Seeking safe harbour: Water immersion for women with complex pregnancy

Abstract

BACKGROUND Water immersion is used by women, particularly within midwifery-led settings, as a strategy to manage the sensations of labour. Low-risk women who have used water immersion in labour express feelings of increased relaxation, support and control in their labour and birth experience. Being labelled ‘high risk’ can significantly impact both a woman’s experience of her pregnancy and her opportunity for experiencing a physiological birth. Women with complex pregnancies have reported an increase in anxiety and a feeling that their normal childbearing journey has been interrupted and subsumed by medical monitoring and risk management. Midwifery frameworks in Aotearoa New Zealand protect and promote the woman’s role as a decision maker within her experience and her right to make informed decisions about her care.

AIMS The aim of this research was to develop an understanding of the influences, facilitators and barriers for women who chose to use water immersion for labour and birth, in a hospital setting, when they were labelled/identified as being clinically complex, as well as to explore their experience of using water immersion in labour.

METHODS A qualitative descriptive inquiry, using semi-structured interviews was undertaken to explore seven women's experiences of using water immersion during their labour and/or birth after having a complex pregnancy. Inductive thematic analysis was used to analyse participant data.

FINDINGS Thematic analysis identified four themes within the women’s experiences. Women use water immersion to resist the medicalisation of their birthing experience and protect themselves from the iatrogenic risks of birthing within a hospital setting. The desire to use water immersion is often driven by dissatisfaction with previous medicalised experiences of birth and the women’s desire to avoid repeating these experiences. Water provides a safe and protected space to labour which supports a sense of control and privacy. The LMC midwife is a vital ally and advocate in negotiating to use water immersion within the hospital setting. In this environment, staff can either facilitate or be barriers to using water immersion in labour with a complex pregnancy.

CONCLUSIONS Women use water immersion in labour to optimise their opportunity for physiological birthing, often in response to previous medicalised births. Water immersion is experienced positively as a strategy to manage labour. Individualised holistic midwifery care from a Lead Maternity Care midwife was valued by the women and viewed as a key support in negotiating for the choice of water immersion. Women needed to purposefully seek a midwife who was willing to support them in their choice to use water immersion.