Waterbirth Stories

Midwifery Reflections

Maria Paz Miranda, Sian Marie Barnard

• Publisher: Routledge
• Year: 2019
• ISBN:
  9781351010757
• Edition: 1
• Topic: Medicine
• Subtopic: Nursing

Drawing on years of midwifery experience of waterbirth, this collection of stories, based on real-life events, illuminates a rewarding way of birth and emphasises the theoretical knowledge, skills, understanding, and resilience needed to practice well.

Waterbirth Stories includes chapters on the criteria for use of water in labour and birth, on the different stages of labour, and on some more serious or unusual situations such as shoulder dystocia, postpartum haemorrhage, breech presentation, and other unexpected maternal and neonatal events. Each chapter includes several stories from a midwife's perspective, told in the context of evidence-based guidelines available for this topic. The stories end with learning points to help readers reflect on their own practice.

Ideal for student and practising midwives with an interest in waterbirth, this research-informed book is enjoyable, challenging, and informative.

Chapter 1

Use of water in midwifery in the UK

Maria Paz Miranda, Sian Marie Barnard, Catriona Cusick, and Pat Hutson

Introduction

The provision of maternity care has changed dramatically over the last few ­decades across the planet, with, sadly, wide differences in its improvement according to the political, financial, and educational resources available in each country. Nevertheless, globally, the maternity death rate has decreased thanks, amongst other reasons, to the incorporation to the midwifery practice of better training, new drugs, and the formulation and implementation of clinical guidelines.

In this first chapter, we would like to introduce you first to the particularities of midwifery and maternity care in the UK, its evolution throughout the years, and the incorporation, in the last few decades, of the concept of ‘maternal choice’, which includes the use of water in labour and birth, within the wider context of the National Health Service (NHS). To be able to fully comprehend the relevance of the previous statement, it is important to remember some of the key principles of the NHS since its creation in 1948:

• The NHS provides a comprehensive service, available to all.
• Access to NHS services is based on clinical need, not an individual’s ability to pay.
• The NHS is accountable to the public, communities, and patients that it serves (Department of Health and Social Care, 2015).

As midwives working in an NHS maternity unit in the UK, we work under these principles. We believe that the implementation of maternal choice within maternity services, specifically in the case of ‘place and mode of labour and birth’, has been made possible, amongst other reasons, because of these key principles mentioned earlier. In this context, we believe that respecting and promoting maternal choice, which includes the use of water in labour and birth as one of the pain-relief options available, is essential in achieving a high level of safety and increased levels of maternal satisfaction, whilst still adhering to statutory bodies’ guidelines.

The second part of this first chapter is dedicated to the description of a basic criterion for the use of water in labour and birth throughout the country, with samples from different hospitals and National Institute for Health and Care Excellence (NICE) guidelines.

We sincerely hope you enjoy reading this first chapter. We would like to believe that it provides the reader with the necessary basic historical context to comprehend our stories and where they have come from. Also, the stories provide an insight into how far we have come, in terms of being able to facilitate maternal choice during childbirth.

The birth of midwifery within the NHS: Catriona Cusick

In the early nineteenth century and before the NHS was founded, maternity care was mainly provided by midwives. They attended childbearing women at home and worked independently from the medical profession. These midwives were untrained, unregulated, and often unpaid; the skills and knowledge they acquired would usually be passed on from veteran midwives to their inexperienced counterparts.

Infant and maternal deaths were high due to factors such as poor nutrition, inadequate sanitary conditions, and the lack of maternity provision (Reid, 1990). Doctors were not legally obliged to attend labouring women and this, coupled with a lack of interest and guaranteed payment, meant there was a reluctance from them to attend births when midwives were an available and free resource.

The beginning of the twentieth century saw a radical change in midwifery provision. The Parliamentary Midwives Act of 1902 was introduced to regulate and improve standards of care. As a result, the very first federal registered midwives were commissioned. The Central Midwives Board (CMB) was also formed as a part of the Midwives Act 1902 to monitor and approve training. The CMB created rules of practice that enabled continuing professional standards and registration to a legally recognised regulatory body (Arney & Neill, 1982). This altered the person present at births from the lay practitioner or handywoman to the registered midwife. With the introduction of the Midwives Act 1902 and registration as a prerequisite, midwifery became the domain of educated women, and therefore, the ownership of midwifery practice was transferred from the unqualified layperson to an erudite body of women.

Most women at this time were still having homebirths, but thanks to the Midwives Act, they were now mainly attended by registered midwives. Any woman who practised midwifery unregistered was fined if caught; however, caring for women in labour was still seen as an additional income rather than a professional occupation. To monitor adherence to necessary regulatory stipulations, local authorities started to pay midwives a salary and a pension to improve enrolment. This improvement in standards also meant that pain relief was made available to childbearing women at home, whilst still having the process of normal, physiological birth supported.

