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.