HelenRichmond
of
Womenb
experience
waterbirth
Inthesecond
oftwoarticles
Helen
onwaterbirth,
presents
Richmond
the
resultsof a questionnaire
views
women's
usedto assess
onwaterbirth
Htltn
Ricltmottd P(il)ipF-d NISc l)PS\l
IL\l SRN
is l Scnior Lccturcr in i\lidn ifLrv rit Angli:t
Polrtechnic Unirersitl rnti r (llinicrl trlidsitb at
erpcricnce of x':rtcrbirth hrs not been svs,rnalvscdbefirre. Tl'risstudv s'as
te n-rirticirllr'
i n i t i . r t c d\ l l l c t ( ) l r . t p i . lr i s c i r t c o r t s u t r c r
clemand fbr ii'irtcrbirtl-rir-rthc 1990s. It
cxplorcs tl'o cluestiorrs:
- Whlt lre the cxperiencesof u'omertu ho
h.rvca u'eterbirth)
- l)o lll \\'onrenpcrceive\\'aterbirthirsther
l1-rcutrc?
Thc linclingshavc sonrc practicc implicatlons.
thc Quccn Elizrbeth Hospitrl, I-onclou
Analysisof the data
irualvsisof the clirtl,
To irssistin the svster-t-t;rtic
u'irsused to cntcr the
ln Exccl sprc;rclshcct
rhtl, thcn cloullolclcd in l-otr-rs123 fbmat
tbr stltisticrrlanalrsisusing SPSS.Rehtionships
betri'ecn orclinal vrrrilblcs u'ere exlurinecl
tusingSpcarnrln's Rho Colrcl;rtior-rCo-effi cicr-rt.Proportions rr'ithin the c-lilfLrentgror-rps
s'ere comprrecl using Chi-Squarccltcst. Socirrl
cllss l rs cocleclusing thc StrnclirrclC)ccu1-rritior.ralClassificltion(OPCS l99l ).
Methodology
Abstract
Firc birthing ccntt'csn,tre nf)proacbedJbrptrrtt issiott t o n d lt i tt isttr n {ltt t stiil1I ttn i ri. ni t'i tt.n
nctd
n snmpb oJ'189notlttrs n,holtnd e.rperie
n,nttrbirth. trIotlttt'sn,holtnd Apgars lon'er
thnn 7 nt I n,treucludtd f'om rb snmple.t'itr
cthical reasons.T-bermilts shon,tdthat n,nttrItirtb i n consumer-ltdtrend, mninh'purnrd
bt,cdrrcatcdrniddlt' classntlilten.Bttttr nrttcttfltal prtpnrntion is neededto rtdttct tbt ueed
.for othcrformsof nnalgesinn,ht'nn,otrttnnrt
irt tt,nttr. Most tt,oruendcsirtd n,tttrbirtb as
tlttt thought it n,as a nntural drug-Ji'et
nttthod nnd n,ould lte n lesspniu.t'hl birtb.
Thtt, nho n,&nted n gtntb dtliru't, Jbr the
Ltnbt,aud thougltt fiatcrbirth sennd tb rigltt
nrcdiumJbr tbis. Tbetfch more in control of
their utrironment in n,attr, and pnrticttlarlt
Iihed thc rtlnting cnlnting qtmlin,of tltt il,t7ttr.
the plnsicnl vtpplrt it garc tltem nnd btirtg
ablc to hold thtir balticsimnttdiatth nJitr
Itirth. Womtn's rtspouststo tht sttrrtl su17gestrd thnt motbtrs perceit,edn,atcrltit'th ns
tbcrnpurtic. Tltct,dtmonstrattd n strorg duire
for n,atcrin lnbour.Tbtrt n,ertrtosillnticnnt
biltayiour diJfertrtcts bttn,ten n,ntct'-bont
babicsnnd nort n,nttr-born babies.
Introduction
Over the llst dccadc thcrc has bcen llt
increascin researchanclaucliton \\'aterbirth
(Alderdiceet al 1995, 1996, Cirmr.r.ru
et al
I994, Burke and Kilfi>r'lc1995, Grrlar.rcl
errclfones 1994,1997, Schorn et al 1993,
Lenstrup ct al 1987). Hos'cvcr u<rnten's
u6 March
zoo3
A rirnclomsirr-r-rple
of 240 \\'omcn \\'irstrkelr
fl-om 482 \\'onren s'ho hrcl experiencecl
\\'aterbirth in South E,rst Engllnci over r
t\\'o-\'err 1-rcrioc'l.
Tl-risstucivinvolvcc'l5 incliviclu:rlbirthir-rgcerltres.At tl-retir-r-re
of the
coulnrcuceurentofthe rescrrchtl-reclcsign
of thc stuclvl-rrclto bc rctnrs;rcctile, ;rsthere
u'ls .r suclcleurctluctior.rin thc clcm;rnc1
for
s'rtcrbirtl.r(Cooke I994, Stirnt I993;cluc
to the pressreportir-rgfirtirlitiesin \\'rtcrlrirth
and rttributing tl-renrto u'irterbirth.Thcrc
fore lll birbiess ith Apg;rr scorcslos'cr than
7 irt I r-nin l-rac1
to be excluclcclfhrnr thc
str-rclr',
in orcler fbr ethicll l;-r;rrovirlto be
giver-rfbr the stuclr; as the fe:rrof litigltior-r
rvls higl'rlt thc timc. Although this s'irsclis
appointing lnd introc-lucecl
sonre bias, or.rtconre \\'r.lsnot the kcv fbcr-rsof tl-restuclr',s<r
the reselrch procccdccl.
A p i l o t s t u d v u ' l s c i r r r i c t lo u t u ' i t h 9
\\'()nrenin the semple.This inr'olieclf, qLlestior-rnirirerncl then ir rccorclcc-lintervies,
rhich u'ls tr:lnscribcclirnclanalvscclanclusccl
All nor-r-rcr-r
ir-r
to inrprovc thc qucstior-rr-ririre.
thc samplc hacl l-rac1
r nomrrl c'lelivcrvin
srtcr u'ith l gestationbenveen37 ;urd 40
u'eeks.
