Nursing and Water Birth - Research Paper Example

Water Birth Nursing March 30, Water birth is the process of giving birth in a pool of warm water under controlled andcareful conditions, requiring extensive planning and patient education. Water birth offers many physiological benefits to the mother, originating in the 1970’s and gaining popularity in the 90’s (Caple). Sixty-four types of risk have been identified that are associated with water birthing. The most common risks are pneumonia and infection. Benefits are numerous. The calm, peaceful, and relaxing environment which is associated with water birth reduces blood pressure, improves the mother’s concentration, reduces stress hormones which inhibit oxytocin and the need for an epidural is reduced due to the increased release of hormonal endorphins which make contractions less painful. The perineum becomes more elastic, reducing tears, and the buoyancy created in the pool promotes more efficient contractions and allows greater freedom of movement. A study completed from March 2001 through April 2004 at a British birthing center evaluated a number of factors in a comparison study. The study aimed to differentiate between ‘pool users’ and ‘pool births,’ women who labored in the pool and those who actually remained in the pool to give birth. Factors evaluated included parity, deciding factors in laboring and delivery within the pool and the effectiveness of the warm water on pain relief. The study indicated that an equal amount of primigravidae and multigravidae women were interested in the pool and the outcome indicated that 89% of the women who used the pool received both verbal and written information from their midwives during their antenatal appointments and training classes. Pool births increased steadily from 2001-2003 while the number of pool users remained nearly the same. This suggests that the idea of being calm and relaxed appealed to birthing mothers who chose to remain in the pool during the actual birth. 98% insisted they would both recommend using the pool and would also use the pool again themselves. Reasons for leaving the pool were various and included slowing down contractions when immersion was completed too quickly. This prolonged labor and guidelines were then established to make sure that labor was in an active phase before entering the pool and the majority who decided not to remain the pool left once labor reached the transitional or second stage. Other main reasons for leaving the pool were a prolonged second stage of labor, fetal heart rate deceleration, meconium staining, poor contractions in the first stage of labor, need for pharmacological analgesia, and maternal choice. Women were also asked to rate the effectiveness of the warm water on helping with relaxation and pain relief using a scale of 1-10 and 93% of women had a high perception of relaxation while 80% scored pain relief at a level seven or above. Estimated blood loss and incidence of perineal trauma were reduced in pool births versus traditional births though the incidence of second degree perineal tear is similar in both groups (Baxter). This study reflects the results of only one location and the key point from this study is that immersion in warm water during the birth process has been proven to reduce the need for pharmacological pain relief. A 2005 study conducted on 1600 patients in Italy gathered statistics from an eight year period to determine the risk of neonatal infection in water births (Thoeni). The episiotomy rate in all water births were lower than in traditional delivery methods and the rate of neonatal infection was not shown to be increased whatsoever. This study also concluded that the first stage of labor was much shorter, and analgesic needs were reduced in comparison with other birth methods. This study found that water births appear to be a safe alternative for both mother and infant. Waterbirth International was founded in 1988 and is an international organization which provides education, training, programs, and referral for practitioner’s who are interested in water birth (Waterbirth). The website provides many articles and links for those interested in water birth. One of the most common concerns expectant mothers have is the possibility of the infant taking a breath before he is lifted out of the pool. Infants born in water are slower to begin the complex chain of hormonal and environmental processes which initiate the infant’s first breath. Of 150,000 water births worldwide between 1985 and 1989 there have been no valid reports of infant deaths due to water aspiration or inhalation (Harper). It is important that the infant be brought out of the water at an appropriate pace; trauma is possible when lifting the infant too quickly out of the pool after delivery. Some practitioner’s require the mother to be removed from the pool quickly after delivery in order to accurately judge blood loss. The practitioner must also ensure that the cord is intact. Some practitioners prohibit the mother to labor in the pool if her membranes have ruptured. Proper infection control techniques must be followed between births and the pool must be thoroughly cleaned and sanitized to include pumps, hoses, and filters. Infection control techniques demonstrate routine cultures that are negative for bacteria or the presence of infections. The role of the midwife and doula are each complimentary to each other though each have different responsibilities. The midwife will provide all medical care including prenatal care, delivery, post-partum care, and newborn care. They can also provide other services such as annual female exams, family planning, and general gynecology. The role of the doula is supportive care; emotional and physical support though no medical care, their involvement in the birthing process has been shown to improve the outcome of both mother and infant. A doula will assist the mother in developing a birthing plan and will help to facilitate communication between the mother and others in the delivery team. They are certified through DONA International and can also be certified for postpartum care such as education, newborn care, and coping skills. Women report greater satisfaction with their birthing experience, the need for Pitocin is reduced, pain medication requests are reduced and labors tend to have fewer complications and be shorter (DONA). Midwifes are certified and educated in both midwifery and nursing. They must earn a graduate degree and pass the national certification exam through the American midwifery Certification Board. It is not necessary for the midwife to practice under the guidance of a physician though they will often have some partnership or relation with a facility where the birth takes place. This is to ensure the safe delivery of the infant in case of complications that may require specialized care. Many midwifes specialize in home birth, allowing the mother to labor in deliver in their own home if the pregnancy shows no signs of complication. This option allows the birth to be an event that can allow the entire family to become involved. Midwifes use a women-centered model of care that has been proven to reduce birth injury, trauma and the need for caesarean section. Technological interventions are minimized and the process strives to be as natural as possible. Costs associated with water birth include the installation and/or rental of labor pools if there is no specialty center in your area. These costs can be offset by the reduced need for analgesia and pain relief. One study indicated that water birth can be more costly though it leads to an increase in maternal well-being and reduces perineal tears with no adverse consequences in labor duration or newborn status. All studies and research indicate this could be a good choice for expectant parents, providing an individualized, comfortable and calm environment for labor and delivery. References Baxter, L. (2006). What a difference a pool makes: Making choice a reality. British Journal Of Midwifery, 14(6), 368-372. Caple, C. (2012). Water Birth. CINAHL Nursing Guide, DONA International. (2012). DONA International – Birth Doula FAQs. DONA International – Birth Doula FAQs. Retrieved April 3, 2012, from http://www.dona.org/mothers/faqs_birth.php Harper, RN, B. (2000). WaterBirth Basics. WaterBirth Org. Retrieved April 3, 2012, from http://www.waterbirth.org/assets/documents/Waterbirth%20Basics.pdf Thoeni, A. A., Zech, N. N., Moroder, L. L., & Ploner, F. F. (2005). Review of 1600 water births. Does water birth increase the risk of neonatal infection?. Journal Of Maternal-Fetal & Neonatal Medicine, 17(5), 357-361. doi:10.1080/14767050500140388 Waterbirth International. (2012). About Water Birth International. Water Birth. Retrieved April 3, 2012, from http://www.waterbirth.org/about-us-2 Read More