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Cooper M, Madeley AM, Burns E, Feeley C. Understanding the barriers and facilitators related to birthing pool use from organisational and multi-professional perspectives: a mixed-methods systematic review. Reprod Health 2023; 20:147. [PMID: 37794365 PMCID: PMC10548665 DOI: 10.1186/s12978-023-01690-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 09/13/2023] [Indexed: 10/06/2023] Open
Abstract
AIMS To identify and synthesize the evidence regarding the facilitators and barriers relating to birthing pool use from organizational and multi-professional perspectives. DESIGN A systematic integrated mixed methods review was conducted. DATA SOURCES MEDLINE, CINAHL, PsychINFO, EMCARE, PROQUEST and Web of Science databases were searched in April 2021, March 2022 and April 2024. We cross-referenced with Google Scholar and undertook reference list searches. REVIEW METHODS Data were extracted from studies meeting the inclusion criteria. Barriers and facilitators to birthing pool use were mapped and integrated into descriptive statements further synthesized to develop overarching themes. RESULTS Thirty seven articles (29 studies) were included-quantitative (12), qualitative (8), mixed methods (7), and audits (2), from 12 countries. These included the views of 9,082 multi-professionals (midwives, nurses, obstetricians, neonatologists, students, physicians, maternity support workers, doulas and childbirth educators). Additionally, 285 institutional policies or guidelines were included over 9 papers and 1 economic evaluation. Five themes were generated: The paradox of prescriptiveness, The experienced but elusive practitioner, Advocacy and tensions, Trust or Trepidation and It's your choice, but only if it is a choice. These revealed when personal, contextual, and infrastructural factors were aligned and directed towards the support of birth pool use, birthing pool use was a genuine option. Conversely, the more barriers that women and midwives experienced, the less likely it was a viable option, reducing choice and access to safe analgesia. CONCLUSION The findings demonstrated a paradoxical reality of water immersion with each of the five themes detailing how the "swing" within these factors directly affected whether birthing pool use was facilitated or inhibited.
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Milosevic S, Channon S, Hughes J, Hunter B, Nolan M, Milton R, Sanders J. Factors influencing water immersion during labour: qualitative case studies of six maternity units in the United Kingdom. BMC Pregnancy Childbirth 2020; 20:719. [PMID: 33228569 PMCID: PMC7682119 DOI: 10.1186/s12884-020-03416-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 11/12/2020] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Sarah Milosevic
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, Wales, CF14 4YS.
| | - Susan Channon
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, Wales, CF14 4YS
| | - Jacqueline Hughes
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, Wales, CF14 4YS
| | - Billie Hunter
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Eastgate House, 35-43 Newport Road, Cardiff, Wales, CF24 0AB
| | - Mary Nolan
- College of Health, Life and Environmental Sciences, University of Worcester, Henwick Grove, Worcester, England, WR2 6AJ
| | - Rebecca Milton
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, Wales, CF14 4YS
| | - Julia Sanders
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Heath Park Campus, Cardiff, Wales, CF14 4XN
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Maude RM, Kim M. Getting into the water: a prospective observational study of water immersion for labour and birth at a New Zealand District Health Board. BMC Pregnancy Childbirth 2020; 20:312. [PMID: 32434478 PMCID: PMC7238728 DOI: 10.1186/s12884-020-03007-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 05/11/2020] [Indexed: 12/27/2022] Open
Affiliation(s)
- Robyn M Maude
- School of Nursing, Midwifery, and Health Practice, Faculty of Health, Victoria University of Wellington, PO Box 7625, Newtown, Wellington, 6242, New Zealand.
