Help in Labour - Waterbirth (W/S 8) Flashcards
What potential benefits does waterbirth provide?
- “philosophy of non-intervention”
- a means of facilitating birth without pharmacological pain relief (studies show reduced use of pharmacological analgesia)
- often more choice, control, privacy, shelter, protection and relaxation for the woman
- One-to-one care by the midwife (many Guidelines say woman is not to be left alone)
- ease of movement
- studies show reduced duration of first stage of labour
- no evidence of increased adverse effects to the
baby or woman from either the first or second stage of labour.
What should water temperature be for a waterbirth?
Many Clinical Guidelines suggest 36.5-37 however no evidence around strict temperature levels .
RCOG & RCM statement 2006: ‘there may be more benefit to allow women to regulate the pool temperature to their own comfort’
Hyperthermia should be avoided as it may override
the baby’s natural inhibition of breathing.
How do APGAR scores differ for waterbirth compared to land and why?
Slower adaptation to extra-uterine life is reported with lower 1 minute APGARs, however 5 minute APGARs
are the same. Thought to be due to less noise,
handling, bright lights, etc.
What are the criteria for waterbirth?
- Low risk pregnancy and labour
- Term gestation (>36 weeks)
What are exclusion criteria for waterbirth?
- Complicated pregnancy or labour
- Use of opioids
What equipment is recommended / needed for a waterbirth?
- Running hot and cold water
- Adequate supply of towels
- Sieve—for keeping water as free of faecal contamination as possible
- Waterproof torch
- Mirror
- Waterproof Doppler
- Bed or mattress nearby
- ?Portable N2O O2
What can labour management look like during a waterbirth? (7)
- Ensure active labour
- Fill tub to the woman’s chest
- Maintain the water temperature according to the woman’s comfort or local Guidelines
- Carry out routine labour obs
- Encourage fluids
- Use the sieve to remove faecal matter
- Ask the woman to leave the tub to pass urine
What can birth management look like during a waterbirth?
- Remain with the woman
- Carry out routine second stage obs
- Use a ‘hands-off’ technique to keep tactile stimulation to a minimum
- Usually not necessary to check for a nuchal cord. In most cases the nuchal cord can be loosened and
looped over the baby’s head or disentangled under water as the baby is born - The baby should be born completely under the water and brought gently to the surface
- Avoid sudden cord traction to avoid cord snapping
Following a waterbirth, what does midwifery management look like?
- Watch the baby’s face so that it does not re-submerge
- APGAR score may be lower at 1 minute than land birth
- Maintain the baby’s temperature
- Conduct a physiological third stage, where the cord is left unclamped until the placenta and membranes have been passed
- For active management the woman must leave the tub
- Monitor blood loss continually by watching the colour of the tub water
- Assist the woman from the tub to a mattress on the floor or very nearby couch or bed
When must the woman must be asked to leave the tub? (8)
- Fetal distress
- Meconium
- Slow progress in labour (any stage)
- Use of narcotic analgesia
- Tight nuchal cord.
- Maternal hyperthermia—this may lead to the overriding of the baby’s normal inhibition of breathing
- Shoulder dystocia
- Postpartum haemorrhage
What are potential risks/complications/disadvantages of waterbirth?
- Increased cord snapping
- Potential for gasping at birth, inhaling water into lungs if the fetus were experiencing severe acute hypoxia.
- Some studies found increased perineal trauma and higher rate of 3rd degree tears
Example exam question - “Sam is 36 weeks pregnant and is interested in using a bath during labour and birth. What points would you discuss to ensure Sam is fully informed?”
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