Waterbirth
is a
consumer-[edtrend,
mainlypursued
by
middleclass
educated
women
Retiabitity
andvalidity
u irs brsecl or-rones thlt
The clucstionr-raire
hrcl t-rccntriccl ;rr-rcltested (N{irson I989,
Green et rl 1990). The mothcrs intcrprct
ing thc qucstions corrcctlr' ,rnd shosing a
unifbn-n rcsponse conf-irnredreliabilitv of
thc cpestionnirirc.Desigr-ringtl-requestionnairc s'ith cliffcrcnt sfi'lesof questior-rs
on it
incrcmeclcontent vdiclin'. For cxarnple, some
cpestionssuggcstccians\\'crslur-lothersu'ere
opcn cnclcd. Ottcn d-rct\\'o iurs\\'ersriere the
g tl-rcinten'icu' resultsu'ith
sirmc.Compirrir-r
thc rc-pilotctl qucstionneircresultsincremec'l
construct llliclin'. It u':rsclc.rrbv comperinu
theseresultsthirt thc mc;rslu'cbcir-rguseds'rs
succersfirlh contorrling to erpect.ttiorts.
Results
Thc u omen in the studr'(I89 in total) l-racl
208 u'aterbirthsbenveen thcm. 170 \\'onrcn
hrrl one s'lterbirth ancl 19 mothcrs had 2
u l t c r l . i r t h s .5 8 r i o r r r c nu c r c l r i r t t i l t . r r o t r s
lr-rcl l3l \\'omcn s'cre r-nulti;rr'rror-rs.
The
responscratc to thc sirrvc\'\\';ls78.75%.This
r.r-rotivltedgroup. Thc
clen.ronstrltccle l-rigl-rh'
\\'ourcn slicl thev hlc-lenjovecltakir-rgpart in
thc suncr'. Bv occupation irnd educatior-r
thcse s'ort-tcrts crc prcctlttin;rr-rtlvr-nirldlc
chss, inclicating thrrt thc s'rtcrbirth movcmcllt iu thc Southeirst of Englancl begrrn
;mlong miclcilechss \\'omen. trirosledge
rbout \\'rterlrirtl-rappeareclto have spreird
mainh' through telcvision(64.5%), magazines urrl books (39.5%).Hou'ever 17.5%
hc;rrclvii-rtheir nric'ls'ift.This r.rr-rclcrlir-res
thc
rrr
ol'l
lre
rrrctli.r
irr
irr
l.)
uerrcing
cr
P,
Ircgn.lnt
THEPRACTISING
MIDWIFEI VOLUI\4E
6 NUMBER3
Somemothersspentlongerin thewaterthanothers.
Frequency
*Laboured
in water(a)
764
86.8
*Gavebirthin water(b)
181
95.8
placenta
Delivered
in water
24
72.8
Received
oainreliefin water
103
TotalMothersin Sample
189
54.5
100.o
65 mothersgot out of the woterto deliverthe placenta,and rcj mothersreceivedpain relief
in the water.
No
7"
*TransElectrical
NerveStimulation
27
20A8
gas
Entonox
97
88.3o
Pethidine
o.97
Meptid
o.97
In the sun'ci,\\'omen ciivicleclthcmselvcs
into thrce crollps. Those s ho tl-rotrqhttheir
\\';ltcrbirthNls goinq to bc 'r.rotplrticr,rlarh
plc:rsurrrblc',
thoscs'ho dror-rghtit u rrsqoit-tq
to bc 'qr-ritcplcasurlblc' irncl those l'ho
erpgclccl it to bc 'r'erl plc;rsurablclncl firlsh:rt thci
fillirrg'. Trblc 4 den.tonstr'.rtcs
rctr.lrlh fbunrl on cxpcrience. Out of the 28
lr()thcrs s'ho clicln'ttl-rinkit s':rsgoirtg to be
p.rrticulrrh' prlciisLrrllrle.
I I hrrdrheir expcc'(lLritcplcxtilti()lls lret, -l nrothers tbur-rclit
s u r r b l c ' . a r - r cl13 r c t u i r l l v f o u n t l i t v e r v
plcrsurablcinrl fulfilline. Out of the 109
rnothcrs $'ho crprectc.lit t<.rbc 'clLritcpleirsurlble' 6 mothers tbuncl it 't-tot plrticularJvpleirsurable', 42 hrrcitl-reircxpectetions
nrct rlur16l fi>urrc1
it verl plcrsur:tblcanclfirli r l l i n g .4 5 \ \ 1 ) n l c rrrl r o u q l r ti t r r r i r q o i r t qt o
be len' ple;rsr.rrrbleencl fulfilling. Out of
this group, 2 l'omcn fbuncl it 'not prrrticuIlrlv plcasulirblciinrl tirlfillir-rq',5 somen
fbunclit quite plcirsurablc
mcl 38 rror-nenhacl
thcir expectirti()ns
lnet.
1 5 . 3o L r to f 1 8 9 n r o t h c l s( 8 l t { , t u c r e i n
far'our of h,rling lnothcr \\'rtcrbirth rftcr
thcir first u'irterbirth.
Other
Total
103
Mothers'feelingswhenenteringthe
pool
(*Before entering the bath)
Althoughwaterhaspain-relievingqualities,severalwomenwantedsomeother from of pain
reliefin the wateras well.
NB:Womencouldchooseas manycategories
astheywanted
Frequency
7o
Total
Thoughtit seemednatural
745
78.o
r8g
Thoughtit wouldbe lesspainfuIin water
r45
78.o
189
Thoughtit wouldbe gentledelivery
for baby
IJ)
72.6
189
Wanteda drugfreelabour
9f
50.3
189
Lovewarmwater
91
48.9
189
Thoughtit wouldpreventmetearing
7o
37.6
18g
Hadit recommended
51
27.4
189
Thoughtit wouldpreventinterference
fromothers
45
24.2
189
17.7
189
rotherreasons
Total
189
70c0
'One womonwanteda woterbirthbecouseshe hod a bad back.Anotherthoughtit wouldbe
more relaxingand easierthan being out of water.Onewomansaw it on the televisionand was
curiousabout this experienceand onotherjust wantedto be different.Onewomonfelt she
wouldbe less vulnerableto healthcareprofessionalsin water.Onewomonwasosthmaticand
couldn'tusegas andair anddidn't wantotherdrugs.Onewomenthoughtthepool room
looked'niceandcosy'.