| | - Mikyung Kim
- School of Nursing, Midwifery, and Health Practice, Faculty of Health, Victoria University of Wellington, PO Box 7625, Newtown, Wellington, 6242, New Zealand
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'They follow the wants and needs of an institution': Midwives' views of water immersion. Women Birth 2020; 34:e178-e187. [PMID: 32144024 DOI: 10.1016/j.wombi.2020.02.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 02/24/2020] [Accepted: 02/24/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND A midwife's ability to fully support women's autonomy and self-determination with respect to midwifery care is often challenging. This is particularly true of water immersion for labour and birth. However, the woman's agency over what happens to her body and that of her unborn baby should be key considerations for maternity care provision. OBJECTIVES A three phased mixed-methods study was undertaken to examine how water immersion policies and guidelines are informed. Phase three of this study captured the knowledge and experiences of Australian midwives, their support for water immersion and their experiences of using policies and guidelines to inform and facilitate the practice. METHODS Critical, post structural, interpretive interactionism was used to examine more than 300 responses to three open-ended questions included in a survey of 233 midwives. Comment data were analysed to provide further insight, context and meaning to previously reported results. FINDINGS Findings demonstrated a complex, multidimensional interplay of factors that impacted on both the midwife's ability to offer and the woman's decision to use water immersion under the themes 'the reality of the system', 'the authoritative 'others'' and 'the pseudo decision-makers'. Multiple scaffolded levels were identified, each influenced by the wider macro-socio-political landscape of Australian midwifery care. CONCLUSIONS The insight gained from examining midwives' views and opinions of water for labour and birth, has aided in contextualising previously reported results. Such insight highlights the importance of qualitative research in challenging the status quo and working towards woman-centred practice and policy.
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Milosevic S, Channon S, Hunter B, Nolan M, Hughes J, Barlow C, Milton R, Sanders J. Factors influencing the use of birth pools in the United Kingdom: Perspectives of women, midwives and medical staff. Midwifery 2019; 79:102554. [PMID: 31610360 PMCID: PMC6894355 DOI: 10.1016/j.midw.2019.102554] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 10/03/2019] [Accepted: 10/05/2019] [Indexed: 12/29/2022]
Abstract
Objective To identify factors influencing the use of birth pools. Design Online discussion groups and semi-structured interviews, analysed thematically. Setting United Kingdom. Participants 85 women and 21 midwives took part in online discussion groups; 14 medical staff participated in interviews. Findings Factors influencing the use of birth pools were grouped into three overarching categories: resources, unit culture and guidelines, and staff endorsement. Resources encompassed pool availability, efficiency of pool use and availability of waterproof cardiotocograph equipment. Unit culture and guidelines related to eligibility criteria for pool use, medicalisation of birth and differences between midwifery-led and obstetric-led care. Staff endorsement encompassed attitudes towards pool use. Key conclusions Accessibility of birth pools was often limited by eligibility criteria. While midwifery-led units were generally supportive of pool use, obstetric-led units were described as an over-medicalised environment in which pool use was restricted and relied on maternal request. Implications for practice Midwives can improve women's access to birth pools by providing information antenatally and proactively offering this as an option in labour. Maternity units should work to implement evidence-based guidelines on pool use, increase pool availability (even where there appears to be low demand), and enhance awareness amongst medical staff of the benefits of water immersion.
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Affiliation(s)
- Sarah Milosevic
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, Wales CF14 4YS, United Kingdom.
| | - Sue Channon
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, Wales CF14 4YS, United Kingdom.
| | - Billie Hunter
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Eastgate House, 35-43 Newport Road, Cardiff, Wales CF24 0AB, United Kingdom.
| | - Mary Nolan
- College of Health, Life and Environmental Sciences, University of Worcester, Henwick Grove, Worcester, England WR2 6AJ, United Kingdom.
| | - Jacqueline Hughes
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, Wales CF14 4YS, United Kingdom.
| | - Christian Barlow
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, Wales CF14 4YS, United Kingdom.
| | - Rebecca Milton
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, Wales CF14 4YS, United Kingdom.
| | - Julia Sanders
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Heath Park Campus, Cardiff, Wales CF14 4XN, United Kingdom.
