What are the benefits? Are they concerned? Women's experiences of water immersion for labor and birth

Sense of coherence as facilitated by water immersion during labour and birth: A concept analysis and synthesis

OBJECTIVE

To explore the concept of sense of coherence as facilitated by water immersion during labour and/or birth.

DESIGN

A concept analysis and synthesis. A literature search of CINAHL, Medline, PubMed, PsycINFO and Emcare was undertaken in February 2022. Results were cross-checked with Google Scholar. No timeframe was specified, and results were restricted to research papers written in English. Overall, 2768 papers were retrieved and after removal of duplicates and unrelated papers, abstracts were screened to ensure the paper met the inclusion criteria i.e. women's experiences of water immersion for labour and/or birth. This process yielded a total of 37 articles and two theses, these were used for the concept analysis. Attributes were described and an exemplar case developed after mapping and charting of the data set.

FINDINGS

Three attributes were identified; agency, holistic and complete and more than pain relief which align with the three sense of coherence components: comprehensible, meaningfulness and manageability.

KEY CONCLUSION

There is a growing evidence base regarding the use of intrapartum water immersion. The literature exploring women's experiences and views of water immersion, appears to consistently report that women experience physiological, physical and psychological benefits and that these benefits complement each other to facilitate greater self-efficacy and a more holistic experience. This combination of benefits afforded by water immersion facilitates a sense of coherence and subsequently, increases the likelihood of the woman experiencing labour and birth as both positive and satisfying.

IMPLICATIONS FOR PRACTICE

A greater understanding of women's experiences of water immersion will provide rationale and reason for making the option a real choice while revealing the positive impacts that it can have on all outcomes beyond just the physical.

Perception and knowledge of Saudi women about water birth: A cross-sectional study

BACKGROUND

Water birth has been considered an efficient non-pharmacological modality with numerous maternal and neonatal benefits as well as rare complications. Perception and knowledge about water birth can affect women's decisions in the future. Few available studies addressed this area in Saudi Arabia. Thus, the current research fills this gap and contributes to further understanding this phenomenon.

OBJECTIVE

This study aimed to assess the perception and knowledge of Saudi women about water birth.

METHODS

A cross-sectional study was employed among 388 Saudi women conveniently enrolled for the study. An online questionnaire that included four sections: sociodemographic characteristics, obstetrical history, perception, and knowledge of water birth, was used for data collection. Descriptive statistics (frequencies, percentages, means, and standard deviations) and inferential statistics (Chi-Square, Fisher Exact, and t-tests) were used for data analysis.

RESULTS

The participants' mean age was 34.91 ± 8.851, with 83.2% of them highly educated. The mean number of deliveries was 3.36 ± 2.167, with 60% having no history of abortion. Less than half of the participants (40.2%) preferred to have a water delivery. Of the total participants, 96.4% had a fair knowledge level, and 3.6% had a good knowledge of water delivery. A significant relationship was found between age, educational course, and the knowledge of the participants about water delivery (p <0.05).

CONCLUSION

Most Saudi women had a fair knowledge of water birth; however, they wanted more information on it. It is recommended that midwives and nurses broaden their understanding of water birth and enhance its practice in order to educate and inspire women to make informed decisions about all available childbirth delivery methods, including water birth.

A systematic meta-thematic synthesis to examine the views and experiences of women following water immersion during labour and waterbirth

AIMS

To gather, quality assess, synthesize and interpret the views, feeling, and experiences of women who used water immersion during labour and/or birth.

DESIGN

A systematic meta-thematic synthesis and GRADE-CERQual.

DATA SOURCES

We searched MEDLINE, CINHAL, PsychINFO, AMED, EMBASE (MIDIRS only), LILACS, AJOL. Additional searches were carried out using Ethos (thesis database), cross-referencing against Google Scholar and citation chasing. Searches were carried out in August 2019, updated February 2020.

METHODS

Studies that met the selection criteria were appraised for quality. Data were extracted from the studies using meta-thematic analytical techniques; coding, descriptive findings, and analytical findings. The descriptive findings were subjected to confidence assessments using GRADE-CERQual.

