More expectant women are requesting water pools during labour and births, writes Sylvia Thompson
The use of water pools for pain relief during labour is growing in popularity in this country. The use of water pools for giving birth is also in demand but, in many cases, women who opt for a water birth during their pregnancy, then decide to give birth outside water, having used the pool during labour.
Our Lady of Lourdes Hospital in Drogheda, Co Louth and Cavan General Hospital were the first hospitals in Ireland to offer water pools for use in labour and childbirth in 2004.
Studies of their usage has found that 80 to 90 per cent of women use the pools during labour and then choose to get out to give birth. Between 10 and 15 per cent of women give birth in water.
The recent case of a baby who was born using the water pool at Cavan General Hospital and subsequently died in a Dublin hospital has, however, led to the suspension of the use of the water pools for the actual birth itself in both hospitals. However, the pools are still available for women to use during labour.
According to the HSE Dublin North East, an internal review into the deceased baby's birth found no cause for concern with the care during pregnancy, labour and birth.
"The suspension of the use of the pools for birth is a precautionary measure pending the results of the coroner's post mortem and to allow an external review to be carried out," says a spokeswoman from the HSE.
Warm water has long been recognised for its soothing properties during labour and many women have a bath or a long shower at home in the early stages of labour.
Similarly, in maternity hospitals, baths and showers are often used by women for pain relief in the early stages of labour.
The Rotunda Hospital in Dublin is planning to install a water pool for women to use during labour.
"The use of water for pain relief during labour is well documented. The difference between a bath and a water pool is that the latter allows the mother-to-be to relax in a larger space and be covered with water," says Aideen Keenan, midwifery manager of the delivery suite at the Rotunda Hospital.
Padraicín Ní Mhurchú from the Home Birth Association of Ireland says "the demand for water birth is huge and much higher than the demand for home births.
"Some women opt for a home birth because they can use a water pool at home and they have had some experience of a water birth in midwifery-led units in places like Australia."
Ní Mhurchú estimates that up to half of all women who choose to have home births use a water pool. Hiring a water pool in Ireland costs around €250, but inflatable pools can also be purchased for approximately €125.
Some 60 per cent of Britain's 300 maternity units have water pools. A forthcoming joint statement from the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists supports the use of water pools during labour for low risk women.
Declan Devane of the School of Nursing and Midwifery, Trinity College Dublin, says: "If Ireland is to follow what is happening in Britain, the use of water pools will become much more popular here."
He continues: "Defining which mothers are low risk varies from hospital to hospital, but it often precludes women who have had pre-eclampsia [a precursor to a rare and serious disorder of eclampsia which is identified by high blood pressure, fluid retention and protein in the urine during pregnancy] and those who had previously had a Caesarean section delivery."
Generally speaking, the use of water pools during labour is widely supported among midwives and mothers alike. It helps women to relax and cope with contractions, feel more in control of labour and can reduce the use of pharmacological interventions.
There is also some evidence to suggest that it may shorten labour.
Some advocates of water births also suggest that water allows the perineal tissues to stretch more spontaneously so that birth can occur with minimum intervention.
One observational study over a nine-year period found women who gave birth using water were less likely to suffer "serious perineal trauma, use analgesia and have a lower blood loss than women in the landbirth group".
Another study has found that significantly fewer episiotomies were carried out on women who gave birth in water pools.
However, the biggest advantage of a water birth is to provide the baby with a gentler transition from the intra-uterine to extra-uterine environment - from womb to air.
Declan Devane explains: "The principle is that in water, the baby doesn't realise that the transition has been made and only gets the stimulus to breathe once he or she arrives at the surface of the water and experiences air."
There have been a number of studies pointing to the risks of water birth.
These studies, which are often based on individual case reports, point to the risk of the water becoming cross-infected with blood, meconium (the first stools passed by a newborn baby) or the amniotic fluids which surround the baby in the womb.
Individual cases of near-drowning and drowning have also been reported in medical literature. The risks of water temperature not being carefully controlled has also been raised.
Various guidelines suggest a temperature between 36 and 37 degrees Celsius provides the appropriate lack of stimulus from water too hot or too cold for the newborn baby.
"The problem with the research into water births is that there have been so few randomised controlled trials. The vast majority of the studies are retrospective or are based on case reports of adverse outcomes," says Devane.
"There isn't a large body of evidence to support underwater birth but complications are rare and if good practice guidelines are followed - for infection control and eligibility criteria - then complications should be very rare indeed."
See also www.infochoice.org