Water in labour & birth

difference between water immersion and waterbirth

Water immersion involves labouring in water, waterbirth involves baby born fully submerged.

reported benefits of water immersion during the first stage of labour

Reduced need for epidural/spinal anaesthesia, potentially shorter first stage, and increased maternal satisfaction.

potential risks associated with waterbirth

Cord avulsion (cord tear), infection, and aspiration (breathing in liquid)

inclusion criteria for waterbirth

Full-term, singleton, cephalic presentation, low-risk pregnancy, normal progress, afebrile (no fever), and stable observations.

three contraindications for waterbirth

Non-reassuring fetal heart rate, maternal pyrexia (fever), and heavy vaginal bleeding.

contraindication for recent opiate analgesia use in waterbirth

can cause maternal drowsiness and sedation, increasing safety risks

recommended water temperature for labour and birth

36-37°C.

protocol for managing the third stage of labour in water

mother should exit the pool if active third stage management or uterotonics are required to avoid infection

'hands-off' approach during the second stage of labour

Avoiding unnecessary touching under water and allowing the mother to follow her own instincts for pushing.

newborn handling immediately after birth in water

Gentle emergence, keeping the face clear of water, and immediate skin-to-skin contact while submerged.

primary reason for exiting the pool if the mother's legs are no longer visible

To ensure accurate assessment of blood loss and safety.

equipment essential for emergency preparation during a waterbirth

Equipment for cord avulsion, PPH, resuscitation, plus plan for manual handling/exit.

purpose of using a sieve during waterbirth

remove meconium or fecal matter

rationale for waterproof Doppler connected to the skin before turning it on

avoids loud feedback noise.

maternal observations required during water immersion

Temperature, pulse, blood pressure, and emotional state (MEWS).

midwife's role regarding neonatal thermoregulation after a waterbirth

Ensure skin-to-skin contact, dry the baby with warm towels, perform ongoing temperature checks.

signs of neonatal respiratory distress to monitor for in the first hour

Grunting, nasal flaring, tachypnoea, poor tone, and delayed transition.

When midwife should escalate care for a newborn born in water

If Apgar scores are low, breathing is not established, temperature is unstable, or there is meconium/infection concern.

importance of cord management in water

cord must remain untwisted and unobstructed to prevent complications.

documentation required for waterbirth

Informed consent, pool checks (fill time, temp, cleaning), ongoing labour progress, and clinical reasoning for any deviations.

importance of avoiding re-submerging the baby after they surface?

To prevent aspiration

midwife's responsibility regarding the pool environment

Ensuring it is clean, filled with potable water, maintaining temperature, and ready equipment.

How should blood loss be estimated during a waterbirth?

Cautiously, with equipment ready for potential postpartum haemorrhage (PPH).

What should be done if there are concerns about fetal heart rate or maternal condition during water immersion?

Advise the mother to exit the water immediately for further assessment or intervention.