Labour afloat - disabled women using birth pools

After an introduction from DPPI, here are two accounts of disabled women who have recently given birth in water and that of one of their midwives.

Using warm water baths during labour has long been a popular form of pain relief in many countries but it is only the relatively recent arrival of commercial birth pools that has made the prospect of water births a reality for more women. The depth of water in these pools is greater than can be achieved in an ordinary bathtub and this is essential for buoyancy and to permit upright positions for the labouring woman. In Britain the growing movement to get birth pools into maternity hospitals has been almost entirely client-led by pregnant women who have done their own research and satisfied themselves of the safety aspects. An increasing amount of medical literature is appearing in the journals, attempting to evaluate the effects of water on labour and childbirth outcomes.

There is no doubt that informed use of birth pools potentially offers many disabled women a number of specific benefits. The buoyancy and relaxing effect on ligaments and joints can enable much more freedom of movement to a woman who may be relatively immobile on dry land or who finds movement painful. The drug-free pain relief they offer may be particularly important for women who cannot, or do not wish to, risk the side effects of the available forms of medical pain relief. The humid environment may be beneficial to women with asthmatic conditions. The drop in blood pressure associated with being in warm water may aid women with high blood pressure. The support and softening effects of the water means less likelihood of bad perineal tears - this means a less painful postnatal period which is important to every woman but even more so to women who spend most of the day in a sitting position. The sense of control and of being in an enclosed and calming environment may be particularly significant as many disabled women fear being treated less respectfully by childbirth professionals.

Ruth’s Story

Having been diagnosed as having Ankylosing Spondylitis (AS) in 1991, I had to seriously reconsider my outlook on life. I had been extremely physically active, being a partner in my father’s farm but, finding that too demanding, I retrained as a chef. After a year and a half this occupation also became too much and I realised I had to take a very close look at my future.

AS affects my neck, shoulders, top of back, sacroiliac joints and hips causing stiffness and pain. I am unable to sit, stand or lie for any great length of time. I have always wanted a family and felt that if my physical condition was to deteriorate I would have to consider starting one very soon. My partner was very supportive of the idea, so I consulted my doctor, rheumatologist and my physiotherapist, none of whom could foresee any problems although they recommended I consider a caesarean section if my sacroiliac joints became too stiff.

It was the worry of the caesarean as well as the fear of going into labour and being laid on a bed (which would lock me up and immobilise me), that led me to consider a water birth. As I have hydrotherapy every week I realised the benefits of buoyancy, having freedom of movement with a reduction of pain. My own doctor was in favour, as was the consultant paediatrician.

My next task was to find out more about it, as the information from my local midwives was minimal, there being no birth pool in the area. I had to hire the pool then engage the cooperation of the maternity hospital. The pool came in four pieces with a pump and liners which had to be assembled when I thought labour Was imminent. The cost of the pool was £130 whilst the maternity hospital also wanted £150 towards the cost of strengthening the floor, as the full pool weighs about one tonne.

This seemed like a lot of money, so when the Devon Orthopaedic Association gave me a grant for the hire fee and Exeter Health Authority offered to pay for the floor work I was much relieved. The hospital has now shored up the floor permanently for others to use, so I feel my efforts have been worthwhile.

Having made contact with the hospital midwives, then I felt I was getting the support I needed. From the very start, the idea of having a water birth made me feel confident and I just hoped that I could actually deliver the baby in the water - that was my dream!

My condition improved during my pregnancy until the last two months, when I became heavy and stiff. The final day came on July 10th when, after five weeks of being prepared and carrying the pool round in the car, all the theory was to be put into practice.

I was nervous but, having the tremendous support of my partner and a midwife (who was so keen to be at the birth that she came in from her holiday), I felt in control of the situation. The pool took about three quarters of an hour to set up and fill, and by that time I was the required 5cm dilated. (Any less than this and the warm water can stow down the labour). At 2.15am I hobbled into the pool and to my relief the benefits of which I had dreamed became real. I could move to any position my body sought.

The midwife monitored the baby in water, as getting out would have broken my concentration and more importantly, my breathing rhythm. As the water temperature had to be kept at 37 degrees Celsius, if the baby were to be born in it, I began to feel hot and at this point was glad of the ice-cold flannels that my partner applied to my forehead. Towards the end of my labour he entered the pool to help physically support me.