N IGD W I F:EV O L U M6EN U M B E3R
I H EP R A C T I S IM
trlothcr-su'crc unifirrrn in dc.scriLringthcir
ftclings stcn thel entcrcclthc ;rool.
- Itelaxation u'es used 99 tir-nes
- Ilclicf u'.rsusccl5l timcs
- l'rin relicf rvasrefbrrccito 50 tir-nes
- \\rirmth s'.ts usec'l4.3 timcs.
Othcr *'orcls, uscclto clcscribethcir erpericncc $hcn tirst cntcring thc $'rlter $'crc
lluovincr', Control rnd Cirluring. It bcclnre
obvious tlurine the stur'h'thirt u'hcn r-nothcrs entercclthe pool ther fblt rclf,\ed,rnd il
senscofrclict. Thcir cclrrtllctionsu crc perceiveclls lcss plir-rful. Thev enjoveclthc
$;rrnrth of' thc $'rter, the buoi'lnci'. Thc
cnvir()nnrcnthlcl l c.rlnringcf'tccton thcrn
;trtcl r-nirnvfclt ;r feeling of securin' *'herc
thcv coulci rcgilin ilnv lost control rtnd bc it-t
contml. Whcn rnotl-rers\\'ere rrskerlhon
thcir s'lterlrirth sas rlitfcrent fiorlr othcr
cx[]evisl1gc5
of giving birth:
- 39 comnrcnteclth;rt thev fclt 'rlorc in
control'
- 28 userl thc s'orc1s'urorc relering
'lcss
2.1 useclthc u orcls
1-r;iinfirl'.
O t h c r s u s er l t h c s c > r r - l'sl c s s i n t c r f c r encc/nror-ritoring','quicker
labouls','mole
person:rl','srtish'ir-r
g','calmcr','trore nirtu r i r l ' , ' l e s sr c s t r i c t c c l ' , ' e a s i cnrr o v e m e n t ' .
Thcse rvorclsoccurretl rcpetitioLlslvin their
c-lcscriptior-rs.
Tl-revcrrjor,eclbcing unre strictecl,i.c., thev s'crc not lrcil]g lnor.ritorecl
on ir lreclirnd could nrovc ilnd chirrrgeposi
March2oo3 27
it l
tion elsilr'. Tl-rer tblt cahrer ancl fiu-rr-rc1
rrore sirtish'ingtrirth erpcricncei rnrl nrlurl
clescribeclthcir lirbours ls 'quickcr'.
FOUND
Notparticularly
pleasurable
Notparticularty
EXPECTED
very pleasurable
Quite
pleasurabte
pleasurable
and futfitting
No
%
No
No
17
6.0
Quitepleasurable
6
Verypleasurable
and futfitting
3.3
%
7j
42 23.t
6t
33.5
2.7
38
2o.9
5
Numberof womenansweringthis question- t8z (7 missingvalues)
Somemothersspentlongerin the waterthanothers.
Frequency
%
It wasmorerelaxing
16o
8 5 .j
I t c a l m e dm e
118
62.8
Weighttessness/buoyancy
helpful
118
62.8
Soothing
111
62.2
by thewater
Feltsupported
tt6
6t,7
- no-onetookbaby
Abteto holdbabyimmediately
tt6
61.7
F e l tm o r e i n c o n t r o l
to6
56.4
movement
Unrestricted
in the oool
94
50.o
Lessformal
84
44.7
Easier
to pushbabyout
83
44.1
Morepersonal
8o
42.6
Feltlessfearful
7o
37.2
I felt safein the water
7o
J/.2
Senseof privacy
aboutit
68
35.2
monitorine
Reduced
electronic
6t
32.4
Feltmoreconfident/[ess
worried
6o
37.9
FettDrotected
bv the water
47
25.o
*Otherreasons(seebelow)
3o
16.o
in thewaterwith me
Partner
11
5.9
Total= 189(r88valuedcases)
Otherreosonsgiven werethat they enjoyedthe socialsupporttheygot at the waterbirth,and
thot it wasa veryfriendlyinformalatmosphere,ond theyfelt moredignifiedgiving birth.
Motherswelcomedthe ' handsoff' approachfrom midwives,as this gave the mothersa great
senseof ochievement.
2 8 M a r c h2 o o 3
frommothers
General
comments
The urothersgenerlllv pririscclstlff but tho'
u'cre criticll of gencral hcli of triiining in this
motle of delivcrv ilre:r.
()nc nrother colnurcntccltlrirt sl-rc'ftlt
likc e ri'l.rrle, nc1 clclivcrecllikc l u hlle'.
Some mothers rlislikecll-ravingto stirntl
Othe rs s cre
to be nronitoreclintcn-r-rittentlr'.
rrorriecl lbont thc sholc processirr-rc1
siric-l
thcv u'oLrlcllikc to scc nrorc rcsclrch ir.ttcr
u'lterbirth irnrl rcccivc rcrlssltrancc
rlbollt
sirftn'be fbrc thcv hirvernother oue. Scvcnl
mothers criticisec'ltl-reficilities in their areir
fbr n':rtcrbirth.Nlirnv complrineclof slipping in thc b:rth cir.rringthe pushing stirgc.
Behaviour
differences
between
water-born
babiesandnonwaterbornbabies
129 rlothcrs in tl-res.rnr;rlch:rcl2 or more
cl-rilclrcr-r.
102 (79"/")mothers irnsu'crcclthis
cluesti()n.
49 (48%)nrothersnoticeclno ciifl
f.:rcnccsin their s ltcr Lrom bal-l''s Lrcluvior.rr
l'hcn conrl-rrrrerlto tl-rcir non l'rtcr bon-r
brbies.53 (52%) srid thcv clid notice r tlifl
tcrcncc in thcir s lter borr-rbabv'sbchalior.rr
cor-r-rpirretl
to thcir non \\'rtcr-borr-rblbics.
Thesc mothers slicl thcir n';rtcr lrorn blbics
rr'ere:'r'nore
alert','morepci'Lceftll','cdmer',
'more contcnt', 'phcici', 'lcssstresseci'
lncl
'slcpt s'cll irfiers'irrds'.The nrothcr's pcrccp-rtion$ ls thlt thci suckctl bcttcr rrt thc
trrc.rst.St;rtisticlltcstsshos crl no sisnitrcurt
clitltrcr-rccin neu'born bchluour.
