Industry and policy
the establishment of a national body to publish water
birth data. What impact do you think that would have on
decision‑making among expectant mothers and midwives?
I think that pooling national data would give us a larger amount of
information so we can ensure that optimal care and outcomes are
given to women selecting this birth option.
In providing more information, we’d be able to give women
informed choice as to why this option might not be viable for
them, because as research also shows, not all women who set out
to birth in water achieve the same.
I also think that if we pooled data, this might give us more of
a chance of having national clinical policies and procedures,
because at the moment South Australia and WA are the only states
and territories with statewide evidenced-based guidance.
I think it would be optimal to have national guidance. I think it
would promote a cohesive multidisciplinary approach to water
immersion for labour and birth among midwives, obstetricians
and neonatologists.
In a separate paper published in BMC Pregnancy and
Childbirth earlier this month, you explored the perceptions
and experiences of women who achieved and did not achieve
a water birth. What were some of the key reasons women
wanted to birth in water?
have meant that they had to get out of the pool. So there were a
number of reasons.
That paper was slightly different. We did a critical incident analysis,
where you interview women and get a snapshot of what they think
with a few short questions.
So you might ask her why she decided to have a water birth, and
she might give a few answers: my sister had one; I saw one on the
TV; I like being in water. And then you read them back to her and
ask her to rank those questions – one, two and three – and so we
get a ranking of women’s answers in relation to why they chose a
water birth, and why they thought they achieved or didn’t achieve
their water birth.
What does the research reveal about the role midwives play
in identifying and approving women for water births?
Research shows that midwives are selecting the right cohort of
women to birth in water. It also shows that midwives are following
their WA statewide guidance and are transferring women if a
complication occurs. And that they’re giving the right care to the
right women at the right time.
We also have a paper, which is currently under review, which
is actually exploring the midwives’ experiences of their training
and their practice in relation to water birth. We hope it will give us
much more information about the role midwives play in identifying
and approving women’s water births.
You said your most encouraging finding concerned the
number of women who experienced a caesarean birth. What
did you discover there?
Well, I think the reason we had such a low rate of caesarean births
was because this was a very low-risk group of women. Initially we
just looked at 500 women and then 300 women, and all these
women were very low risk.
Additionally, most of those women had actually had a baby and
a low-risk pregnancy and delivery before, so they were entering
labour the second time as a low-risk pregnancy. And so, in that
case, you’re less likely to have a caesarean.
You’d like to see maternity units that offer water immersion
for labour or birth to collect and publish data, as well as
We surveyed 296 women, and one of
the main reasons these women chose a water
birth was that they hoped it would provide
them with effective pain relief.
We also offered some words to describe their water birth. We
surveyed 296 women, and one of the main reasons these women
chose a water birth was that they hoped it would provide them
with effective pain relief.
But when it came to actually exploring the women who did
achieve a water birth, we found that the main reason women
perceived they did achieve a water birth was that they were
supported in labour, and most women said the midwife was
the main support person. That was just over 40 per cent of
the women.
If the water birth didn’t go ahead as planned and they didn’t
achieve their water birth, then similar to this research, the
women felt the reason was that they experienced an obstetric
complication. And so the research kind of overlaps. We found the
same findings across two pieces of research, which is actually
quite interesting. ■
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