It was a magical moment when our little son popped his head out into the water, four and a quarter hours after I had entered the pool. The midwife slowly brought him to the surface and all three of us just sat there in a wonderful cocoon.

I came out of the water to deliver the placenta and had to wait an hour for my skin to harden sufficiently for the insertion of a few stitches.

My baby’s birth was completely natural and, looking back, I feel sure that if I had had to lie on a hard bed this would not have been the case.

I also found it tremendously satisfying to be in a position to give something back to the professionals who were all delighted to be learning from my experience.

Although being disabled sometimes makes it difficult to be positive, the birth of Oliver has helped me tremendously in this direction. Whilst doctors figure largely in the process we must also follow and trust our instincts and have faith in ourselves. This positive attitude helps both ourselves and the medical professionals, and the possibilities are endless if we call on our own strength and determination - together with that bit of help from our friends.

Ruth Carter, from Devon, UK,

The midwifes account

I became involved with Ruth quite by chance when She rang to confirm that it had been agreed for her to have a waterbirth.

Discussing the arrangements and Ruth’s main reason for wanting a waterbirth, (the fact that she has Ankylosing Spondylitis), I found myself becoming interested and quite excited at the thought of looking after someone who wanted to have her baby in water After talking to her several times we developed a rapport and Ruth agreed to me being the midwife to care for her during labour.

I had read articles on how to conduct waterbirths and read a copy of a procedure drawn up by another hospital with experience of this kind of situation. I also approached colleagues who had conducted waterbirths for tips and advice. As for hands-on-experience - I had none. Nevertheless, I felt well prepared, knowing I could draw on my experience in midwifery of unusual situations and also that of my colleagues, if necessary.

I knew little about Ankylosing Spondylitis and relied on Ruth to tell me what she could cope with. I soon realised the extent of her disability when I met her in the Maternity Unit when she thought she was in labour. A mere 20 minutes of monitoring the baby’s heartbeat with Ruth resting on a bed made her obviously uncomfortable. The prospect of spending most of her labour lying on a bed must have been extremely daunting. I became concerned about how she would cope when in established this was a false alarm and the contractions were subsiding.

However, when labour became established several days later, and once Ruth was happily esconced in the pool, I did not even consider her disability. I had no need, as the water gave Ruth all the buoyancy and physical support she required. My main problem was to work out how to listen to the babys heartbeat without disturbing Ruth too much. The portable monitor - a Sonicaid - was not waterproof so the probe needed to be protected. Initially using a condom seemed an excellent idea except it was not long enough to allow me to put the probe deep into the water. I therefore resorted to placing my arm and the probe (condom still in place), into a large plastic bag, held in place with a tourniquet which worked well. The alternative would have meant that Ruth would have had to stand each time I needed to check the baby’s heartbeat.

Ruth’s partner was extremely supportive throughout the labour. In the dimly lit peaceful surroundings, they were able to ‘swjtch off’ to extraneous noises and create their own world. This enabled Ruth to relax and remain in complete control during the contractions, not requiring any other form of pain relief apart from the warm water and breathing deeply. Ruth’s partner joined her in the pool towards the end of the labour to help her squat for the birth. His support allowed me to concentrate on the labour as well as bailing out in order to top up the pool with more hot water.

I found the labour more stressful than usual due to my lack of experience with waterbirths. I was also aware of Ruth’s particular need to remain in the water as much as possible. With any slight concern I had to ask myself what action I would take had Ruth been walking about or lying down. The answer was always that my care would be no different. Although stressful, it was also a challenge and in retrospect very enjoyable. To see baby Oliver’s face under the water, watch his eyes open and look at us was an incredible experience for me and I cannot begin to know how Ruth and her partner felt.

I appreciate how valuable it was for Ruth to be able to use water in her labour. She was in considerable pain with her hip as well as her contractions and I doubt if she would have coped very well without it. Caring for Ruth in her labour and discussing the problems she faced on the postnatal ward has brought to my attention how much we need to think of the needs of women with physical disabilities when having a baby. I hope that my maternity unit may  be able to address some of the problems in the near future.

Teresa Ashford, midwife at the Royal Devon & Exeter Hospital.

