Water immersion has been utilized as an effective physiological support for birth since the early 1980s.
This article will explore the holistic benefits of water for labour, and demonstrate the principles and considerations of safety for midwives supporting women using water immersion in labour.
Water immersion is defined as the use of water irrespective of the stage of labour, although this article will focus on the first stage of labour.
"Midwives and women have come to see water immersion as a philosophy of non–intervention and a means of facilitating birth without pharmacological pain relief” (Pairman et al., 2015, p.672).
Current Practice
Evidence provides many benefits of water immersion during labour, including:
- Less use of pain relief, especially epidural analgesia,
- An increase in relaxation and lower levels of perceived pain,
- Fewer medical interventions for slow progress in first stage of labour, and
- A greater sense of control and empowerment for the woman in labour.
(NSW Health, 2023).
Access to immersion in water for labour and birth is reliant on both the care provider and the policies and procedures that guide clinical practice.
Recent Australian research found some midwives perceive waterbirth policies and guidelines can limit their scope to facilitate water immersion and did not always support women’s informed choice. (Lewis et al., 2018).
Midwifery Responsibilities
- Achieved current competency for water immersion
- Adhering to locally agreed policies with appropriate equipment required
- Providing compassion labour care, with additional considerations for comfort and safety of the woman and baby
- Identifying any occasion when removal from the pool is indicated
- Contemporaneous documentation
(Johnson & Taylor, 2021).
Considerations for Midwifery Practice
A 2018 Australian study explored what midwives had enjoyed about caring for women who labour or birth in water revealed three distinctive themes:
Instinctive birthing - this describes how midwives perceived labouring or birthing in water nurtured an instinctive birthing behaviour led by the woman;
Woman-centred atmosphere – this outlined a labour and birth environment which was woman centred, calm, peaceful and relaxed; and
Undisturbed space – the way in which water creates an undisturbed space where access to the woman is mediated by the water.
(Lewis et al., 2018)
Key Messages
- Clearer guidance now exists to support women and midwives in their use of water for all the stages of labour. The mother can benefit from a number of positive effects of immersion in warm water, namely comfort and relaxation.
- Learning through reflection – this illustrates how midwives Can learn by documenting and then reflecting on the clinical challenges encountered during their day to day clinical practice around water immersion for labour and birth.
- Appropriate waterbirth facilities - ensuring waterbirth facilities were suitable, available and accessible for women and identified challenges relating to the provision of infrastructure around waterbirth.
References
Johnson, R., & Taylor, W. (2021). Skills for Midwifery Practice (Fifth edition.). Elsevier. Lewis, L., Hauck, Y. L., Butt, J., Western, C., Overing, H., Poletti, C., Priest, J., Hudd, D., & Thomson, B. (2018).
Midwives’ experience of their education, knowledge and practice around immersion in water for labour or birth. BMC Pregnancy and Childbirth, 18(1), 1–9. https://doi.org/10.1186/s12884-018-1823-0 NSW Health. (2023). Maternity – Water Immersion in Labour and Birth.
Pairman, S., Tracy, S., Dahlen, H. G., & Dixon, L. (2023). Midwifery: preparation for practice (S. Pairman, S. Tracy, H. G. Dahlen, & L. Dixon, Eds.; Fifth edition). Elsevier Australia.
