Development and implementation of a multi pronged strategy designed to increase access to water immersion during labour — ASN Events
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Development and implementation of a multi pronged strategy designed to increase access to water immersion during labour (#7)

Valerie Slavin 1 , Carolyn Hastie 2 , Sally Byford 3 , Faye Duke 3 , Tracy Roper 3 , Abigail Taylor 3 , Rhianna Crosthwaite 3 , Monique French 3
  1. Women, Newborn & Childrens Services / School of Nursing and Midwifery, Gold Coast Health / Griffith University, Southport, QLD, Australia
  2. School of Nursing and Midwifery, Griffith University, Southport, Qld, Australia
  3. Women, Newborn and Childrens Services, Gold Coast Health, Southport, Queensland, Australia

Background / Aims

Warm water immersion (WWI) is an effective form of pain relief during labour1-3 yet many women are denied access.4-6  To better support women’s choices, improving access to WWI during labour was identified as a priority area at Gold Coast University Hospital. A 2-year program of work was conducted with the aim of developing, implementing and evaluating a strategy designed to increase safe access to WWI during labour.

Methods

A mixed method multi-phase project was conducted between 2021 and 2023 including: (1) literature review; (2) local clinical audit; (3) national scope of practice. 

Results

While the safety of WWI was established for most women during the first stage of labour and for waterbirth for women deemed ‘low risk’, insufficient evidence was identified to inform the safety of waterbirth for other women. Significant variation was identified in woman’s accessibility of WWI. Of the 11 national responding  hospitals, 8 (73%) reported they support WWI for women experiencing oxytocin infusion or those with uterine scar, depending on the ‘support of the treating team on the day’ and despite the absence of a supporting clinical guideline. Similar findings were identified at GCUH. Evidence of widespread, albeit ad hoc support of WWI for women deemed ‘not low risk’ supported the development of a clinical practice guideline, consumer resources and targeted implementation plan designed to facilitate safe, effective and transparent clinical governance processes pertaining to WWI. Since implementation, rate of WWI has doubled and increased 14-fold for women experiencing induction of labour; women planning vaginal birth after caesarean section continue to experience inequitable access to WWI. Rates of waterbirth remain unchanged.

Conclusion

The strategy has successfully increased safe access to WWI for some women but further work is needed to deliver equitable access. Statewide uptake of the strategy is recommended.

  1. Clews, C., Church, S., & Ekberg, M. (2020). Women and waterbirth: A systematic meta-synthesis of qualitative studies. Women and Birth: Journal of the Australian College of Midwives, 33(6), 566-573
  2. Feeley, C., Cooper, M., & Burns, E. (2021). A systematic meta‐thematic synthesis to examine the views and experiences of women following water immersion during labour and waterbirth. Journal of Advanced Nursing, 77(7), 2942-2956
  3. Cluett., Burns., Cuthbert, & Cluett (2018). Immersion in water during labour and birth. Cochrane Library, 2018(6), CD000111-CD000111.
  4. Young, K. & Kruske, S. (2012). Water immersion in Queensland: Evidence, access and uptake. Queensland Centre for Mothers and Babies. University of Queensland.
  5. Milosevic, S., Channon, S., Hughes, J., Hunter, B., Nolan, M., Milton, R., & Sanders, J. (2020). Factors influencing water immersion during labour: Qualitative case studies of six maternity units in the United Kingdom. BMC Pregnancy and Childbirth, 20(1), 719.
  6. Newnham, E. C., McKellar, L. V., & Pincombe, J. I. (2015). Documenting risk: a comparison of policy and information pamphlets for using epidural or water in labour. Women and Birth : Journal of the Australian College of Midwives, 28(3), 221–7.
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