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?

Corner Baths

We’ve had a bit of a flurry of requests for corner baths, mainly from export customers, so we thought we’d better write a short blog on them.

The short answer is, ‘yes, we do make them.’ They are an excellent option where space is a bit tight but the hospital still want to give a birthing mum the option of a water birth.  Sometimes, corner baths are avoided as the midwives want to be able to access the woman from as many parts of the bath as possible.

Our Dunoon model birthing bath is ideally suited to being used in a corner.  It is already designed specifically to be compact and fit in smaller rooms but to still give a labouring woman plenty of room to move and keep active during birth.  It does this by virtue of its rounded rectangular shape and by using space wisely so that it still has the capacity of a birth.

The Dunoon can be fitted in any position and doesn’t have to go in a corner but if you let us know when ordering, we can include an extra piece of trim (at no cost) so that you can have a neat finish against the corner walls.

Dunoon compact birth pool

Why use fibreglass (GRP)?

Canberra birth bath
Best birth bath ever
Canberra birth bath at Furness General

GRP or acrylic? What’s the difference?

Every few years we look again at materials.  And again, we have chosen to use fibreglass (GRP) rather than acrylic or composites because, on balance, it gives a better all-round product for a hospital.

Whilst acrylic is slightly harder than GRP, the way acrylic baths are made (heat bending and forming) results in thin patches along bends and edges which we have found to be brittle weak-spots.  Acrylic tends to resist scratching in the domestic setting, however, we have found that the main type of accident or mishap in the hospital environment involves beds!  And both materials will chip then.  Fibreglass can be repaired easily and cheaply.  Acrylic, if it can be repaired at all, is neither quick nor cheap.  Additionally, we found we could add to the robustness of the GRP by having an extra deep gel-coat.

Cleanability is another commonly cited advantage to acrylic baths (in the home).  Acrylic stays cleaner looking than fibreglass if one does not clean the bath regularly.  In the hospital setting, this is irrelevant as cleaning is both thorough and regular.  For hospitals and maternity centres, acrylic baths would cost more for no benefit.  And as they are more difficult to repair and refurbish, we came down on the side of GRP.

We also want to offer midwives the ability to customise our pools or come up with their own bespoke pools.  This is what the midwives at Leeds did and the ‘Heart-shaped’ model is what they came up with.  Acrylic baths have far higher tooling costs, so the cost would be prohibitive.  Acrylic is good where there are fixed designs and mass-production.

For all these reasons, we keep choosing to use GRP for our birth baths.

LED lights for birth baths

LED light for Aquabirths bathWe often fit these lights to our own baths but it is possible to retro-fit them to other baths.  If your bath already has an older light that is larger than this compact one, we can supply an adapter to cover and reduce the hole.

The advantage of LEDs, aside from their much lower consumption, is that they last much longer.

Plugs and drains and such glamorous things!

For historical reasons (that is, reasons lost in history and no-one knows why any more!) birth baths had their waste pipes leaving sideways at an angle.  This has caused a problem because these so called ‘low profile’ wastes have an inbuilt weakness: standard or proper plumbing fittings don’t fit conveniently.  One solution was to try and incorporated a piece of plastic pipe as part of the bath, which is what one company did and still does.  The problem being, as evidenced by several site visits to leaking baths, is that the seal between the the bath and the pipe was never durable enough, water got into the fabric of the bath and caused bloating and staining.  Repairs were usually ugly and ‘stop-gap’.  The best seal comes from using plumbing fittings designed for the job.  But a plug hole on its side gives a bit of a lip.

So, for a bath with a better sealed waste, the plug should go through the base and not out sideways.  One company claims to have a (sic) low profile fast flow system.  Not sure what this is because pipes are pipes and gravity is the same everywhere! Also, the slightly higher bath (1″) with the plug in the base (more water pressure still) would be quicker to empty than a  ‘low profile’ arrangement.  ‘Fast flow’ might include an in-line trap, and we did introduce the use of in-line waterless traps to birth pools, so it’s nice to be copied.

Being able to use standard plumbing fittings mean that the most appropriate fittings are used, they are easy to source, easy to fit and can be repaired.

With this in mind we have redesigned one of our baths to incorporate these improvements to give the best value for money bath that is easy to fit and keeps on going.  We call it the Canberra bath after the first hospital to have this improved birth bath.