating.

 

Make it a Team Effort Involve the Estates Department as early as is possible / helpful to you. They may be able to help with much of the above and undertake some of the works to make your budget go as far as possible.  We do offer an installation service for our pools so you can be sure it is fitted correctly.  However, budgets are often stretched and it should be possible for the hospital’s own Estates Department to fit the bath.  Make sure your pool comes with instructions and telephone support from the birth pool provider. 

 

If you’re not sure, ask. A birth pool may be one of your biggest investments of the year, so don’t be afraid to ask questions throughout the process. Once the bath is in, it’s sometimes too late to make changes so keep the channels of communication open throughout the design, build and installation process.  A good birth pool company will have time to talk through your options and be willing to answer any questions you have. It’s a good idea to have clarification on points you are unsure of in writing to avoid any confusion or surprises later down the line. If you discuss something with your birth pool provider on the phone, drop them a quick email afterwards to confirm what you agreed. Don’t assume that because you know exactly what you want, they do too – they’ll only know if you tell them.

 

And finally – once your pool is installed, make a bit of noise about it. Be sure to let the local press know about your fabulous new facilities (your birth pool company may be able to help you with this) and invite local stakeholders, community midwives, doulas, GPs, practice nurses and mums to be to come and take a tour of your new birthing room. You wouldn’t buy a new pair of shoes and never wear them, likewise don’t commission a pool and forget to show it off – that way it will get used more frequently, you will get your money’s worth and you will see an increase in the number of mums enjoying your new birthing pool.”

 

 

 

 

The Heart-Shaped Birth Bath at Leeds – Design Your Own Birth Pool.

Here isHeart-shaped Leeds birth bath by Aquabirths the Heart-shaped birthing pool in the finished room at the Leeds General Infirmary. A beautiful birthing bath, designed by midwives and hand made in Yorkshire. Made and delivered for under £7000!  The midwives wanted a very large birth pool so that women, short or tall, would have plenty of room to move around and adopt whatever position they wanted during labour. This is probably the biggest birthing pool on the market and really is a ‘statement’ birth pool.

IMAG0178 BIRTH POOL IN PLACE 030

New Bespoke Birth Pool Being Installed at Leeds

Midwife-led design IMAG0178

Made in Yorkshire.

Designed by midwives and Bradford-based firm Aquabirths, made in Yorkshire: a brand new birthing bath has been installed today at the Leeds General Infirmary so that Yorkshire mothers can birth their babies in water.