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
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
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