Information for patients Using water for labour and birth A guide for women and families in Sheffield

Jessop Wing Why do women use water in labour? Immersion in warm water during labour is an excellent form of pain relief, and many women describe an increased sense of privacy, calm and control. Warm water encourages relaxation and reduces feelings of stress and anxiety which allows the release of endorphins, the body's own natural painkillers. Immersion in warm water during labour is well documented as contributing to a feeling of well-being, whilst buoyancy increases comfort and mobility which can lead to a more active role in the birth experience. It is thought that waterbirth allows the baby a more gentle transition from the womb, by softening the light and reducing noise. Can anyone use the pool? You must have had a straightforward to be able to use the pool during labour. There are some circumstances in which it may not be suitable or recommended, these include: • If your labour starts before 37 weeks. • If you have any medical conditions such as high blood pressure, diabetes or an infection. • If you are expecting twins. • If your baby is in the breech . • If your labour is induced. • If you are booked for Consultant-led care (although always ask your because you may still be able to use the pool if a plan is made before you go into labour). • If you have any mobility problems which would make it difficult for you to get in and out of the pool. Your midwife will discuss your individual circumstances with you.

Will I give birth in the pool? You may choose to labour and give birth in the pool, or you can choose to get out of the pool to give birth if you wish. What should I do if I want to use the pool? Unfortunately you cannot book the pool in advance so we cannot guarantee that it will be available when you go into labour. However, when you arrive at the Jessop Wing you should tell the midwife that you would like to use the pool and the staff will do their best to support your request. If you are having a home birth and would like to use a pool you should discuss this with your community midwife so that she can organise it with you.

When do I get in the pool? Water can be used effectively in early labour to help you cope with the contractions and the midwife may well advise you to try a warm bath or a shower first. Immersion in a pool (which is deeper than a bath) is recommended for when you are in established labour. Your midwife will advise you when the time is right and support you in the pool.

Will my care in labour be different in the pool? No. The care the midwife provides will be the same and will include listening regularly to your baby's heartbeat and checking your pulse, blood pressure and temperature. What if there is a problem? are experts in caring for women in normal labour. If the midwife is concerned about the condition of either you or your baby the midwife will ask you to leave the pool. A thorough assessment will be made and if all is well you may be able to re-enter the pool. If a problem has arisen you will be transferred to Consultant-led care where you will be cared for by a midwife in partnership with the doctor. The National Institute for Health and Clinical Excellence (2007) state that "the evidence shows that immersion in water provides effective pain relief. As far as we know this does not adversely affect maternal or neonatal outcomes".

Can I have any extra pain relief whilst I am in the pool? • You may use the gas and air whilst you are in the pool. • You may wish to consider the use of complementary therapies during your labour. You will need to discuss this with your midwife during your pregnancy to find out what is available. Which methods of pain relief are not available whilst I am in the pool? • If you decide you want a pain-killing injection (such as pethidine) you will not be allowed to use the pool for a minimum of two hours, or until the midwife feels you are alert enough to be safe in the water. • You will have to leave the water if you decide you want an epidural. • T.E.N.S. machines cannot be used in the pool.

Can I change my mind? Of course you can. At any time during your labour you can change your mind whether you are in hospital or at home. If the pool is not for you the midwife will support your decision. Alternatively, if you had planned only to labour in the pool then choose to deliver your baby underwater, this is fine. The midwife's role is to support you in your decisions and advise where necessary.

What should I wear? We aim to maintain privacy and dignity for all women in labour, including those who choose to go in the pool. Some women choose not to wear anything in the pool, whereas other women choose to wear a t-shirt or a bikini top. What about the afterbirth? You will need to decide how you would like to deliver your (the afterbirth). If you decide to have active management which means that you would like to have an injection of syntometrine to help deliver the placenta, then you will be asked to leave the pool for this part of your labour. If you decide to have a physiological third stage which means that you would like to deliver your placenta naturally then you may stay in the pool.

What if I need stitches? If you need any stitches (suturing) you will need to leave the pool. Suturing usually takes place one hour after you have left the pool, when the tissues have had time to settle.

Homebirth: Birthing Pool Information The Jessop Wing has 18 home birth pools, so if you are planning a home birth and would like to use a pool you should discuss this with your community midwife so that all the necessary arrangements can be made. The home birth pool includes: • An inflatable birthing pool and instructions for use. • A pool liner. • A manual/electric inflation pump • Silver bubble wrap insulating pool cover. • An electric emptying pump, wide bore hose, and a jubilee clip. You will need to supply: • A thermometer suitable for measuring the pool temperature. • Plastic sheet to protect your floors/furniture. • A hose to fill the pool. A basic garden hose is fine, you will need to make sure that it reaches the pool easily from the tap you intend to use. • Tap adaptor to attach your filling hose to your tap. • A plastic sieve and a bucket. • Plenty of towels. • You may like to use a bathrobe when leaving the pool, but this is not essential. • Snacks and plenty to drink - birth requires energy for all involved!

You may also find the following helpful: • A mirror for seeing the birth more clearly. • Music you find relaxing. • A face cloth. • An inflatable pillow. • Some drinking straws. • Aromatherapy oils. You will need to discuss aromatherapy with your aromatherapist or your midwife during your pregnancy. Your midwife will supply: • All the other equipment required for a homebirth, including emergency equipment. • Entonox (gas and air) should you wish to use this.

Using your pool: • Please have a trial of inflating the pool and leaving it overnight to ensure that there are no punctures. The pools are very durable, however it is always best to check before your labour starts. Please notify your midwife in the unlikely event of your pool being punctured. • Where you choose to put your pool is entirely up to you. The pools are oval shaped with a step/seat at one end. Some women find that having the end with no seat in a corner works well, as it gives them a private area which they appreciate in labour. The seat can then be used to sit on after you have given birth as it raises you and enables your midwife to easily assist you when you are breastfeeding. • We recommend emptying the pool as soon as is practical. The emptying hose is long, and you need to make sure that it can reach an outside drain or your bath. You should take this into consideration when you are deciding where to place your pool.

Further reading The Waterbirth Book Janet Balaskas (2004) The Waterbirth Handbook Dr Roger Lichy and Eileen Herzeberg (2005) Labour and Birth in Water National Trust (2002) www.aims.org.co www.nctpregnancy&babycare.co www.waterbirthinfo.com NICE Clinical Guideline No 55 Intrapartum Care; Care Of Healthy Women And Their Babies During Childbirth September 2007. Sheffield Teaching supports organ donation. Do you?

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PD5156-PIL1692v2 Issue date: August 2011. Review date: August 2013.