RESULTS

Seven studies met the inclusion criteria. Nine key statements of findings were generated - one had high confidence, three moderate, three low and one very low confidence in the findings. The analytical findings generated three main themes: Liberation and Self-Emancipation, Synergy, transcendence and demarcation and Transformative birth and beyond. Overall, women experienced warm water immersion during labour and/or birth positively. Both the water and pool itself, facilitated women's physical and psychological needs during labour and/or birth, including offering effective analgesia. Our findings indicated that birthing pools are versatile tools that provide for a space that women can adapt and influence to best suit their individual needs.

CONCLUSION

Women who used warm water immersion for labour and/or birth describe liberating and transformative experiences of welcoming their babies into the world. They were empowered, liberated, and satisfied. We recommend maternity professionals and services offer water immersion as a standard method of pain relief during labour/birth.

IMPACT

Understanding women's experiences of labour and birth will inform future clinical practice. Midwives are optimally positioned to enhance women's access to water immersion. These findings have implications for education, guideline, and policy development as well as clinical practice.

Factors influencing water immersion during labour: qualitative case studies of six maternity units in the United Kingdom

BACKGROUND

Water immersion during labour can provide benefits including reduced need for regional analgesia and a shorter labour. However, in the United Kingdom a minority of women use a pool for labour or birth, with pool use particularly uncommon in obstetric-led settings. Maternity unit culture has been identified as an important influence on pool use, but this and other possible factors have not been explored in-depth. Therefore, the aim of this study was to identify factors influencing pool use through qualitative case studies of three obstetric units and three midwifery units in the UK.

METHODS

Case study units with a range of waterbirth rates and representing geographically diverse locations were selected. Data collection methods comprised semi-structured interviews, collation of service documentation and public-facing information, and observations of the unit environment. There were 111 interview participants, purposively sampled to include midwives, postnatal women, obstetricians, neonatologists, midwifery support workers and doulas. A framework approach was used to analyse all case study data.

RESULTS

Obstetric unit culture was a key factor restricting pool use. We found substantial differences between obstetric and midwifery units in terms of equipment and resources, staff attitudes and confidence, senior staff support and women's awareness of water immersion. Generic factors influencing use of pools across all units included limited access to waterbirth training, sociodemographic differences in desire for pool use and issues using waterproof fetal monitoring equipment.

CONCLUSIONS

Case study findings provide new insights into the influence of maternity unit culture on waterbirth rates. Access to pool use could be improved through midwives based in obstetric units having more experience of waterbirth, providing obstetricians and neonatologists with information on the practicalities of pool use and improving accessibility of antenatal information. In terms of resources, recommendations include increasing pool provision, ensuring birth room allocation maximises the use of unit resources, and providing pool room environments that are acceptable to midwives.

Systematic Review of Case Reports of Poor Neonatal Outcomes With Water Immersion During Labor and Birth

Water immersion is a valuable comfort measure in labor, that can be used during the first or second stage of labor. Case reports of adverse outcomes create suspicion about water birth safety, which restricts the availability of water birth in the United States. The objective of this study was to synthesize the information from case reports of adverse water birth events to identify practices associated with these outcomes, and to identify patterns of negative outcomes. The research team conducted a systematic search for cases reports of poor neonatal outcomes with water immersion. Eligible manuscripts reported any adverse neonatal outcome with immersion during labor or birth; or excluded if no adverse outcome was reported or the birth reported was unattended. A qualitative narrative synthesis was conducted to identify patterns in the reports. There were 47 cases of adverse outcomes from 35 articles included in the analysis. There was a pattern of cases of Pseudomonas and Legionella, but other infections were uncommon. There were cases of unexplained neonatal hyponatremia following water birth that need further investigation to determine the mechanism that contributes to this complication. The synthesis was limited by reporting information of interest to pediatricians with little information about water birth immersion practices. These data did not support concerns of water aspiration or cord rupture, but did identify other potential risks. Water immersion guidelines need to address infection risk, optimal management of compromised water-born infants, and the potential association between immersion practice and hyponatremia.