It is quite common for women who would like to use water in labour to be told that the Trust does not have sufficient midwives available who are trained to attend them, and that they will have to leave the pool to give birth if a midwife with training is not available. This may be an issue for women planning homebirths as, if they are covered by a team of six midwives and only three are considered competent to attend a waterbirth, they may face a fight if they don't get one of those midwives on the night. On the other hand, women who are planning a hospital birth have no guarantee at all that there will be a pool available OR that there will be staff who feel competent to attend them in it - hospital pools seem to spend a remarkable amount of time unavailable due to being dirty, faulty, occupied etc, and it is a common complaint on the UK midwifery discussion list that a maternity unit will have a shiny new pool, but tnat babies are hardly ever born in it.
I sympathise with the midwife who feels that she is not confident in attending a waterbirth because her employer has not provided training. I am aware that midwives cannot always rely on fair treatment from their employers when they support a woman's informed choice. My ultimate priority is to support women's informed choice, but I'd like to do that in a way which also supports midwives.
In your own home, it is up to you whether you use a birth pool for labour or birth, regardless of whether the midwife is happy about it. Many women who have had waterbirths before feel that there is no need for the midwife to have any special training if they themselves are aware of issues regarding temperature control and bringing the baby to the surface immediately after birth, and in at least one birth story listed below the mother, on being told by the midwife "But I don't know how to do a waterbirth!" has replied along the lines of "Don't worry, I do!" !! Obviously if you decide to stay in a pool against the midwife's advice then you need to know what you are doing and to take responsibility for your decision. You would probably find the discussions on waterbirth training from the UK Midwifery Discussion list helpful.
Women who are told that waterbirth-trained midwives may not be available can help to get training arranged for their midwives, and to get the service they need. One route is to write an 'assertive' letter to the Head of Maternity citing the Royal College of Midwives (RCM) and Royal College of Obtetricians and Gynaecologists (RCOG) position statements on waterbirth etc.. .
For an example of real change occurring as a result of such a letter, see Sonia's story, below.
"Dear Ms X,
I am booked for a home birth with Team Z and my due date is (date).
I intend to hire a birth pool and may wish to use it for labour and for birth itself. My community midwife told me there may not be a midwife available who is trained to attend waterbirth. I was surprised to hear this, as the Royal College of Midwives' position paper on waterbirth, published in October 2000, clearly stated that all midwives should be competent in assisting waterbirth. It also stated that:
"Women experiencing normal pregnancy, who choose to labour or deliver in water, should be given every opportunity and assistance to do so.".
I am copying here one of the relevant sections from the RCM position paper:
2. Managers and supervisors should ensure that midwives acquire and sustain the competence, skills and confidence necessary to assist women who choose to labour or deliver in water (UKCC, 1992a; UKCC, 1992b; UKCC, 1998a).
3. Midwives should ensure they are competent to provide support to women who choose to use water, and should keep themselves updated on the research evidence in this area.
You are no doubt also aware of the Joint Position Paper published by the RCM and the RCOG in May 2006, on immersion in water for labour and birth. This paper stated:
20. "All midwives should ensure that they are competent to care for a woman who wishes to have a water birth .."
21. "Midwives, managers and supervisors of midwives should ensure that training in caring for a woman who wishes to have a water birth is undertaken by midwives who undertake intrapartum care, in order to increase choice for women and promote normality and ensure quality care."
I find it hard to believe that, in light of the RCM's paper of nearly six years ago, the community midwives in my area are really not all trained in the use of water for labour and birth. I would appreciate it if you could please confirm to me in writing whether this is the case, or whether there has been a misunderstanding.
If it is indeed true that any or all of the midwives on my local team are not trained in the use of water in labour and birth, then I am sure that this will be rectified immediately. It will surely be to the benefit of all mothers, and midwives, in the community that their training is brought up to the standards which are expected of midwives nationally in this area. I understand that the most important issues need not be time-consuming to cover - see for instance the UK Midwifery discussions on www.midwifery.org.uk/waterbirth.htm
I look forward to your confirmation that the relevant training has been received by community midwives in this area, and to their care in my labour.
THE USE OF WATER IN LABOUR AND BIRTH
Royal College of Midwives
Position Paper No 1a, October 2000
Immersion in water for labour and birth
Royal College of Midwives/ Royal College of Obstetricians and Gynaecologists
Joint position paper, May 2006
Sonia had gone to some effort to make sure that midwives trained in waterbirth would be available, but still encountered problems when the attending community midwives said they would not ' deliver her' in water. Here's what happened:
A few months ago, I asked my Community Midwife (CMW) about my planned home water birth and she had told me some of the CMWs were not "comfortable" with water births, not trained, and would ask me to get out the pool to deliver. Well I wasn't happy with this, so I used a letter from the homebirth website to complain to the Head of Midwifery at East Surrey Hospital (and told my CMW I would be doing this, which she was fine with)
I really wasn't expecting a great reply, so was very pleased to get a letter back which said "much has been invested in ensuring all midwives are trained in managing water births. There is a dedicated session on the mandatory training programme which all midwives have to attend annually.....I can assure you that your choice will be fully supported". Also that the CMW has been "enlightened and is now aware that she must not repeat such communications to women"
Well, in the end, on the day itself - it didnt go as planned. When the CMW was on her way she told me neither she nor her colleague who was coming were comfortable with homebirths due to lack of experience. I explained my letter from the Head of Midwifery saying all midwives were trained, but she still said she and her colleague still wouldn't deliver in water. I rang delivery suite and spoke to supervisor who was very helpful and said I could transfer to Crowborough Midwife centre or Brighton hospital for a water birth, or she would send a midwife from the delivery suite once the CMW had assessed me. I went for the last option, but in the end it wasn't needed (I didn't feel the pain was bad enough to get into the pool, until I felt ready to push, then the midwives finally arrived, I pushed for 2 mins and out he popped!)
So, a few weeks after Oscar's birth, I wrote to the Head of Midwifery again, letting her know what had happened, and how I didn't appreciate a) arguing with midwives whilst in labour and b) the possibility of not having a water birth because of the MWs inexperience, or being stubborn and refusing to get out the pool had I got in ! I suggested she sort out the rota so at least one experienced water birth midwife was on call at a time.
Well, she replied - and it's even better news.
"I have to stand by my original communication and reiterate that all MWs are trained in water births. Where the discrepancy lies, it seems, is that yes they are all "trained" in the theory, but those who have not gained practical experience recently feel their confidence is lacking"
"As all midwives are trained and I believe competent to undertake water births, I have taken steps to correct the situation, beyond reviewing the on-call rota. I have written to each community midwife individually to highlight their responsibility in maintaining their competence and confidence in the skill. They have been directed to make arrangements to attend hospital water births until they reach a level of competence that allows all women this experience as part of their right to choice. I hope I never hear of a woman being denied this choice in future. I can reassure you that it is the first time it has been highlighted to me"
"I will use your experience to ensure women are not put in this position again"
Hoping this will help ladies in the Surrey/Sussex area with their home water births.
Home Birth Reference Page