Babieswhohadprobtems
in the
sample
Dcsl'ritc tl-rc soocl Apulr scores, 3 b;rtrics
haclprobler-nslfter s'rterbirths. These rirngccl
tl'onr snutlles to lcxv blooci suglr lncl 'lnng
infbctior.rs'
recluiringvcntilltior.rin SCBU.
\\rl-rcrcproblcnrs <>fthis sort hrcl occurrccl
the nrothcrs first blirrrcclthc u'irtcrbirth irnrl
thcn thc miclri'if.:, enclsiriclthcv s'oulc1ncvcr
h i r v c r - r n o t h e ro n e . T h e p l e d i l t r i c i l n s
involvetl hrrl r vcrv negltiic rttiturlc t<r
\\'rterbirth, lncl in sor.nccascsthc paccliirtri
ciln suegestcclit n'i-rsthe u'atcrbirth th:rt
criuscclthcir birbr''sproblcr-r-rs.
Discussion
Lr the sar-nplccighn'-or-repcrccnt of r-notl-r
crs hlcl r q(x)c1crpericnce of l'lterbirth.
Wor-r-rcr-r
s rrntecl'u.rtnrlluess' fi>rthcir birth
T H E P R A C T I S I NM
G I D W I F E! V O L U [ I E5 N U M B E R?
c\pcricnce.urdthcir bebics.Fittv-thlccfrcr'
cent of mothers in the sar-nplc
chooses'.rter
'niltunl'
birth becauscthev ftlt it rr'rrsr-nr>rc
,rndfiftl perccntbecnse thcv fblt thcv srrulcl
This liov seenrsto
.rvoid tl-reusc of r.1rugs.
of Lcbovcr ( I975 ) anci
reflect thc influcr.rcc
Oclent (1983 ). \Vhether\\'iltcrbirth is natural
is l tlebatablc p'roint.Therc is r-roeviclcr.rcc
thrt \\'rtcrbirtlr is better lirr the brbv (Ne I'
son ct rl 19801.Thc nrothcr'sdcfinirion of
uhirt thei'nrcrllt bv natur.rl\\':r.s
not clctinccl
but it appcaleclto meen no rlrugs irucl n<r
tiom miclu'ivcs.Tl-rcclesirctirr
nror-ritorir-rg
nrturrl chilclbirth fronr r nritlri'iti \\'i1sllsc)
firr.urcl
bv Field ( 1985 ) ;urr1NIcClair-r
11983).
As r result of their l'aterbirth expericncc
the rnothers s';rnteclto tcll as mlnv p-rcople
irspossible.rbout their brbi-'s birth lncl hou'
nttr\ cllous it rrls. Hou cr er ntc,istrrirtq
sltisfirctior.rin childbirth is nrcthoclologicirllv
difllcult (llrar.r.r;rdat
et irl I993).
The po$'er of tl-remediii $'esirlsoeviclcr-rt
in controllir.re
the trcnd (Cooke I994 ). It is
knou'n thrrt nridc-llcclirss\\'omen teucl to
rercl more lntenltlllv than *'orking cless
\ \ o n r c r lr f u l c r 1 9 7 7t . s o i t i s r t o t s r r r p r i s i r t g
thirt knoulcdce of this nrocleof clelilcrv
s p r c i r r lt h o t r g h l i t c r i l t u r c . I I i c l t ' l l e c l e s s
\\'omcn \\'cre morc likelv to luvc dreir ti'ishcs
respecteclth.u-rs'orking chss u'omen (Nclson 1983 ), utich r-navirdrl to *'hv thc s.rrnplc n'as;rreriorlin:rnth' nri ddle chss rlsr.t.t;ul'
\ \ ( ) n r c n s l t o r rc r l c . r c . r tr l ( t c n n i t t l r i o r t i r t
u hirt thev *'irntcd (Ori cn 1992 1.
acl-rievir-rg
(]irrlurc-l(1994) rncl Footner (I992)con.rlurentth;lt \\'omcn lskir-rgfor $'aterbirtl'r ir-ritiatcclthc senice.
T l - r cf i c r t h e t 1 7 . 5 ' ) Lo f u o m c n i n t h c
rcseirrchuerc introtlucecl to the icle.rof
s rtcrbirth bv a micin'ifbcr>nflrr.ns
that n-riclw i v e s h a v c r c c o g n i s c ctih e p a i n - r c l i c v i n e
cffccr of rvlter.rncirccogniscrratcrbirth as
J n o t h e r c l i o i c c t o o f l ' c r u o r - n e n .S o r - r . r c
\\'()l-ncnl;rboureclfbr lor-rgcrtlrrn othcrs ir-r
t h c \ \ ' r t c r , : r n d1 2 . 8 %o f u < > u r c u ; r l scol c l i r ' cleci the plirccr-rtlin the \\'rrter. trIlnr' ;rrirctitionershl c avoidcdclcliverinethc plirccnt.r
runclcrs'ater duc to thc theoretical risk of
s'rter embolus ii'hen thc prlircent;r
sepilrirtcs.
Ho$'evcr it \\'ilsn()tcL'lirt lhe \\'irtcrbirthcolrterence in 1995 thrt olrt crfthc I 0,000 cloc
Lrrcntccl $.rterbirths ir.r()unclthc $orlcl l
cilsc of \\'atel'embolus has never bcen rlocnr-nented. In Soutl-rAfiicr tl-rq' hrcl over
4,000 u'rtcrbirths bv 1994 (Internrrtionrl
lVlterbirth Confbrence 19951 ancl it sirs
rcported thirt thc pllcentl l'as rls';ri'sciclir'clccl in s'ater. The rrgunrent fbr not doing
occursit is diflicult
so is thlt if l'r;rcrnorrhege
to cstiurilte Lrkrodloss arrd lecognitiorr of
suchln e\ ent nrrlvbc dcl.rve
tl. Also it is crsier to clcll r-rpr
and clrain thc pool if thc phN IGD W I F.EV O L U M5EN U i I 4 B E3 R
T H EP R A C T I S IM
Somemothersspentlongerin the waterthanothers.
