Use of Baths during Labour and Birth · Web viewit is often difficult to be exact in determining blood loss. Midwives should observe water colour and woman’s condition carefully

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Canberra Hospital and Health ServicesClinical Procedure Use of Baths during Labour & Birth Contents

Contents....................................................................................................................................1

Purpose.....................................................................................................................................2

Alerts.........................................................................................................................................2

Scope........................................................................................................................................ 2

Section 1 – General Information...............................................................................................2

Section 2 – Waterbirth competency and education requirements...........................................3

Section 3 – Prior to using the bath in labour and/or birth........................................................3

Section 4 – Contraindications to use of bath in labour and /or birth........................................3

Section 5 – Practice Points........................................................................................................4

Section 6 – Health and Safety Concerns....................................................................................6

Section 7 – Emergency Bath Lifting Mat...................................................................................6

Related Policies, Procedures, Guidelines and Legislation.........................................................6

References................................................................................................................................ 7

Search Terms............................................................................................................................ 8

Doc Number Version Issued Review Date Area Responsible PageCHHS17/222 1 11/09/2017 01/09/2022 WY&C 1 of 8

Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register

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Purpose

The purpose of this document is to outline the delivery of appropriate and safe care for women who make an informed choice to use baths during all stages of labour including birth.

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Alerts

If a woman chooses to continue in the bath contrary to the advice of the midwife or medical officer, the staff member should notify the Continuity CMC, the Obstetric Registrar and/or Birthing Team Leader, and document all of the advice provided, discussion and subsequent outcome in clinical records


Scope

Scope

This document applies to Canberra Hospital Health Services (CHHS) clinical staff working within their scope of practice including: Medical Officers Registered Nurses and Midwives Students working under supervision



This Standard Operating Procedure (SOP) describes for staff the process to

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Possible advantages of using warm water immersion during labour include: decreased use of epidural analgesia enhanced production of endorphins hence aiding relaxation assistance in changing or maintaining positions by supporting woman’s weight provides a sense of privacy thereby decreasing inhibitions and distractions.


Section 2 – Waterbirth competency and education requirements

Midwives inexperienced with waterbirth will: Attend a minimum of two waterbirths as the primary midwife with a midwife

experienced with waterbirth present/assisting attend the CHWC waterbirth in-service/education session and complete the waterbirth

competency checklist. The education session and competency are available from the Clinical Development Midwives

be familiar with the principles of all stages of labour in water seek assistance from an experienced midwife at any time support is required all staff will attend annual manual handling training including bath evacuations.


Section 3 – Prior to using the bath in labour and/or birth

During pregnancy and/or labour care midwives will discuss the possible advantages and disadvantages of water immersion during labour and birth. This information should include prerequisites and contraindications, as well as the reasons a woman may be asked to leave the water. Women should be informed that whilst maternal autonomy and choice are respected, they should be prepared to leave the bath if midwives/medical staff has concerns regarding maternal/fetal wellbeing.

Prerequisites to use of bath in labour: Term, cephalic baby with reassuring fetal heart rate well hydrated, afebrile woman

Prerequisites to birthing in bath: Term cephalic baby with reassuring fetal heart rate and clear liquor well hydrated, afebrile woman no oils, soaps etc added to bath water.


Section 4 – Contraindications to use of bath in labour and /or birth

Contraindications to use of bath in labour: Antepartum Haemorrhage (APH)



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Febrile woman active herpes infection/genital lesions non reassuring fetal heart rate Poor quality Cardiotocograph (CTG) tracing where a good quality trace is unable to be

achieved. the use of a fetal scalp electrode mobility/skeletal issues that may prevent leaving the bath when necessary known HIV positive, Hepatitis B or Hepatitis C. BMI over 35kg/m2 at term. women who have received narcotic analgesia in the last 4 hours (or are still affected by

same). Nitrous oxide and oxygen may be used for pain management for women labouring in the bath.

