Allow Victorian women to use water for pain relief in birth
Allow Victorian women to use water for pain relief in birth
BIRTHING CHOICES FURTHER REMOVED IN VICTORIA!
USE OF WATER IN LABOUR BANNED!
The use of water is an affective pain relief for a birthing woman. The use of water shower or bath has now been removed in Victoria. Victoria is already limited in pain relief options with the use of Gas also been banned in most hospitals. THIS IS NOT EVIDENCE BASED- See the statement from the Australian College of Midwives below.
ACM’s updated position on use of water in labour
The Australian College of Midwives (ACM) has assessed the current evidence in relation to the safety of access to water immersion during labour and birth. Having reviewed the available evidence, it is ACM’s position that the current evidence does not support discontinuing the use of water in labour or of water immersion. This is especially true if the laboring woman is not suspected or confirmed as having contracted COVID-19.
ACM appreciates the situation in COVID-19 hotspot areas is confronting, and recognises the desire to prioritise the safety of health care workers. However, we encourage hospitals to act in accordance with clinical evidence.
ACM notes that our position is aligned to that of the United Kingdom’s Royal College of Midwives (RCM) as outlined in their Clinical Briefing Sheet – Waterbirth during the COVID-19 pandemic (29-July-2020) which recommends that “current evidence does not suggest that there should be a blanket cessation on the use of water in labour or waterbirth for all women.” The RCM Clinical Briefing Sheet can be accessed at the following link:
Water immersion for labour and birth during the COVID-19 pandemic
The COVID-19 pandemic has elicited changes to the provision of maternity care around the country. Directives and policies have been initiated with recognition of the significant risks associated with the virus and the devastating outcomes that have been seen across Australia and the world. ACM supports the implementation of evidence-based practice to safeguard as much as possible, the health and wellbeing of both women and their babies but also midwives, obstetricians and other health care workers who are providing care.
The rapid and dynamic changes in directives, while necessary in light of the evolving situation, have resulted in women experiencing heightened uncertainty, anxiety and fear. Women have expressed frustration with policies and recommendations that have limited their ability to exercise choice, especially those that have limited support people and impacted on their birth preferences (1). Concerns have been raised about the short and long-term impacts of such decisions on women’s mental wellbeing.
ACM supports a woman’s right to exercise informed choice about all aspects of their pregnancy, childbearing and transition to parenthood, with this including the use of pain reducing strategies beyond the available pharmacological methods. This includes the use of water immersion during labour and birth.
We have recently become aware of recommendations surrounding the use of water immersion for labour and birth in response to the COVID-19 pandemic. More specifically, we hold concerns about a recent recommendation that advises that the use of water immersion for labour and birth be suspended for all womenin areas of high community transmission and in particular, the suggestion that the practice presents an ‘unacceptable risk.’
Immersion in warm water provides women with much more than pain relief; research demonstrates that women feel a greater sense of safety, privacy, control and self-determination when immersed in a bath of water (2-4). The pool provides a physical barrier between the woman and her environment with this facilitating a sense of protection, both from distractions and interventions and the creation of a personal space leading to ease of movement and synergy between mind and body (2, 5). The benefits are well-documented. While concerns surrounding the safety of water immersion have been raised, research consistently demonstrates that there is no increased risk when compared with labour and birth out of water (6-8).
While we acknowledge and support the recommendations that have been implemented to slow and stop the spread of COVID-19, we continue to hold that women who choose to labour and/or birth in water are supported to do so, where there are no known contraindications. ACM has not found evidence that warm water immersion poses an ‘unacceptable risk’ to clinical staff, women and/or their babies but instead, an effective option for not only supporting women to achieve a normal, physiological birth but also for facilitating a positive and satisfying birth experience. Furthermore, this decision seems out-of-step with a further recommendation relating to the use of nitrous oxide. Despite the potential for aerosolisation as a result of nitrous oxide use, a ‘cautious approach’ is advised for women with suspected COVID-19 and usual practice for those at low-risk of COVID-19.
In light of the paucity of research to suggest that warm water immersion during labour and/or birth presents additional risks to well women and their babies in an area of high community transmission or indeed, any other setting, we implore those who have suspended the practice to reinstate access as a matter of urgency.
COVID-19 and water immersion: key points
· COVID-19 is not a waterborne virus; it is transmitted through air via droplets (due to coughing, sneezing, breathing) or from surfaces that may be contaminated by said droplets; as such, the act of immersing in warm water during labour and/or birth is not likely to increase the risk of transmission, instead it may actually reduce the risk of transmission.
· A watery environment dilutes any potential risk of respiratory droplet and/or faecal contamination (NOTE: Testing of faecal samples has been conducted in water due to the reduced risk of droplet and aerosol contamination (9)).
· While COVID-19 may be found in faeces, there is currently no evidence of faecal-oral transmission (10).
· Acknowledging that faecal contamination has been raised as a concern, it is important to note that the water has the effect of diluting virus particles that may be present providing some level of protection against transmission particularly when compared with land birth.
· The physical barrier offered by the bath/pool assists with social distancing between the woman and those who are present for labour and/or birth including midwives and support people.