Freq
uency
I got cold
77
%
5.9
Babygot cold
Couldn't
standuDto deliver
t.6
Contractions
wentaway
4.8
Staffwerenotsupportive
5.3
*Otherreasons
47
25.o
Noneof these
110
85.o
Total
r88
LOOo/o
Otherreasonsgiven oncewerethat they didn' t like the midwifeexaminingin the bath,ond that
they dislikednot havinghandlesto grip onto. Thewaterwastoo hot for one mother,and
anotherdislikedhavingto stand up to be monitored.Onemothersaidshe wasfrightenedher
baby woulddrown,and anotherdislikedthe physiologicalthird stogeshe had.
centa hrs rrot bccr-rdeliverccl in u rtcr.
Sonrc sorlen nccrlecl lx)rc thi-ln \\'rrnl
\\'irter for pein rclief. \\tr:len nccclto unclerstlnrl th.rt thev rrre ()pring fbf l rlrug-frcc
birth l'ith l'aterbirth and that it is not safi:
to ;rdnrinisterother fbmrs of irr-rrlgesia
u1-rile
mothcrs rre in \\';ltcr. Clrcfirl irntenatrl
prcp.Iriltion mlv hclp evoiclthc usc of u-rllgesi;i(Nightinerlc 1994). Wonren in this
slr-nplecor-nmenteci
thet one of the pr.rsitii'e
thinqs ;rbout s'atcrbirth \\'asthc fie edonr of
nr()\'cntcntthcY cxPcricr.rccd
in the tyltcr;
thcv rrcrc not rcstrictcclto ir ber'ltl uroni
tors irncl other equipnrent. Dissrtisfiction
u'itl-rthis ispect of c;u'cis ir conlr.tronrcasor-r
fbr secking irltern,rtivebirth scttings (Fielcl
1 9 8 5 . N I c C l a i u 1 9 8 3 ) . P o s s i L . rrh(') t i l t i n g
u'hcn rn pain mirv hclp kccp thc fbtusoff thc
nervecentrc in the brck uten thc uterusis
contrrlcting,but this r-rccds
furtl-rer reselrch.
Stcrens\1976) fi>n:rc1
thlt rhc ntorc speqivcr one rlroup
cill lrrcntion tlte rcsc.rrchcr
of sut-rjccts,the greilter thet gror-rp'slbilitl
to cnriurc prin conrparcclto il control group
thirt rcccivccllittle .rttcntion fronr tl-rcer;rer'
irlenter. At rhe timc of this stutil' thcre arc
relativelv les miclu ivcs pnctisille the lrt oi
\\'i-rtcrbirthso \\'onrclt tcnclcclto get coltti
nttin' c>fcirre, s'hich increirscss;rtisfictior-r
(Hor.rse
o f C o n r m o n s1 9 9 2 , G r c c n 1 9 9 0 ) .
Ottcn rrhcn thcv lrc tlclivcring thcv hlvc
micluiies obscrvins thc cvcnt ls u'ell rs
clelivering the b;rbr', l-rc1 botl-r the pncti
tioncr :rncithc mothcr look fbnvrrcl to tl-re
\\irtcfbirth. Tl-resocialsupport rccciveclin
\\'atcrbirth coulcl l-rci-rflctor in rcciucingthc
piln rclief neeclccliC)irklei'1979, 1985, Gar-
ciirct d I982. Lilfbrciet al 199,1).Sociirlsupport is xls()linkec'lrvith tl-rcclfects of clte
cholrrr-r.r
ir.rcs orr u terinc c()ntractilitv illtcj
rutcdnepl.rccnt:-rl
flos'(Sosect al 1980, Klaus
et il 1986). It is pclh.rpstinre fbr nriclu'ivcs
to embrece J more social moclel of crre
lWirlsl-rlncl N:cs'burn 2002) rn llbour to
tlccrcirsc i.tt-ttictvlnci pr.rir-r
tbr *'or.ncn in
lirbour. llut it cirnnot bc tlenicd th.rt \\'rter
immersionrlecreascsp;rinin hbour (NIilncr
I 989, Zirrnrcrmirrr19931.
Hiel-r cxpcctrrtionsh,rve lrecn fbLrnd tc>
hiri c l positivccffect on prequ,rncvlntl lrilth
outcome ((ilee n ct rrl 1990 ). Clontrlst r-noclc l s | 1 g . l i ; 1t l r , r tr r l r c r tc ( ) n \ u n r c rI\) c r c c i \ cJ
cliscreplncv bets'ccn cx1'rcctrrtior-rs
irncl<>nt.ollrcs, thcv tr'ilI nrirgnih'thc diflcrcncc lDai
19 7 7 ). T b.e.rssimilirtion nrocleIpredictsthet
inconsistencies
Lretsccn cxpcctJtionsilltd
or-rtcomcsrl ill bc rcci,rccclor .rssimihtet'lirnrl
cousllmcrslill rrcljustthcir pcrccl'rtionof
thc outconres to be nrorc consistcnt ri'ith
(I)l' 1977 ).Tb.c\\'ornen
thcir cxpectiitior.rs
in this rescerchh;rcll-righerpcctirtior-rst>f l
u'irtcrbirtl-rcrpcricr-rcc(Tlblc 4), ercl lareelv
thcsc c\pectiltiorrsu'crc rlct tbllou inq thc
rlssirrilrtion urodcl. These tirctsmirv hell'r1o
cxplrin the positivc resp()nseof a highh
moti\'rtecl {roup of s'orrcn. \\rhen \\'omclr
g()t into the pool in l:rbour nranv of thcnr
dcscribctl teelings of' conrpletc rel;rr.rtiolr
anclrelicf. \Vomen fblt thlt thev s'ere sivell
immeclilte plin relief lr-rclthc \\'rrmth \\'ts
enjoved the buor's()()thing.Nlrrrrvr-r-rothers
rncr'. Othcr sriters hlc lncntionecl this
rdvantagelBrlaskrs 1990, JepsonI9891.