Note: There have been no studies to indicate any associated increased risks for women with group B strep infection when using baths during labour

Contraindications to birthing in bath: As above for labour pre-eclampsia requiring medication as this may alter fetal reflexes non reassuring fetal heart rate or meconium stained liquor high risk of shoulder dystocia history of post-partum haemorrhage in excess of 1000mls intrauterine growth restriction previous caesarean birth.


Section 5 – Practice Points

First and Second Stage of labour There is some evidence to suggest waiting to enter the bath until cervical dilation is

>5cm may decrease length of labour and need for augmentation. Other methods of pain management may be more appropriate in early labour.

Document all care and observations as usual including the time the woman enters and leaves the bath as well as her reason for leaving bath in clinical records.

Record the woman’s temperature prior to entering the bath and record her temperature hourly while immersed. If the woman’s temperature rises more than 1 degree Celsius from her pre-bath baseline temperature or if she has two consecutive temperatures above 37.4, fetal oxygen consumption may also rise increasing the risk of fetal hypoxia. The woman should be asked to leave the bath until her temperature has returned to baseline. An increased temperature can also be a sign of infection or dehydration.

Encourage additional oral fluids while immersed to prevent dehydration



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A midwife / medical officer may perform a vaginal examination underwater if deemed necessary. The woman should leave the water if the midwife / medical officer cannot perform an accurate assessment.

Inform the woman of the need to keep perineum completely submerged during birth as the change in temperature or pressure with partial submersion may stimulate the baby to breathe.

Assist the woman to leave the bath if desired or required Maintain bath water at temperature that the woman finds comfortable. Keep the room

warm for when the woman exits the bath.

Birth in water If the woman plans to birth in the water and birth is imminent ensure a second midwife

is available to assist. Ensure that Neonatal resuscitation equipment is prepared and available as per usual practice.

Water birth should be “hands off” as much as possible to avoid stimulation of the baby. Immersion in water appears to facilitate slow crowning of the head and this should be encouraged with gentle and clear communication to facilitate controlled birth of the head and minimise perineal trauma.

The midwife/medical officer can loosen the cord and disentangle as the baby is born if required. Do not attempt to cut and clamp a tight nuchal cord underwater as this may stimulate respirations. The woman should be assisted to stand before cutting and clamping a tight cord.

Be aware of the small possibility of cord avulsion, particularly in the event of a short umbilical cord. Undue traction on the cord should be avoided and cord clamps should be readily available. If any blood loss is evident, early cord clamping should be performed immediately due to the slight possibility of blood loss being fetal. Cord snapping at a water birth is not an emergency if it is recognised promptly. Neonatal review is recommended if the umbilical cord snaps.

The baby should be gently lifted to surface as soon as born – often by the mother or her partner. The baby’s body can be kept submerged to keep baby warm, gently dry the face and head to aid warmth and stimulate respirations. The baby’s head must not be re-submerged under water once it has surfaced. Warm towels should be available for baby and mother.

The midwife/medical officer should ensure that if concerned about the condition of the baby, the cord should be clamped and cut, and the baby removed from the bath for resuscitation.

The woman should be immediately assisted to leave bath in the event of any emergency e.g. shoulder dystocia, antepartum haemorrhage (APH) or postpartum haemorrhage (PPH).

Third Stage of labour: The usual indications for active management of 3rd stage should be followed there is no reliable data on third-stage management in the bath and the benefits and

risks are not known



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If active management is chosen for third stage, syntocinon can be given into the upper arm if the woman’s thigh is under water and the woman assisted out of the bath or the bathwater drained before controlled cord traction for delivery of the placenta.

it is often difficult to be exact in determining blood loss. Midwives should observe water colour and woman’s condition carefully. If the midwife cannot see the woman’s thigh or the plug in the bath because of blood loss, it is very likely that a PPH has occurred.


Section 6 – Health and Safety Concerns

Clean up any water spills from the floor immediately keep electrical equipment away from bath/shower wear gauntlet gloves and practice universal precautions be aware of posture and back care when providing care and assisting women in and out

of bath any blood clots or faecal matter should be removed from the bath and the bath rinsed

as soon as practicable after the birth.


