Waterbirths in the Coombe - finally!

SanFran07 · 12-07-2014 11:47pm #1

Thought some mums might be interested to hear that the Coombe has had a couple of waterbirths over the last few weeks so mums don't have to get out of the fabulous pool when they have the urge to push.

Great to see this option being supported in one of the Dublin hospitals. NMH has no pool (and no baths) and the Rotunda removed their labour pool a few years ago.

January · 13-07-2014 8:55am

Too late for me

But delighted to hear other mums will get to experience it!

Cameoette · 13-07-2014 6:31pm

Thanks

At my 32 week appointment one of the midwives gave me a leaflet about the pool and asked would I consider it and I said definitely, and she was surprised, saying that they often can't get women into the pool.

The official line given to us at the antenatal class run by the coombe is that you must leave the pool when it comes to pushing. The leaflet says same, but adds that should you have your baby in the water, the midwives are equipped to look after you in that circumstance too.

Is it a legal thing that they aren't officially allowed say you can deliver your baby in the pool? I'm just curious!

January · 13-07-2014 9:02pm

I'm sure SanFran can answer this properly but afair the ban on water births was lifted a while ago and the issue with having them was training. The Coombes pool(s?) are new so they must have been anticipating this.

Merkin · 13-07-2014 9:30pm

This would have been my first choice for labouring but the hospital I'm going to give birth in is going through expansion and the birthing pools are out of action until the end of August. I think it's such a lovely way to birth so I'll be interested to hear feedback from anyone who goes through the process as it's something I'd like to do next time hopefully.

pwurple · 13-07-2014 10:38pm

Surprised this is allowed again after the drowning of that poor baby in the Cavan waterbirth.

I would consider the risk of accidentally drowning my own baby a tough one to justify. Labouring in water is great, I loved the water at the end of pregnancy and during labour, certainly more comfortable. But the pushing stage? I remember on my second birth, my daughter was making noises and starting to cry/breathe before I had pushed the shoulders. The midwives and my husband were joking afterwards that she was going to be very chatty when she grew up, couldn't wait to talk. She would have taken water into her lungs if she was underwater though at the time. Reading the medical journals on waterbirth fatalities would scare the pants off you.

Journal link
http://journals.lww.com/amjforensicmedicine/Abstract/2010/09000/Forensic_Issues_in_Cases_of_Water_Birth_Fatalities.14.aspx

lazygal · 14-07-2014 7:03am

pwurple wrote: »

Surprised this is allowed again after the drowning of that poor baby in the Cavan waterbirth.

I would consider the risk of accidentally drowning my own baby a tough one to justify. Labouring in water is great, I loved the water at the end of pregnancy and during labour, certainly more comfortable. But the pushing stage? I remember on my second birth, my daughter was making noises and starting to cry/breathe before I had pushed the shoulders. The midwives and my husband were joking afterwards that she was going to be very chatty when she grew up, couldn't wait to talk. She would have taken water into her lungs if she was underwater though at the time. Reading the medical journals on waterbirth fatalities would scare the pants off you.

Journal link
http://journals.lww.com/amjforensicmedicine/Abstract/2010/09000/Forensic_Issues_in_Cases_of_Water_Birth_Fatalities.14.aspx

Pretty much this. I thought the death of a baby was reason enough to ban birthing in water. I'm very surprised hospitals are open to this.

Millem · 14-07-2014 8:09am

Cameoette wrote: »

Thanks

At my 32 week appointment one of the midwives gave me a leaflet about the pool and asked would I consider it and I said definitely, and she was surprised, saying that they often can't get women into the pool.

The official line given to us at the antenatal class run by the coombe is that you must leave the pool when it comes to pushing. The leaflet says same, but adds that should you have your baby in the water, the midwives are equipped to look after you in that circumstance too.

Is it a legal thing that they aren't officially allowed say you can deliver your baby in the pool? I'm just curious!

That is the same rule in drogheda MLU, get out when you need to push. What a great facility to have, they are meant to be amazing for pain relief

Chattastrophe! · 14-07-2014 8:18am

It sounds lovely for labour, I imagine it provides great pain relief, but I could never take the risk of trying to give birth underwater. Doesn't the head usually come out a few minutes before, and the body doesn't come until the next contraction? I'd be so stressed for those few minutes in between, wondering if the baby was OK, was he gulping in water into his tiny little lungs, was he choking?

I'd never heard about that case in Cavan until now.

That poor family. How awful to go through nine months of pregnancy and have it end like that ... and, even worse, knowing it was avoidable.

