December 08, 2003

Water birth policies

The question of what constitutes a “Birth Centre” has come up. Last weekend when I was at Sutherland District Hospital, the midwives told me of their plans to set up a Birth Centre in the labour ward area. They asked me for some ideas about how they could make it different from the main labour room area, all of which is newly constructed with an en-suite bathroom (with tub and shower) for each labour rom. At the present time, two rooms have been set aside for the “Birth Centre” and these have been equipped with very expensive hydraulic double beds, other wise they are almost identical to the regular labour rooms.

When Birth Centres were first established in Australia (almost 20 years ago now), the concept was a place in which a natural birth could take place. The decor wasn’t all that wonderful in many cases, as usually the area allocated was a re-cycled facility rathe than a purpose built one. However, with a bit of imaginative decoration they came up quite well, and emulated a home like setting, with regular pine furniture, settees (sometimes fold away double beds) kitchen type table and chair settings and an en-suite bathroom. The baths were usually like those at home, not the large tubs that came later, but even then some babies were born in water - it was no big deal.

What made Birth Centres different was their philosophy that no drugs would be offered or used and that women would need to use other means, such as heat and water, to ease their pain. Friends and family were welcomed (even necessary) and attendance at a quality prenatal class was mandatory, so that parents felt confident in being able to “look after themselves” as much as possible. The women able to use these facilities were all deemed low risk and the transfer rate was fairly high, because strict limitations were imposed by the obstetricians who were doubtful about normal births and felt threatened by the Birth Centres’ increasing popularity.

A lot of experience has now been accumulated in Birth Centres and a lot of research has focussed on their outcomes. We know they work well, that women like them, and that babies do better when born in these kinds of facilities. Given all that, the transfer rates are still high, although some of the acceptance criteria have been dropped. Many Birth Centres now support VBAC (Vaginal Birth After Caesarean) and the age limitations have been relaxed.

It seems that the use of water, however, has become more limited. I have learned, in the past few weeks, that many of the Birth Centres in Australia are now not “allowing” water births. Women may be encouraged to use the tub for labour but are asked to get out for the birth. I have been told, that the reasons for this restrictive practice, are that “the hospital doesn’t have a policy on water birth” and “the staff have not had training”.

These days, it seems that even sneezing in hospital requires a policy ! Given that there are plenty of guidelines around such as Sheila Kitzinger and Ethel Burns excellent manual, it is hard to imagine why hospitals can’t quickly establish a set of policies. As for staff training, this is also easy - midwives just have to learn to keep their hands off!

For women arriving into hospital in labour and spying a large inviting bathtub it must be very unsettling to know that it can only be used for the labour and that they will have to struggle out when the birth is imminent. This is not only dangerous, but just plain silly. One women, booked to give birth in a hospital in the north of the State, took matters into her own hands. She arrived in labour with a letter that she handed out to everyone, clearly stating that if she wanted to give birth in the bath and someone pulled the plug to prevent a water birth, she would personally sue the doctor, the hospital, and the Regional Health authority. That Region had a policy in place within a week. I feel sure that this could be achieved elsewhere - it just requires a concentration of the mind.

As for training the of staff, these are skills that must be learned “on the job”. We will be offering some water birth workshops early next year to show midwives how easy and useful it is to facilitate a water birth - let’s hope that then our Birth Centres can get up to speed with the care that women are wanting.

Posted by andrea at December 08, 2003 03:07 PM

Comments

I'd just like to paint a picture of my experience birthing in a NSW hospital-based birth centre, to contrast with the ideals that Andrea stated were originally in place.

1. No drugs. I could have either nitrous oxide or pethidine. I took the nitrous oxide because the support I was getting was pretty hopeless.

2. Environment. Basically just a bigger delivery suite with a bath tub. Regular hospital bed that was just a (slightly) larger size.

3. Bath/water birth. I was never told about or encouraged to have a water birth. I got in the bath but when the pain became too strong for me in there (I really needed mobility) instead of offering to walk me around or try the shower or something, I was offered the gas. I was not in an emotional state to disagree.

4. Support people. Husband and midwife. Midwife was only in the room every now and then. One husband definitely not enough support. I was not encouraged (prior to the labour) to have any more than one support person.

5. Childbirth education. Definitely not mandatory; I did not attend and was never encouraged to.

Another point: Prior to birth I expressed desire for physiological third stage and for my baby to have oral vit k. These decisions were, however, taken out of my hands at the last moments when I had just given birth - at my most vulnerable.

'Birth centre' in name only, methinks. The experience was enough to make me very sceptical about hospital birth centres, which seem to just be a bit of a PR exercise on behalf of the hospital. Other women I know tell a similar story with the theme being always the physical and emotional absence of the midwife. 'With woman'? Not in NSW public hospitals.

Posted by: Kelsey on December 13, 2003 12:30 AM

Comments

You may find it interesting to visit the sites about poker card, casino no deposit, online casino casions, gambling cash, blackjack sites, roulette casions, gamble tip, internet casino web, slot machine odds, online casino bonus deposit, online gamble game, casino gambling strategies, casino game strategies, las vegas table, video poker casinos, roulette online card, slot rule, blackjack online deposit, blackjack betting 3d, poker 888, gambling 8888, blackjack tip, poker on net, casino casions, casino gaming, gambling no deposit. .

Posted by: blackjack on January 19, 2004 10:38 AM