Conclusion
There appears an increasing dichotomy between obstetricians and the women that we care for, with consumer perceptions that the former are keen to ‘over medicalise’ both labour and birth (11). The “medicalisation” of birth has diminished women’s satisfaction with their experience (24), and in recent times, there has been a substantial increase in the application of a range of practices to initiate, accelerate, regulate and monitor the physiological process of labour, with the aim of improving outcomes for women and babies(1). Certainly, caesarean section and induction rates continue to rise (25) without a concomitant reduction in perinatal mortality and morbidity, perhaps because women under hospital care have increasing numbers of medical comorbidities(12). Maternal request for caesarean and induction are also rising (25) and obstetricians must tread a careful line between over and under intervention.
Despite these challenges, it is of paramount importance to provide safe, quality maternity care that is evidence-based, supports women, respects their choices for intrapartum care and promotes labour and spontaneous vaginal birth as normal, yet empowering life events. This is likely to be achieved by partnering more effectively with women and the maternity care team, ensuring that each person has a shared understanding of what the woman wants, and how that might be achieved under an umbrella of safe care.
Despite increasing numbers of women wanting access to and using WWI, peak bodies internationally are not supportive of waterbirth. The RCOG has no current guideline and NICE recommends that women should be offered WWI for pain relief but states that there is inadequate evidence to support or discourage waterbirth (26). RANZCOG cites data suggesting that waterbirth can be achieved safely but falls short of endorsing the practice (10) and ACOG recommends that birth occur on land (9).
The growing body of literature around WWI/Waterbirth suggests that hesitation and lack of support for waterbirth amongst obstetric staff is unfounded and not based on current evidence. Demand for access to non-pharmacological analgesia continues to increase and as a profession we need to ensure that we are flexible and proactive in meeting these demands. We must continue to work with, and listen to, pregnant women under our care and base recommendations and guidelines on current evidence, not personal bias. Where possible we should ‘take the plunge’ and support increasing access to water immersion, including for those women who have moderate obstetric risk factors. This must coincide with the development of evidence-based guidelines, audit of practice and the provision of suitable education to ensure that the practices of WWI and waterbirth are implemented safely.