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Hello Yes most definitely we are being dominated by modifying our practice by the insurance, and all the research done are clinical audits checking we have met the set criteria. Sad just sad Regards,Lorraine --- On Tue, 6/4/10, Pamela Harnden <[log in to unmask]> wrote: From: Pamela Harnden <[log in to unmask]> Subject: Re: Waterbirth and hoists! To: [log in to unmask] Date: Tuesday, 6 April, 2010, 22:44 Hi, I agree with Robyn that it is about keeping a clear idea of normal, natural birth happening to normal healthy women who have had uncomplicated pregnancies. A thought that came to me last night and please correct me someone if I am wrong but don't hospitals in the UK have a rating with insurance companies who pay out in the events of litigation? Is then one of the purposes of policies and protocols to get the best rating possible so that they pay reduced insurance premiums as well as being in place to protect women, babies and staff? All this talk of hoists probably comes from risk management and thinking of worst case senarios. Don't new policy and protocol come from an incident which has occured somewhere at some point? I understood that one of the purposes of the Supervisor of Midwives in the UK as the guardians of good practice, to look at local policy/protocol and then to meet nationally to discuss what is going on. What sort of evidence or documented cases of incidents are there involving women collapsing and what sort of evidence is there which suggests a hoist would have made a difference in such cases? Funny the things you think about when you wake up at 3am! Cheers Pam Harnden On Sun, Apr 4, 2010 at 11:52 AM, Robyn Maude [CCDHB] <[log in to unmask]> wrote: Hi all in Wellington New Zealand we moved into our new hospital a year ago. This is a tertiary/secondary unit of 4000 births per year. As it is the only birthing facility in Wellington (there are 2 level 0 maternity units 30 and 60 minutes out of the city) Primary women also birth in this unit (if not having a home birth). The design briefs for the unit required each room to have baths to allow access for water immersion for labour and/or birth (in the manner of a birthing unit). So all 12 rooms have baths (deep spa corner spa baths -without the jets - and 5 rooms have round purpose built birth pools. Even the 2 'HDU' rooms have baths in the ensuite. Nine rooms have the pool or bath in the birthing room, the others in en-suite. Leading up to the building of the new unit we had renovated 3 roooms in our old delivery suite so that they better reflected the needs of 'low risk' birthing women and each had a deep spa bath (without the jets). I must admit we had many many debates and discussions with H&S reps and Infection control and engineers and just about every other person who thought they had something to contribute to the birthing environment of low risk birthing women. It takes a lot of energy to argue that these women are well and healthy and just giving birth naturally. In the design of the new rooms, as in the old rooms, there was some give and take. There was a discussion about hoists - I am aware this has happned in other units in NZ and Australia also - but somehow we managed to dispel the fear about the need for hoists - arguing from the position of well women again - adequately prepared during pregnancy about water immersion women respond clearly to requests to get out of the water when asked. In my years of using birth pools and baths for labour and birth I have only had one women faint as she stood to get out of the water to birth her placenta (she was getting cold in the water) - her husband and I managed to get her onto a bed without too much fuss - using a hoist would haave taken considerably longer. I have had 2-3 shoulder dystocias - the women respond to a 'command' to stand up and place their leg on the side of the pool - McRoberts - and the babies have been born. I had had 1 or 2 low FHR in second stage and have pulled the plug meaning the baby is born in air and easily managed from that point. My point is that hoists are the thinking of fearful people who deal with the sick - "in case the woman collapses", not with well and healthy women who are simply giving birth. It is the same with steps into the pool - what a silly idea climbing up steps then stepping down into a pool - well women can step into a pool and out again - the movement is good for shifting fetal position when required. I have been keeping an ongoing data collection about the use of the baths/pools in our new unit and hope to analyse the first year of data soon. Keep the discussions going with the engineers, H&S etc and keep focusing on well healthy women, properly screened to use the pool undergoing a normal life event - birth! cheers, Robyn Maude Midwife Leader Capital and Coast DHB Private Bag 7902 Wellington South New Zealand From: A forum for discussion on midwifery and reproductive health research. [mailto:[log in to unmask]] On Behalf Of Francesca Turner Sent: Wednesday, 31 March 2010 00:13 To: [log in to unmask] Subject: Waterbirth and hoists! Dear All We are currently doing risk assessments on our new Midwifery Led Birth Unit and both the Health and Safety Rep and the Resuscitation Oficer are saying we need a hoist just in case a woman collapses in one of the pools and needs to be moved out of the water. We have safety nets which can be used but they still say we need a hoist. Does anyone out there know of a situation where a hoist has been required and how many of your units have a hoist on the wards? Many thanks Frankie Turner PDM University Hospital Lewisham Do you want a Hotmail account? Sign-up now - Free -- Pam Harnden http://pamdh.wordpress.com http://www.facebook.com/#/pages/Young-Mums-and-Maori-Antenatal-Classes/180461813792?ref=sgm http://pamdh.blip.tv/ http://midwifeblogger.blogspot.com http://www.youtube.com/Midwifepam http://nzmidwiferypractisingreflection.blogspot.com http://midwifepam.wikispaces.com http://www.google.com/profiles/Pam.Harnden