· Women who give birth in water commonly receive their baby and gently guide their baby to the surface thereby reducing contact between the woman (and baby) and midwives (unless, of course, there is a need to intervene).
· Adherence to birth pool cleaning protocols further reduces if not eliminates the risk of transmission to subsequent users.
· Midwives have ready access to personal protective equipment (PPE).
1. Cooper M, King R. Women's experiences of maternity care during the height of the COVID-19 pandemic in Australia. Canberra: Australian College of Midwives; 2020.
2. Ulfsdottir H, Saltvedt S, Ekborn M, Georgsson S. Like an empowering micro-home: a qualitative study of women's experience of giving birth in water. Midwifery. 2018;67:26-31.
3. Cooper M, Warland J. What are the benefits? Are they concerned? Women's experiences of water immersion for labor and birth. Midwifery. 2019;79:102541.
4. Fair CD, Crawford A, Houpt B, Latham V. “After having a waterbirth, I feel like it's the only way people should deliver babies”: The decision making process of women who plan a waterbirth. Midwifery. 2020;82:102622.
5. Carlsson T, Ulfsdottir H. Waterbirth in low‐risk pregnancy: An exploration of women’s experiences. Journal of Advanced Nursing. 2020;76(5):1221-31.
6. Neiman E, Austin E, Tan A, Anderson CM, Chipps E. Outcomes of waterbirth in a US hospital‐based midwifery practice: a retrospective cohort study of water immersion during labor and birth. Journal of Midwifery & Women's Health. 2020;65(2):216-23.
7. Snapp C, Stapleton SR, Wright J, Niemczyk NA, Jolles D. The Experience of Land and Water Birth Within the American Association of Birth Centers Perinatal Data Registry, 2012-2017. The Journal of Perinatal & Neonatal Nursing. 2020;34(1):16-26.
8. Hodgson ZG, Comfort LR, Albert AA. Water Birth and Perinatal Outcomes in British Columbia: A Retrospective Cohort Study. Journal of Obstetrics and Gynaecology Canada. 2020;42(2):150-5.
9. Wang W, Xu Y, Gao R, Lu R, Han K, Wu G, et al. Detection of SARS-CoV-2 in different types of clinical specimens. Jama. 2020;323(18):1843-4.
10. World Health Organisation (WHO). Water, sanitation, hygiene and waste management for the COVID-19 virus Technical brief 3 March 2020 2020 [Available from: https://apps.who.int/iris/bitstream/handle/10665/331305/WHO-2019-NcOV-IPC_WASH-2020.1-eng.pdf
“Anyone who has either laboured, or watched their partner labour, can tell you that sitting in a warm bath or standing under a hot shower is one of the most effective non-pharmacological methods of pain relief available. What’s more, there is an ever-growing evidence base to support this very commonly understood fact as well as the multitude of benefits that warm water provides.
Earlier this week, the Australian College of Midwives (ACM) became aware that some hospitals have commenced disallowing water immersion or showers for labouring women. This appears to be in response to a recommendation made by SAFER CARE VICTORIA AND RANZCOG that suggests that water immersion should be suspended for all women in COVID-19 hotspots, including women who have not contracted the virus. Unfortunately, these recommendations do not appear to be based on clinical evidence nor do they demonstrate that banning water immersion and showering will help reduce the risk of transmission of COVID-19.
Having considered available evidence, ACM calls for all hospitals to continue to provide water immersion and showering for labouring women. In fact, water immersion and/or birth and showering in labour may actually provide specific benefits to the risk of transmission of COVID-19. Here are the facts:
· COVID-19 is not a waterborne virus; it is transmitted through air or from surfaces via droplets (due to coughing, sneezing, breathing). The act of immersing in warm water may actually reduce the risk of transmission.
· A watery environment dilutes any potential risk of respiratory droplet and/or faecal contamination also, while COVID-19 may be found in faeces, there is currently no evidence of faecal-oral transmission.
· Water has the effect of diluting any virus particles that may be present providing some level of protection against transmission particularly when compared with land birth.
· The physical barrier offered by the bath assists with social distancing between the woman and those who are with her including midwives and support people.
· Women who give birth in water commonly receive their baby and gently guide their baby to the surface themselves thereby reducing contact between the woman and baby, and midwives (unless, of course, there is a need to intervene).
· Birth pool cleaning protocols are already stringent and adhered to after every episode of water immersion.
The Australian College of Midwives’ Midwifery Advisor Dr Megan Cooper, whose focus of study centered around water immersion said, “The decision to deny women access to the shower is one of the worst I have seen. It certainly makes you question whether there’s an ulterior motive here. Scare mongering and removing a completely safe, natural method of pain relief will mean more women turn to pharmacological options which for many women, is completely unnecessary.”
“ACM supports recommendations that have been implemented to slow and stop the spread of COVID-19, but this new recommendation is nonsensical. We are now denying women an effective option of pain relief and the opportunity to achieve a normal, physiological birth that is a positive and satisfying experience, for no evidence-based reason.””
FULL AMC STATEMENT HERE ��
AMC MIDWIFERY ADVISOR: Megan Cooper 0409 199 087
Safer Care Victoria