M a r c h2 o o 3 2 9
Theimportance
of 'control'
s()nre c.lsesbirbies havc to bc tirken ;rq'a\'
fron'r the nrc)thersimmccliirtelv firr sor-t-tc
It n'irsclc;rr fi'om the
Womcn feelingin c<>ntrol
cifthcir chilclLrirth forrn of resuscitirtior-r.
clltl thlt this irspcctof carc hirsr.rpsct;ncl clisexpcriencehrrrebecn lssociltecllith Iong(SinrkinI99l ) rnci positivc
trlrbcd nrilnv nrothcrs iintl thcv hrivesor,rght
tcrnr s.rtistirction
\\'.rrcrbirthbcclrsc thcv h.nc l'rcrrcithrrt in
s (Grecr-rct .tl i990t.
psvcliologicll()utc()me
\\'rterbirth this l1t>csnot h;rppen.This is
Tl-risaspect nril\'hi1\'einfllrcncer'lthc positilc
vicus mothers hlc of srrtcrbirth. trI:rrrv mothcr inrplic;rtiorrfirr prlcticc. Tocl.r' skir-r
to-skin contect is pr;rctisecllftcr birth both
\\'ol-ncnstiltc('lthilt thcv uscd \\'rtcrbirth t()
'control' tl-reircrl'ironnlcnt, i.c. tci stop sh.rt
to rlirintirin tl-re blbv's tenrpcl'iltr,rreiul(l
cncoLlr:1ge
boncline(Ashmorc 2001, Hunt
thcv tclt \\'rlsLlrrneccss;lrvintcrf-crcncefiont
'got ilt' so
2 000, Wrllirce rncl Nlarsh.rll2 00 I .1
. \Vcrmcr.r
proftssior-rlls.Tho'cor.rlcl-r't be
u'l-rol-redcrperic nccd i nstnrntcntirl delivcrcrsilv ir-rthc \\'iltcr.
'.1
ics lls'lvs conrprlrcclthe rr'.rterl-rirth
erpcrici thc \\ i.rtcrrs
Sonrc s onrcn clcscribe
bhnli.ctof sccuritvfi<>nrthc outsirlcirt>rlci'. cncc t.rior.rrablr'.
r\krst rnothers t1itl not intlicirte rr-rvclislikcs
This l.rasinrplicrrtionsfi>rpractice. r\licivii'cs
rbollt \\'irtel'birth;ho\\'evcr,the slnrplc u'irs
needto consirlerbefirrccomn'tcncirtgunncc
i'agin;rl
biirsecltol'irrt1 \\'()nrcrrrr ho had ir goocl expeessrn' fetrl lno n i tori n g rncl stancl:rrcl
rience of uetcrbirth. But utcn eivcn the
rr hich mothers rlislikcclin this
exurinati<>us
op-rportunin'
to fleeh' c()mmcnt lbotrt u'ltcr
rcse:rrch.
Such eraminltionsshoultlbe ke1.r
birth scvcrel mothcrs cc)rnrrentccitl-rrt thc
to ln ;rbsolnternitrituunr.
staffu'ere not supportivelnd cvcr-rhostile t<r
thc it-lelof s rtcrbirth. Goh ( I993 ) fbuncl in
Catming
hcr str-rclv
thlt nritiyiycs h;rd nrirccl vicu'sor.r
u irtcrbirth lntl sor.r'rc
stronglv o;r1'rosccl
it.
Wirter l-rlsirn lbilin' to clhr.trncl is pou crhtl
Their peersshoulcl not cortclcutr-t
miclu'ivcs
i r r r c r l r r c i r r r. rl r r r i c t l t L e r i r t c 1 9 8 - [r . , \ l o s r
s'l-roclo not \\'ilnt t() prrrctise\\'rtcrbirth. It
\\'omcn in the s.rm;rlec()mmcnted'it crlnrctl
is a verv personirlinclinirtion.
r-nc's'hcn cntcring thc 1-rool..Nhn\'\\'omer)
r\'Iotl-rcrs
uho enc<unterccl prroblcursri'ith
fclt thc l'atcr ntrcle thcir labours quicker.
thcir birbv after u'rtcrbirth s'erc inclinccl t<r
Warr \\'rtcr hls lreen shorr'rt tc'rincrcrsc
blirme thc mit'tuift. To tllte n() nconiltill
tutcrinerctivin'lKh.rnrisct rl 1983). Horrelclths hlle treen .rttrilrr.rtct1
to s'irtcrbirth
cver 129 \\'onre11oLrrof I89 rrorlcn iu this
(Gilbert lntl Ttnkcr' 1999 t.
sirmplclelc nrultip,rrousend this u'ould
Hos'evcr todirv the prJcticcis nrlrch morc
prcclisposcto mofc cfllcient l,rbours.Hol n'idcsprc:rd;lnd ur()rc Jccepteds'ith manv
cvcr sonlc :tlth()rs rlo presentelidencc thiit
\\'iltcr hlrollr rlt>csspecrl up llbour ((iirrr-nids'ivesprirctisine thc irrt of u'atcrbirtlr
(Garlirncl:rnclJones,1997).
l;rnc1ancl Joncs, I994). C)thcrs clislqree
(Schornet al 1993, Burkc rncl Kilfbvle,
\\'omcn comnrented th;rt tl-rcv
Severr-Ll
founcl tl-rcbath too hot. Tl-risis concerning
1 9 9 5) .
thrt \\'itcr tcmThe belief thlt u.rtcrbirth mirkesbrbics
irsStirrlt ( i993 ) spccul.rtcs
cllmer rrnclperccfirl .rticr tl'rcbirth is r-rnsr,rb- [rcrirtrlre r-nil L-re.r contriblrtirrq firctor in
rrct'r'rlt,rl
tlc,rtlr
st;uti;ltcd bl rcselrch cvirlcncc.trlcasure- .rssoci,rtctl
Birtl-rclcsigrru'rrsir.nport,rntto nx)thcrs.
r.r-rcntof this is rliflctrlt clue to thc n.ri-u-rr'
vlriirblcs. Onc r-r-r<>thcr
sto hlcl t\\'o \\'rltcrT l r c v u c r c l c s s l i e c r rr t r r l l r l t l r t h , i t P r c
ventecl them gctting rlcep into the \\':1tcr
births sricl:
'MtJirst n,nterbnbt,n'asplncid attd ptncclnd u'irntcd l-rirnclles
tcl hclltl onto to stop
vtn,
cnlm
child
hon,ner
thcnr
slipping.
nnd
is
still
a
tltc
.fii
stcortdn,attr babyis rert,f'nctioru aud intpatitnt and n,asJi'orn ltit'tb.'
