Midwives’ perspectives on water immersion during labour and birth in Malta

Abstract

The National Institute for Care Excellence (NICE, 2014) claims that women with low-risk pregnancies should be offered the opportunity to labour in water, however the facilitation of water immersion (WI) remains limited in some countries, including Malta. The aim of this study was to explore the local midwives' perspectives on the practice of WI during labour and birth. The objectives were to seek midwives’ knowledge, attitudes and experiences of WI, to explore the challenges in the practice of WI, and to identify the strategies necessary to address these challenges. The study adopted a quantitative method, using a self-administered questionnaire, where 50 midwives working at the Central Delivery Suite were recruited through convenience sampling. Forty questionnaires (n=40) were returned, yielding a response rate of 80%. Manual analysis of the data collected was performed and results were presented in the form of absolute numbers, percentages, bar charts, pie charts and tables. Findings revealed that midwives are supportive of WI in the first stage of labour but are hesitant in facilitating WI during the second and third stages of labour, mainly due to lack of experience and available facilities and equipment. The main cited benefits of WI were that it helps women manage contractions, reduces interventions such as the need for pharmacological analgesia and creates a relaxing environment whilst providing a more positive birth experience. The main concerns expressed by midwives were the difficulty of estimating blood loss and the maintenance of a constant water temperature. Lack of equipment and facilities as well as lack of institutional and staff support were the most common identified challenges of WI. Education and training for staff as well as the acquisition of the necessary equipment were the most mentioned strategies for the facilitation of WI. In conclusion, the midwives’ perspectives of WI are clearly affected by the training received, equipment available and the demand for WI by the expectant parents during labour and birth. Therefore, the implementation of educational and practice interventions, coupled with adequate guidelines, are being recommended based on the findings of this study.