Waterbirth - should midwife encourage it?

[mears]

For women who get relief from it, I think the pool is fantastic for labour. I have had women who never thought of it and who ended up refusing to leave the water resulting in a waterbirth. I have had women who have lasted 5 minutes and hated it!
My belief is that women instinctively know if they are secure in the pool. I belief it is an option that should be tried prior to drugs if possible (no complications etc.).
My manager does not agree with me and thinks the request should come from the woman. There is a concern that women will be forced by midwives to have a waterbirth. I believe women make the decision themselves to stay in the water. I do not think it is an issue.
For those of you who laboured or delivered in water - whose idea was it? Do you think that the pool should only be used if requested by mother and not initiated by midwife?

Mears, I haven't laboured in water but only because I lived in a flat when I had ds and the ceiling wouldn't have held the weight so I couldn't have a pool. I did do a good few hours in our bath though and was told by my midwives to get out as it was slowing me down. They were completely right, it was and as soon as I got out things sped up big time. I find it very hard to believe that midwives will bully women to get into a pool - it seems much more likely that the pool will be busy or that the midwife will be uncertain about using it due to inexperience. Everyone I know who's done it raves about it and as you say, had strong instinctive feelings about when to get out/in. Coercion is never going to be a good idea in any aspect of labour but there's nothing wrong with midwives suggesting it as another pain relief option to try IMO.

I was offered use of the hospital pool in my first labour (nice innovative midwives, whom I'd had to fight to deliver at hospital), but didn't want to because I was so panicky and in so much pain by then (also because I'd tried the bath and it hadn't done anything and I wrongly assumed the pool would be exactly the same).

As I had a home birth second time round, obviously I thought of it and hired one - but only after many recommendations on mumsnet, I have to add. (I never actually intended particularly to deliver in water but it just happened!)

I definitely think it's something which should be on offer, just as other forms of pain relief are offered. I also think that women should have the option of delivering in the water if that's what they find they want, or find themselves doing (my sister is about to have a baby in a hospital where you can labour but not deliver in the water).

HTH.

PS pools IMO are totally fab.

I wanted to but dh wasnt keen - I think perhaps the Husband should be talked around and then the couple left to decide

Thanks motherinferior - as a point of interest - women should not be told that they cannot deliver in the water. Midwives have a responsibility to provide waterbirth as an option.
Here is the Royal College of Midwives position on it
here

It amazes me how units can still prevent women from exercising choice.

Good point codswallop.

Well when I got to the hospital this last time I, even though intending to have the pool before, had gotten into a frame of mind where I just didn't want to have the water. It wasn't a rational feeling, just a 'no the idea feels funny thanks'. I think I wasn't feeling confident enough.

By the time pupuce got to the hospital though I was finding it impossible to get into a better position because of the SPD...she suggested/encouraged it again and pointed out that if I didn't like it I could just get out...so I tried it (had to walk down the corridor with 3 people holding me up.

Once I was in though there was no way I was getting out. The freedom it gave me to move was great...and my baby was so clean

So I think that if the mother is open to idea, maybe if it is mentioned in her birth plan for instance then a m/w could encourage it. I guess I think that its a different sort of pain relief from epidural/pethidine etc which are much more often used and long lasting, I mean you can get out of the pool if it isn't working out for you and have't done something that is going to take hours to reverse iykwim.

I would have loved a water-birth - but my labour took days, and it turned out dd was posterior and I just wasn't dilating, so ended up with an epidural and drip to help contractions. Maybe next time ...

I definitely think that the pool should be actively offered just like other forms of pain relief. Ideally this should happen before the birth as part of the birth plan. My midwives were amazing and really did read my plan, when I'd been having contractions for over 48 hours and was hollering for an epidural the lovely midwife actually said, "I see from your plan that you'd like to avoid it if possible, so here are some other options ... " And we gave some other things a go for a few hours before the epidural was in the end necessary. That's why I feel so positive about my labour. It's all about giving women all the options and helping them make choices they are happy with.