Peni’s story

There’s an old saying “if you want something done properly, do it yourself” and that is exactly what I did. My name is Peni, I was 21, with a partner and a 3 year old daughter. I had always wanted to have two children and my partner was also keen. At the age of 20 I was diagnosed as having polyarthritis which attacks all the major joints in the body and restricts movement without pain. This however did not stop my quest for another child. So with urine sample in hand I made my way to the doctor’s to request the necessary test. The problems started when I returned for my result. A smiling doctor said the magic word (‘pregnant’) and started to tell me all about what was going to happen to me. I listened to what she had to say and then told her No!

Her face visibly dropped as I told her of my plans to have my baby at home, in a water birth pool. She was not impressed and told me in no uncertain terms that it would be better for a woman of my disability to have her baby in hospital. Ever felt like you’re being put on a guilt trip?

I had my first child in hospital and nearly killed three nurses for not letting me have my baby in a squat position on the floor - I have never been so angry in my life! Which is not a good way for a new life to first see its mother. I decided there and then if I should ever have another child, I would plan it all out, to the last detail and do it my way.

After explaining this to the doctor, she took a rather condescending tone and told me that as none of the doctors in that practice had knowledge of water birth, let alone home birth, that unfortunately they could not provide me with the necessary cover - and therefore I was on my own. Unless, of course, I wished to change my mind and agree to go into hospital.

Having been pregnant before I knew that cover from my doctor was not paramount in having a baby but that hospital cover was. Antenatal care was provided by the local maternity hospital who were brilliant. They treated me with the respect that every mom-to-be should get. They listened and talked the whole thing over with me. Although none of them had done a water birth before they made every effort to find out all that they could. Their support was vital to my confidence. I felt I needed more information so I contacted the National Childbirth Trust who sent me lots of names of people to contact about hiring a pool; lots of do’s and dont’s, and lots of encouragement.

Saturday evening while watching the television my waters broke and Gez, my partner set up the pool. We had had practice runs with the midwives so there was no panic, just excitement. At contractions every 5 minutes, we called in the midwives who duly arrived, as requested, without uniforms. I wanted the whole thing to have a relaxed atmosphere. My brother and sister were also informed and arrived with their- partners to look after my daughter Hayleigh. As the contractions got stronger we filled the pool and got in. Two midwives lifted me into the water, one each side. The relief of actually being in the water was wonderful. Just like getting in a warm bath after a hard day’s work. The pain relief was almost instantaneous.

By this time, Hayleigh’s curiosity got the better of her and she got into the water. It was a little deep for her, but at least she was not being left out. Unfortunately I couldn’t stand this for very long and became very irritable. I also asked the midwives to leave the room for a while so that Gez and I could be in peace. That is one of the advantages of having your baby in your own home - you do feel you are in control. Being in the pool gave me a sense of being in my own space. It gave me the freedom of movement to find a comfortable position without getting frustrated.

One comical moment we had was when the midwife wanted to listen to the baby’s heart,-using a portable listening device which they put on my tummy under the water. As it was not waterproof, I had to float on top of the water to enable them to use it. As I am only 5ft 4 inches tall and the pool is 5 foot in diameter, this proved to be very easy and soon became my favourite position, with Gez behind me holding me under my arms.

Though I may be ‘altemative’ in using a pool, I do recognise severe pain when I feel it, so it was time for the gas and air. My pelvis is shaped funny and both my children were born face up rather than face down. This tends to prolong labour. After 22 hours, the big moment arrived. I felt her head coming down, the midwife told me not to push and I told her it was too late - and out she came, straight into my hands. She stayed under water as we took the cord from around her. She looked so surprised as she looked up out of the water. We had dimmed the lights so as not to frighten her, I picked her up out of the water and she started to breathe. As I held her in my arms, I nearly cried: a new life so peaceful and perfect. Gez, sitting behind me all this time, put his arm around both of us. He did cry.

If you want a child, don’t be put off by bullies. I believe any woman who wants a baby should be able to have that baby as, when, where and how she sees fit. So, if it’s for you, go for it. After all it’s your baby.

Peni Whelan, Birmingham, England

First published in Disability, Pregnancy & Parenthood international, Issue 1, January 1993.

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