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Cooper M, McCutcheon H, Warland J. Water immersion policies and guidelines: How are they informed? Women Birth 2019; 32:246-254. [DOI: 10.1016/j.wombi.2018.08.169] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 08/23/2018] [Accepted: 08/24/2018] [Indexed: 10/28/2022]
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Cooper M, Warland J, McCutcheon H. Practitioner accreditation for the practice of water immersion during labour and birth: Results from a mixed methods study. Women Birth 2018; 32:255-262. [PMID: 30196039 DOI: 10.1016/j.wombi.2018.08.165] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 08/21/2018] [Accepted: 08/21/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Water immersion for labour and birth is an option that is increasingly favoured by women. Australian water immersion policies and guidelines commonly specify that practitioners, such as midwives, must undertake further education and training to become accredited. METHOD A three-phase mixed methods approach was used. Phase one used critical discourse analysis to determine who or what informs policies and guidelines related to water immersion for labour and/or birth. Phase two examined policy and guideline informants' experiences of the development of policies/guidelines, whilst phase three surveyed Australian midwives' views and experiences of water immersion and their use of and/or involvement in the development of policies and guidelines. FINDINGS Practitioner accreditation for the facilitation of water immersion was a common finding across all phases of the study. An examination of policies and guidelines found that practitioners, namely midwives, were required to meet additional training requirements to facilitate water immersion. Participants of phases two and three identified and discussed accreditation as a significant challenge to the option of water immersion, particularly where there were inconsistencies across documents and in the interpretation of their content. CONCLUSION The need for practitioners to be accredited to facilitate water immersion was identified as a major barrier to availability and therefore, women's ability to access the option. Given these findings, the need for accreditation should be challenged.
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Affiliation(s)
- Megan Cooper
- School of Nursing and Midwifery, University of South Australia, City East Campus, Adelaide, South Australia, Australia.
| | - Jane Warland
- School of Nursing and Midwifery, University of South Australia, City East Campus, Adelaide, South Australia, Australia
| | - Helen McCutcheon
- School of Nursing and Midwifery, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia Campus, Brisbane, Queensland, Australia
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Cooper M, Warland J, McCutcheon H. Australian midwives views and experiences of practice and politics related to water immersion for labour and birth: A web based survey. Women Birth 2017; 31:184-193. [PMID: 29037484 DOI: 10.1016/j.wombi.2017.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 08/26/2017] [Accepted: 09/01/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND There is little published research that has examined practitioners' views and experiences of pain relieving measures commonly used during labour and birth, particularly for non-pharmacological measures such as water immersion. Furthermore, there is minimal published research examining the process of policy and guideline development, that is, the translation of published research to usable practice guidance. AIMS The aims of phase three of a larger study were to explore midwives knowledge, experiences and support for the option of water immersion for labour and birth in practice and their involvement, if any, in development of policy and guidelines pertaining to the option. METHODS Phase three of a three phased mixed methods study included a web based survey of 234 Australian midwives who had facilitated and/or been involved in the development of policies and/or guidelines relating to the practice of water immersion. FINDINGS Midwives who participated in this study were supportive of both water immersion for labour and birth reiterating documented benefits of reduced pain, maternal relaxation and a positive birth experience. The most significant concerns were maternal collapse, the difficulty of estimating blood loss and postpartum haemorrhage whilst barriers included lack of accredited staff, lifting equipment and negative attitudes. Midwives indicated that policy/guideline documents limited their ability to facilitate water immersion and did not always to support women's informed choice. CONCLUSION Midwives who participated in this study supported the practice of water immersion reiterating the benefits documented in the literature and minimal risk to the woman and baby. ETHICAL CONSIDERATIONS The Human Research Ethics Committee of the University of South Australia approved the research.
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Affiliation(s)
- Megan Cooper
- School of Nursing and Midwifery, University of South Australia, City East Campus, Adelaide, South Australia, Australia.
| | - Jane Warland
- School of Nursing and Midwifery, University of South Australia, City East Campus, Adelaide, South Australia, Australia
| | - Helen McCutcheon
- Faculty of Health and Behavioural Sciences, The University of Queensland, St. Lucia Campus, Brisbane, Queensland, Australia
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