I had always liked the idea of a waterbirth from the beginning and so I made a point of putting it on my birth plan. I was an avid reader of pregnancy mags and so no form of pain-relief had escaped my notice. In the event I got in the water but becasue my labour was so intense (3 hours start to finish for a 1st baby) I found I didn't feel the benefit, I think the pain was bit too advanced for water to really make a difference. When it came to the crunch I wanted to walk around as I felt that moving really helped me through the pain. My DD was delivered without pain relief (wanted to go as far as poss without an epidural or narcotics and had gone too far when I felt I needed them!).

I agree with you that the midwife should make clear all the options for childbirth. It seems a bit prehistoric to suggest that you can only have it if you are in a position to request it (eg, you have the knowledge in the first place).

Haven't had a waterbirth mears, but in general I think it is good for the midwife to promote all the options - I think too much is expected of the woman if she is supposed to think rationally and consider all the options when in labour - it could be she hasn't remembered it, and the suggestion will be just what she needs!

I laboured in water but didn't deliver. Would have liked to deliver in the pool but labour was very very slow and I was exhausted so in the end I requested an epidural and I had to get out of the pool. I loved it and would try it again. I requested it, but I don't see why midwives shouldn't suggest it if the woman doesn't ask, after all shouldn't the widwife be able to discuss all the pain releif options available?

So how are women who might not have realised a pool is available as an option supposed to know about it? Surely it is the MW's job to lay out all the options in a factual, non-directive sort of way?
I did spend time in a pool, and I'm very glad I did, but I would say that there were many points, throughout my ante and post natal experiences where I felt that I was not an individual, but a pawn in a campaign of one kind or another, (on both sides of the low/high-tech divide).

I can't see what could possibly be wrong with MWs suggesting things which may be of support: during labour my mdwives suggested all sorts of things, all of which had been discussed with me in advance, and when the time came, I rejected some and accepted others...but you need the professionals to give you the full range of options in advance, and you then need them to remind you of them in the heat of the moment.

My first labour was 20 hours long, agonisingly painful and punctuated by largely ineffective drugs which didn't take the pain away but did make me talk a load of rubbish. My ds was eventually born by ventouse.

My second and third labours were 6 and 4 hours respectively, the pain was bearable with only gas and air (and I'm a coward)and I felt in control the whole time.

The difference? The first labour was with a midwife who made me lie down wired up to a monitor the whole time the second and third were in a different hospital and were water births.

I'd take the water option every time. Both my babies were born in the water (my decision). The second time the midwife told me to get out of the water to deliver because they didn't have the right number of qualified people present. Figuring that they couldn't make me I refused (and the midwife was really pleased afterwards).

This is an interesting thread. When I was pregnant with ds I always thought I might like to try the pool at the hospital, but in the end I had an unplanned homebirth (and so no pool was available). Tried the bath, didn't like it - I was interested to hear what you said about the pool being nothing like, motherinferior.

Mears - it was always my idea. I had babies 2 & 3 in the pool - labour and delivery. Last time round had to fight to get them to let me in the pool (they thought I wasn't far on - having had 2 quick labours I knew I had less than an hour! Fortunately had dh to fight for me.)

I loved the waterbirths - fantastic pain relief, and generally a wonderful feeling. But it was much better first time with a midwife who was clearly more positive about waterbirths, and more supportive of my decision.

IME lots of women think waterbirths are odd and a bit freaky, and would have no interest in them anyway. But I don't see any reason why a m/w should not mention it as an option to anyone, along with other possibilities.

I didn't have a waterbirth or waterlabour (?), but think that midwives should make women aware of all available options. My first labour I would have gone for it, I'm sure. I would probably have given it a go the second time, too. Is it possible to be hooked up to an IV and do it? I needed the IV antibiotics for GBS. (I'm just curious. If you needed to keep it out of the water, you could put the line in the wrist maybe?) Truthfully, I couldn't have gotten through either labour without the suggestions and reminders from the nurses/midwives.