PsychologicaI
effectsof water
Onc of the nrost srrikinqcomnlents \\ ils
C)ricr-rt
comnrentstltilt \\'omcn rrc 'dreu r.rtr'>
thrt nrothcrssairiibr thenr the nrost nrc)llt h c s ' r t e r * ' h e n i n l i r l r o u r ' { O t l e n t1 9 8 3 ) .
orrble ;rspcctsof'\\'irtcrbirth \\'asthirt:
'No one took their bnbit:snn,q,.fi'om tltntt
This sr-regcstion
ilppcirfsto hirvc soure substillcc \\'hcn \\'omen ile so enthLrsi,rstic
immediatch,aJitr birth'.
lbout
Sixn'-onepciintseven pcrccnt (6I.701,)<>t the expcrienccof rilterbirth. Ever-rthor-rgl-r
s'aterbirth had suflbrcclfiorn sor-r-rc
mothers mrcle this comr-nent.\\rl-rcnr bebv
lcllerse
pr-rblicin'mothers still u'antcclit.
is borr], Often irs soon rs the rnother has
lookcci rt it nrirnt' ntid*'iyes cut the cord
ancl put thc brrbvon ;I \\'rrm rcsusitrire tirr
ConcIusion
drving iurti n rlpl'rilg in l s'irrr-ntou cl. Sonrc
Thc responsesfi'orl thc survcv sr-lsgcstthrt
tin-resthe babvis not gir en blck to thc nx)dr\\'iter hrs therapcuticqu;rlirics.\Vl-rethcr it is
ers until rrftcr thc Pl;rccnt;ris deliverccl. I:r
2oo3
30 March
so fbr babics rcmrir-rsLlncertain.\Voueu
choseu'etcrbirth bccllse thev felt it ri;rs r
n.rturirl qentle clelivcn' ftrr thcir babr', ticc
fi'onr tlrugs lncl intclttrcncc fior-n profbs
sioruls. Or.rcl.runclretlrntl tittv thrce (81%)
\\'onrcn lcrc ilt fivor,rrof h.ivi:rqlnothcr
\\';rtcrbirth. Hos'evcr' .rlthough the samplc
\\'.1sbirsed to\\'rrrls \\'omen rrho lucl r goocl
crpcrienccof s'rtcrbirtlr, it still rcvc:rlerl2
( I.I%) u'orlcr-ruho rrrl..lcilrot \\'ilnt anothcr
s lterbirth. Clelrlv choicc is ncedccl.
Somc u'oncr-r tbur-rc1
strrff l-rostileto \\':lterbirth .rr.rc1
not u'illing to pr.lctisc it. Wl.rcr.r
thcre rvcrcproblcurss ith thc blbr':rftcr the
urrtcrbirtl'rrnothcrs tentleti to bl;rmc the
sltcrbirth, then tl-rcnriclu'if.:.
This reirction
nrirv be influcncccl bv tl-rc p,rccliatriciirn's
rcrction.
i\lost mothcrs u'crc unifbnr.t in iclentih'ing thc cx;rerienccof s'rtcrbirth as rcllxine. pein relieiing, fbelingnrore in control
o l ' t l r c r r r s c cl rs i l n r l t l l c i f c r r v i r o n n r c r r t .
\\burcn fclt protcctcclfi'om profcssion.rlsbv
Thc| cnjoveci tl-re
thcir \\'irtercnr-irouurc:]t.
uciqhtlcssr-rcss
irnclthc eirseof movcllcnt
Thel rlso l-recllcss
thlt the \\'iltcr allo\\'ec-I.
n r o n i t o r i r r q .J n ! l J d . l l n r c lc r r ri r o t t t t t c t t t ,
jovcrl.
u'hicl-rtl-rever-r
Ncirrlv rll \\'()men hrrd high crpcctrtions
ot'thcir \\'rtcrbirth :rnclthesc \\'ere mct. For
the rnclthcrsit s'ls inrportf,nt thlt no onc
took their blbv ls rrvti'onrthcr-nimnrccliatclv
riftcr birth.
T h c r c s ' r s n ( ) s t J t i s t i c i r lt i i f t t r e r - r c e s
bcnvccn the bcl-rlviourof l;rtcr-born b;rbics
rllrLln()n \\'rter-born blbics blsecl on corlr
rlents bv mothersi howcver thc lcscrrcl-r
nrcthod uset-lfirr this qucstron \\'ls not
robust. TI-requcstior-rto .rsccrtiliuthis needs
()utconresnthcr
to bc basctlon rncasr.rrirblc
th:rn strbjcctivercsporlscsfiorr thc lllothcrs.
but such .i stuch'uoultl bc hrrvenrcthocl
oloqic;rlproblcms.
lmplications
for practice
- Nlicll iles neeclto remcurbcr thc ir-npor
t:ncc ()f\\'omcn fbcling in control of tl-rcir
birrl-rcxpcrience,rs this is .rssocilteclu'itl-r
lclnq-term sirtisfrrction
fbr s'onren etter
c h i l d b i r t hl G r c c n 1 9 9 0) .
- itlirls'ives neeclto pmvi,,1cir r.norcsoci:rl
nroclclof cirremrl clenrcrlicllisetheir cirre.
- N'lidri'ivesr-nustrcsist thc ternptltion to
trke brbics iru'l' fiom thcir nrothers
situirtions lnd
e\ccpt in lift tl-rrcatcr-rinq
prictisc skin-to-skincareimnrcclirtelvrftcr
b i r t h ( A s h m o r e2 0 0 1 ) .
- Bettcr antcr-rrtirlprcprrrti()ll oi n'omerr
tbr sirterbirth is ncerlcclto rcclnccthc
nccd fbr othcr fbrms of p:rin rclicf.