The next major change that brought an improvement in maternity service provision came with the birth of the NHS. Its foundations were based on the work of the economist William Beveridge and the coal miner Nye Bevan, who pursued their political aspirations to become leading figures in the drive to improve the health of the nation. Beveridge compiled a report in 1942 in which he recommended that the government should find ways of fighting the five ‘“giant evils” of Want, Disease, Ignorance, Squalor and Idleness’ (Beveridge, 1942). At this time, the country was in the grip of the Second World War and Beveridge identified the poor general health of the soldiers as being attributable to limited access to quality healthcare. However, the key recommendation of his report was that he felt it was ‘imperative to give first place in social expenditure to the care of childhood and to the safeguarding of maternity’, stating that the ‘health of the nation’ was dependent on the health of maternity services (Beveridge, 1942).

In support of this incentive, the Labour prime minister of the time, Clement Attlee, acted as the catalyst to the introduction of the ‘Welfare State’ as outlined in the recommendations of the Beveridge Report (Beveridge, 1942). In 1945, Attlee appointed Aneurin Bevan as the Minister of Health, affording him the responsibility of instituting a new and comprehensive National Health Service. Bevan’s own humble background shaped his political intent; as the son of a coal miner, Bevan was driven by a desire to address social inequality. He became a champion for social justice, fighting for the rights of working people. In his role as Minister of Health he was perfectly placed to spearhead the establishment of a health system that would be accessible to all, regardless of wealth. Both Attlee and Bevan had the foresight and passion to realise that the health of the nation was paramount to the future of the country.

In support of this sentiment, a public campaign was launched. Women played a big part in this campaign and were fundamental in helping to raise awareness about the inequality in healthcare provision; they literally swung the vote and became known as the ‘silent majority’. As a result, in just six months, on 5 July 1948, the NHS was born – an inclusive national health service with no fees and that was free to all. The following years brought changes to the political establishment and a change of prime minister. In 1951, the Conservative Party succeeded Attlee’s Labour government and Winston Churchill (previously in office from 1939 to 1945) returned to power for a second time. Both Churchill and the British Medical Association were opposed to Bevan’s ethics; they were a formidable force and a real threat to Bevan and his ideals of an NHS. Bevan fought on though, stating that ‘no society can legitimately call itself civilised if a sick person is denied medical aid because of lack of means’ (Bevan, 1952).

This was literally life-changing for those who had not previously been able to access quality healthcare. Doctors, midwives, nurses, dentists, and other practitioners specialising in a wide variety of disciplines were employed by the NHS to run the service. The service was funded by the working population’s tax contributions known as National Insurance.

The NHS incorporated and retained the Midwives Act of 1902 within the NHS Act of 1946 but appointed local health authorities as the supervising authorities in place over midwives instead of the local councils. They had to exercise general supervision over midwives practising within the area and to investigate ­allegations of malpractice, neglect, and misconduct.

By the mid-1950s, confusion arose over how much the provision of the NHS was costing and an inquiry and review into maternity services were called for by the government of the day (Davis, 2013). The Earl of Cranbrook was appointed to lead this investigation, resulting in the 1959 Report of the Maternity Services Committee, otherwise known as The Cranbrook Report of 1959. In this report, a target for 70% of all births to take place in hospital was recommended with the committee deciding that the remaining 30% of mothers could safely give birth at home. The midwifery profession was being shaped by regulations and governmental committees, which meant that the growing control of hospitals and physicians was starting to define maternity care in categories of safety and risk.

John Peel, an obstetrician and gynaecologist, headed several steering groups, committees, and government agencies. He went on to instigate a report in which the provision for all women to labour and birth in a hospital setting, regardless of background, became a reality (Peel, 1970). So, it was at this point that community care and homebirths were greatly reduced, and maternity care shifted into a hospital environment. NHS midwifery services were divided between hospitals, GPs, and local authority health services which included antenatal clinics (Davis, 2013). This meant a fundamental change for the place of birth and where and how midwives practised (McIntosh & Hunter, 2014).

In opposition to this, several maternity pressure groups such as the Natural Childbirth Trust (NCT, 2009) and the Association for Improvements in the Maternity Services (AIMS, 2018) argued that most women did not need to be in hospital to give birth safely. The reactions of the NCT ...

Table of contents

• Cover
• Half-Title
• Title
• Copyright
• Dedication
• Contents
• List of contributors
• Foreword by Laura and Russell Brand
• Acknowledgements
• Introduction by Maria Paz Miranda
• 1 Use of water in midwifery in the UK
• 2 The latent phase of labour and the water
• 3 The first stage of labour and the water
• 4 Postpartum haemorrhage and the water
• 5 Shoulder dystocia and the water
• 6 Unexpected events in the water
• Index