Section 7 – Emergency Bath Lifting Mat

The emergency bath lifting mat is situated on the Emergency Response (PPH/ Assisted birth) trolleys in both Birth Suite and the Birth Centre. This is for use in the event that a woman requires quick removal from the bath and is unable to exit the bath herself.

The bath lifting mat is designed to slide under the woman whilst the bath is full of water and cannot be emptied rapidly. Having the woman in water allows for the mat to easily slide under the woman and the buoyancy promoted by the water allows for staff to lift the woman easily out of the water and on to a nearby bed or emergency trolley. At least 4 staff members are required to lift the woman using the mat. Staff are provided with this training at annual water birth or manual handling in-services.

The mat is made from a light weight mesh which allows for water to drain through the mesh as the woman is lifted from the water onto the nearby emergency trolley or on to the bed.


Related Policies, Procedures, Guidelines and Legislation

Procedures Labour – 1st, 2nd and 3rd Stage Care Obstetric Emergencies




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References

1. RCOG/RCM April 2006 Joint Statement no.1 “Immersion in water during labour and birth”.

2. ACM. (2013). Position Statement on the use of water immersion for labour and birth. Australia: Australian College of Midwives Retrieved from http://www.midwives.org.au.

3. Cluett, E., & Burns, E. (2012). Immersion in water in labour and birth. Cochrane Database of Systematic Reviews, 2(Art. No.: CD000111), 56. doi: 10.1002/14651858.CD000111.pub3

4. da Silva, F., de Oliveira, S., & Nobre, M. (2009). A randomised controlled trial evaluating the effect of immersion bath on labour pain. Midwifery, 15, 286–294. doi: 10.1016/j.midw.2007.04.006

5. Mollamahmutoglu, L., Moraloglu, O., zyer, S., Akin Su, F., Karayalcin, R., Hancerlioglu, N., . . . Dilmen, U. (2012). The effects of immersion in water on labour, birth and newborn and comparison with epidural analgesia and conventional vaginal delivery. Journal of the Turkish-German Gynecological Association, 13, 45-49. doi: 10.5152/jtgga.2012.03

6. RCOG/RCM. (2006). Immersion in Water during labour and birth. UK England: Royal College of Obstetricians and Gynaecologists/ Royal College of Midwives.

7. Stark, M. A., Rudell, B., & Haus, G. (2008). Observing Position and Movements in Hydrotherapy: A Pilot Study. JOGNN, 37, 116-122. doi: 10.1111/J.1552-6909.2007.00212.x

8. Zanetti-Daellenbach, R., Lapaire, O., Maertens, A., Frei, R., Holzgreve, W., & Hoesli, I. . (2006). Water birth: is the water an additional reservoir for group B streptococcus? Arch Gynecol Obstet, 273, 236-238. doi: 10.1007/s00404-005-0067-1

9. Zanetti-Daellenbach, R., Tschudin, S., Zhong, X. Y., Holzgreve, W., Lapaire, O., & Hoesli, I. (2006). Maternal and neonatal infections and obstetrical outcome in water birth. European Journal of Obstetrics & Gynecology and Reproductive Biology, 134, 37-43. doi: 10.1016/j.ejogrb.2006.09.012

10. Zanetti-Dallenbach, Holzgreve, & Hosli. (2007). Neonatal group B streptococcus colonisation in water births. International Journal of Gynecology and Obstetrics, 98, 54-55. doi: 10.1016/j.ijog.2007.03.029

11. Zanetti-Dällenbach, R., Lapaire, O., Maertens, A., Holzgreve, W., & Hösli, I. (2006). Water birth, more than a trendy alternative: a prospective, observational study. Arch Gynecol Obstet, 274, 355-365. doi: 10.1007/s00404-006-0208-1




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Search Terms

Water birth, Water immersion, labour, birthBack to Table of Contents

Disclaimer: This document has been developed by ACT Health, Canberra Hospital and Health Service specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.

Date Amended Section Amended Approved ByEg: 17 August 2014 Section 1 ED/CHHSPC Chair



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Use of Baths during Labour and Birth · Web viewit is often difficult to be exact in determining blood loss. Midwives should observe water colour and woman’s condition carefully