IHE PRACTISING
MIDWIFEr VOLUME6 NUMBER3
REFERENCES
.\l.lrrrlicc F. ll.cnfic*
rrtl birtlr rr rrtcr
\1. ,\l.ireh,tnt S ct.rl. 1995. l-.tl.,,Lrr
i r t F - t r g l , t n .,lr r t . l\ \ ' r l r ' : s u r \ c \ r c P r ) r I
6/.11
.3( ): .r-i .rsl
.\hcrciicc F. Rcrticn .\1.lhrch.tnt \ et.il. 1996. Lr['r'trr
rnd hirth in s.rtcr: \.rtion.rl r.rnJti()n in pricticc. 13/.11
4(8): I i
. \ s h n r o r t S . f { ) 0 i . I t r t f . l c r r r c r t r t t r\{k r n t ( r s k r n . ( J I ) I J . l r r l
flrc rnrnrc.li.rt( prrstn.rr.rlpcrirri.
ll(2):2'{-
IIIl)IIl.\
,1Iidr'!l'\t r Din!t
\rchtrlg.ric
.l/rrlrlrli.l(l):
c\pcncr).c\ rrrl l.svchol',qtcrl,'utcotlesof chi[il.irrh:,{
lfr)(l)(.u\r srtrdr oi-32i rrrnrcn. llrrtlr )7(l t: l5'2-l
()rkler -\. 1979. Raiiltutltl tr rrrllr./: R()bcftson. ()\li)rd
H < r r r s rL r t( r r n r n r o n s . 1 9 9 1 . H . n l t l ) ( t i l t i l t r t , i
$.i\ () rmpro\c [.irrlr sciShti .\or.\ir llirl 2I:
5rtnui
().rklcr .\
H u n t S . 1 0 0 0 . S k i n t o s k i n c o n t . r c rr t i c r b i r t l t . . l l i d n ' i t i r \
.lI . t+76.I+::
-l/arari86:7
( ) t t i l c l \ ) l - L r l i t i ( ) r r( c n s u s S u r r c r s r O I ' ( \ r 1 9 9 1 .
\ttrri ttd Oi.tt Irnlrt tr| (-lnttitiiitiil,].1. (ircrrnrcnt
\t.rtistitll Scrr rtc. L,rnri,n
l n r c r n r t i , r r r r l r r r r e r [ . i r t ) ri r ) r ) f e r ! n ( .
l99i
].\Ltth,,r's
()rcn
Tittrcs 85(17):
l{rlevEIID.
22
B u r k c F _ ,K i l t i r r l e . \ . 1 9 9 5 . \ \ r r c r l , i r r h r n c l [ ' c . 1t - r r r h .
l1r'rlnirtr Jrrr: .1-7
(l.rrnnrrr H. ( l.rscn K. r.trt \\trrcrn
l. ct.rl. 1991. Trr l..rthc
()r not t() bJthr dnring thc lirst rtrge ot labottt. Attd ()lt.tt.I
-l
\rna 73: -16ll
( - < x r L cJ . 1 9 9 { . . \
I r e r s t r r r l e ( ) n l n l u n r ! . r t i ( ! lu i t h l e n n r
(.rxrkc. l.rbour \\'.rrri ll.rnrgcr. ( lt.rth.rnr
Drr
-l<rr'.rrrls
R. 1977
.r l.roccss nrtxlcl ()i.onsurtlcr
sitist.r.ri()n. ID: Hunt H K lcil r. ('r)ral?1rdliiattott 'Dttt
l jt ti JM1'ltt al t t tl trtrItt,ttr snt t sf'ntt i ttt,r tt d l issnt rsln t t t ttt.
Ficld l',\. l9Si. I'lrents'rclctr,ns t() nritclnlt\ circ.
\ \ i r n r c r ' s r i e r s o t . u r t c n . r t . r tl . t r c . I t t F . r k i r t
tr1. Ch.rlDrcr. I cdst. Ellilrrrrrrirr
trttd iatisl'trttit,
ut
Garl.rn.l D, Irrncs K. I99{.
i n r n r c r s r r r r( ! n r ) n i r r D c f s i o n i A / . 1 / 2 ( 3 ) : I l . i - 1 2 ( )
L Ir.l.trttq rhc
-3
cr iderrcc. llr rrr.,l /rrurt o I rt -\| t I n't It t .t 5(6): .36S
.tntotrg
tr.rbicsdclir erctl in rrrter: Surr cillrncc sturl\' .urd p(xI,rl
survcr. B.l,?319(7208): 18.l i
Li,rh )'hrng )rrke 5 199-1.llhrtrhirtJt .l1t iinlt)tt1tt il
itJnqt. ottiuttt. trilI 1.1..ltiou
L rrprr[.lislretl.iisserrrtrort.
ThePractising
Midwifeis thevoiceof clinical
which
midwifery.
Wewelcome
contributions
viewpoint
or description
of life
offera personal
of today's
as a midwife'at the coalface'
profession.
Thesemaybe
midwifery
controversia[,
ana{ytical
or reflective.
RESEARCH
Wearepleased
to acceptoriginalresearch
papers.
Yourarticteshouldinclude:
- an introduction
- a briefoutlineof the methodology
- consideration
of anyethicalconcerns
- results,
in cLearly
whichmaybedisptayed
labelled
tablesor graphs
- a discussion
inctuding
their
of thefindings,
practice
relevance
to midwifery
- the timitations
to the research
- imptications
for furtherresearch.
N IGD W I FTEV O L U M6EN U M B E3R
T H EP R A C T I S IM
\ledicrl
Schorn IlN.
I tlrorcr E
I.)7i.
on rll.ltcnt.ll Jn(1 int.!tr
Cliltits i11
^\'o 6-1.Sp.tsrtcsIntcrr.trionll
t r 1 c . \ l l i s t c rJ L - ,B l r n c o J l ) . 1 9 9 . 3 .\ \ ' r t c r
ol'\rrsc
S r r r r k i nI T . i 9 q l . j u \ r r r ( ) t i r t r ( l i \ i n . r s < r t t t . t n ' sl i t e : '
H()tl\c. J.('r1d('rl
\'. Hcrtcl J 198i. \\hrnr rrrtr b.trhinq
rluring lrhoLrr Fllccrs on I.lr\nr.r citcch()lrnrincs.intl
B
cnrlrlphin likc inrnruncle.tctivinconccntrrriols in thc
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- 1 1 r rl 7 : l l i 5 7
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.103: i97 6(X)
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of prin in prcprrcri childbirth - l : ,\ rertcr ()t the reseirch
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