Suspension of Water Immersion For Pain Relief During Birth Explained

Suspension of Water Immersion For Pain Relief During Birth Explained

Last week Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) recommended the temporary suspension of water immersion for pain relief during labour to all Victorian hospitals.

This recommendation triggered a press release from the Australian College of Midwives (ACM) calling for the suspension to be overturned and recommending instead that Victorian women be assessed on a case by case basis. This lead to Change.org petition that has since gone viral and made headlines. 

The Petition

Melissa Dowden, doula, maternity nanny and mother, said that she was inspired to start the petition because she “believes in a birthing mother’s right to choose and believes a further investigation needs to be done in regards to this decision.” 

Anxiety For Expectant Mothers

This controversy and flurry of information has understandably caused a lot of stress and anxiety for pregnant women around the country. As your delivery day draws closer you realise that you have little control over what is coming next. All you can do is listen to your midwife or obstetrician as they educate you on all of the possible outcomes, going into labour early, going past your due date, needing to be induced. There is the option to have your own music, a yoga ball, you can even watch TV (in case you desperately want to watch The Bachelor finale as I did). Then there is the pain relief options, gas, morphine, TENS machine, epidural, showers, water immersion. There is a lot to choose from but when choices are all you can control then the choices become everything. 

One of the main concerns that the ACM stressed in their press release was the impact that the suspension would have on women’s mental health stating that “women have expressed frustration with policies and recommendations that have limited their ability to exercise choice, especially those that have limited support people and impacted on their birth preferences.” Although the ACM has said that they support all evidence-based practices, they believe that RANZCOG have provided no evidence-based reasoning for suspending water immersion. 

On their website, RANZCOG has stated that in regards to the temporary suspension of water immersion services in labour, “the protection of our maternity and neonatal health care workforce is essential. PPE is not effective when wet and consequently, the use of water immersion during this period presents an unacceptable risk.” 

Concerns From a Midwife

Midwife, Tiffany Anderson says “I think to some degree it would be stressful for a woman if she planned on utilising water immersion as pain relief in labour and/ or birthing in water. However, as a midwife, I would help her and coach her by providing a holistic approach. I would also provide information on other forms of pain relief. Although I understand that RANZCOG are trying to protect healthcare workers, I  believe they need to provide more evidence as to why water immersion is currently being restricted in Victoria, because as midwives we need to provide women up to date evidence-based research to so they can make informed decisions and if there is no current specific evidence then women will feel they are having a right taken away from them.”

Water Immersion Suspension Explained 

To understand the reason for suspending water immersion I spoke with Obstetrician-Gynecologist Dr Joseph Sgroi from the popular podcast Hello, Bump. Here is what he had to say:

“Unfortunately, both press releases from the Royal Australian and New Zealand College of Obstetricians and Gynaecologists and the Australian College of Midwives have made pregnant women very fearful of what they can and cannot do during birth which was certainly not their intention. It is crucial that women feel safe and cared for in the hospital that they choose. Hospitals are a safe place for women and their babies in regards to COVID, most of the patients are already self-isolating before they come in because they are pregnant.”

The Risk

Dr Joseph Sgroi explains the reason, “water immersion has been suspended because it has been proven that COVID is present in faeces. The issue with water immersion is that there is a potential risk of droplet inhalation because of the steam created by the warm water. Think about when you put bath salts into a hot bath, you can smell it because you inhale the particles carried in the steam through your nostrils. Particle inhalation is what we are trying to prevent. In a joint statement put out by the United Kingdoms Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives, in UK hospitals they recommend the ‘use of birthing pools in hospital should be avoided in suspected or confirmed cases of COVID, given the potential risk of infection via faeces’. Because of the current situation with COVID in Victoria, we are acting under the assumption that every pregnant woman is COVID positive. There is no doubt in my mind that the use of water in birth provides pain relief and under normal circumstances, it is very much encouraged. Most hospitals are still allowing showers and water pressure for pain relief, it is up to the individual hospital as to whether or not they allow that.” 

Extraordinary Measures

“We have to take extraordinary measures to protect everyone in these unprecedented times. In operating theatres, we are waiting 15 minutes after the patient has received general anesthetic before operating so that the air can circulate five times within the operating theatre, to limit the risk of droplet inhalation. These are the kinds of measures that we are taking in order to prevent infection in health care workers. There is no doubt there is a paucity of evidence regarding this whole pandemic. Everything has been rapidly changing and evolving, for example, originally we were told not to wear masks and now we are told to wear masks. Because everything is constantly changing it is better to be ahead of the wave than have it crash on top of you,  it is better to take the extraordinary precautions now. Suspending water immersion is a harm minimising strategy, it is about causing the least amount of harm to the most amount of people.” 

Protecting Mums, Bubs and Health Workers

At the end of the day, Dr Joseph Sgroiour says ” The primary concern of Obstetricians and Midwives is to have a healthy mum and a healthy baby but we also need to take care of our health care workers, especially midwives who are the backbones of our birthing suites. All you need is one group of compromised healthcare workers and the whole system will grind to a halt.”