Mears, I never did get to labour in water, but was keen to. Our newly built Women's Services Unit has an excellent large permanent pool in one of the suites and has published a leaflet encouraging its use. My community team were cautiously in favour (no-one seemed to have read Michel Odent on the benefits of water especially for would-be VBACs...). My consultant was initially OK about it until it became clear I'd need another c-section, but I felt everyone involved ought to have been promoting it to the hilt. A lot of people don't have access to Mumsnet, or NCT publications, or even baby magazines, and think a pool is the same as having a bath. Midwives are well-placed to inform women about this option. If a client didn't know about gas and air I bet your manager would go bananas if a midwife took that to mean it shouldn't be offered...
I think you are totally right to be suggesting it to anyone who might benefit and I wish more midwives were like you. But then again, with Mears in charge, most of us lot would happily give birth perched on a rooftop
Good luck with your campaign!

JJ - we have had women request to use the pool who have had GBS. You don't actually have to have a full drip - just the cannula in your hand is enough for the antibiotics. They were able to use the pool and have antibiotics as well.

Mears

I had a fantastic waterbirth with No 2, who was actually induced.

It NEVER occurred to me prior to the birth to have a WB. My wonderful midwife suggested it after my labour was well established, and all I kept saying was "I didn't think you could have a WB with an induction" - I think I said this many times LOL!

Anyway, got in the water, and once there really didn't want to get out. My midwife never told me to get out/stay in - just left it to me to decide. At one point, I did say I wanted to get out - stood up, had a very bad contraction - said "sod that, I'm staying put" LOL!

My son was born about 20 minutes later and the birth was fantastic. Desperately wanted a WB with my 3rd child, but she was too keen to get out and I was fully dilated on arrival at hospital!

I totally agree with you - and I am so grateful to Teresa, my midwife who suggested the WB (even though I was induced!) and allowed me to experience such a wonderful thing

Thanks mears. Does your manager not want you to say anything about any pain relief or is it just water births? I mean, water labours are pain relief in many cases, right? They're easier to get out of than a shot of stadol (? don't know the UK equivalent -- demerol?) at any rate. Still, it wore off after a while. I do wish I had been offered a water birth my first pregnancy, but know it wasn't available at that hospital (small community hospital) nearly 6 years ago.

Anyway, you give me his entire argument and I'll rip it to shreds. And we should have a sign for nights we're up drinking wine.

I had a home birth, and hired a pool. I didn't really have any fixed ideas about whether I was going to give birth in it or not. I laboured in the water for quite a long time, but when I started pushing I wanted to get out - it just felt that that was the right thing to do at the time.

I always planned to labour in water first time around but due to staff shortages I saw a different midwife every appointment and only got to do my birth plan very late on. My midwife told me that to use the pool I had to "book" I rang the hospital and left a message but went into labour before anyone got back in touch with me.

When I arrived in hospital I asked about using the pool and the midwife said she would ask, meanwhile would I like to use the bath. I did so but found it quite restricting (too small and couldn't get in the right position as dd was back to back). The midwife never got back to me about using the pool.

This time I am planning a homebirth and would like to hire a pool but the midwife has told me that no-one on my team is trained. I am seriously rhinking of writing to the SOM informing her of my intention to labour in water and that I expect a competent midwife to attend.

What do you think, is this too bolshy? I really like my midwife and it is a novelty to see the same person each time, so I don't really want to go nehind her back but if I wait until I see her again it will be December and I am due in February.

Mears - as you know I have been a doula to quite a few women who had water births.... IME some of them would not have asked for it - simple ignorance of what it can do for them and how it works"... I have letters to testify how happy they were when we suggested it !
As you say if they don't like it they cna get out.

My 2 water labours were my idea.
In the 6 water births that I have attended, 2 had requested it and 4 had it when it was suggested to them.

I have seen 1 MW suggest them (routinely in appropriate situations) and sometimes the parents went for it and other times they didn't.