It's a pity that pools aren't more widely available for labour, but I can't say I'd support the idea of actually babies to be born in the water.

Millem · 14-07-2014 8:29am

Chattastrophe! wrote: »

It sounds lovely for labour, I imagine it provides great pain relief, but I could never take the risk of trying to give birth underwater. Doesn't the head usually come out a few minutes before, and the body doesn't come until the next contraction? I'd be so stressed for those few minutes in between, wondering if the baby was OK, was he gulping in water into his tiny little lungs, was he choking?

I'd never heard about that case in Cavan until now. That poor family. How awful to go through nine months of pregnancy and have it end like that ... and, even worse, knowing it was avoidable.

It's a pity that pools aren't more widely available for labour, but I can't say I'd support the idea of actually babies to be born in the water.

I really don't know much about them accept know someone who used it in drogheda. Apparently some just go in for a little while too, it's up to yourself really but you have to come out before you need to push. (In drogheda) Domino in holles street really want one too. I saw the photo of the coombe and it looks fab! The domino midwives really encourage you to have showers, I remember at ante natal classes the midwife telling us that some people find them so great they won't get out and the baby is delivered in the shower cubicle!!!

Penny Dreadful · 14-07-2014 11:23am

I'm attending the Coombe on my first pregnancy and heard about the birthing pool at the early pregnancy class I attended.
The midwife who ran it has campaigned long and hard to get the pool and the support of the doctors. Eventually it was agreed to support it on the understanding that no one actually gave birth in the pool - you must leave the pool when you are directed to.
The midwife was quite funny and said its only a matter of time before a baby escapes into the water and she is convinced that once this happens and all is well then the doctors will have to support the actual birth taking place in the pool.

I'm keen on exploring the idea of the pool as a means to alleviate the pain of labour once it starts. I might chicken out though:o

vibe666 · 14-07-2014 12:28pm

lazygal wrote: »

Pretty much this. I thought the death of a baby was reason enough to ban birthing in water. I'm very surprised hospitals are open to this.

unfortunately, no matter how a baby comes into the world there is always a risk of mortality. if they banned everything that could even remotely be attributed to the death of a newborn, nobody anywhere would be allowed to have babies at all.

for every study i've seen showing *any* increased infant mortality during waterbirths (and mostly with flawed or incomplete data), i've seen at least as many to the contrary and imho, there are a lot more dangerous things being carried out as "routine procedure" in irish hospitals that are of more concern than a birthing pool, although thankfully things are finally starting to improve in the last couple of years.

the overwhelming conclusion of most of the more recent studies i've seen indicate that there is simply not enough high quality data either way and that there needs to be more research into it before anyone can reliably draw any conclusions, so for now at least it should be a personal choice for the parents to decide what works best for them, but the simple fact that somewhere like The Coomb that is doing a very good job of investing time, money and training into both water birthing and (in general) pulling childbirth in ireland out of the 1960's, says a lot to me. and plenty has changed in the 2 years between the birth of our first and second child (2nd one is 7 months now) and things are still moving forward, slowly but surely.

lazygal · 14-07-2014 12:51pm

Do you have evidence other than anecdotal about the procedures which are dangerous? And on the relative safety of giving birth in water?

vibe666 · 14-07-2014 1:43pm

i could ask you the same thing about waterbirths, that's my point. there's not enough reliable evidence that statistically water births are any more dangerous than any other type of birth.

if you don't believe me then feel free to read the Nice guidelines on childbirth that are in agreement with me on the subject.

Water birth

1.7.21 Women should be informed that there is insufficient high-quality evidence to either support or discourage giving birth in water.

as for the dangers of giving birth in ireland, i should probably rephrase that as procedures carried out as standard practice that are "far from optimal and in many cases not recommended" for now and come back to it later when i have more time, but for now, things like sweeps, breaking waters, traces, routine inductions, coached pushing and plenty more that i can't think of right now off the top of my head, but there are plenty and I have no doubt someone will be along shortly with a much more comprehensive list.

one thing that springs to mind from personal experience is the standard practice in holles street of pushing to get you in and out within 12 hours and pretty much doing whatever it takes to make that happen to speed you along.

here's another one: http://www.theguardian.com/society/2013/jul/11/hospitals-nhs-umbilical-cords-babies-delay-cutting

pwurple · 14-07-2014 4:27pm

Human babies breathe air.

We have lungs, not gills or blowholes.
That's about the end of the thought required tbh.

lazygal · 14-07-2014 4:36pm

It's neither safe nor unsafe according to that link. I think pushing a baby out into water introduces a level of risk, like drowning, that pushing a baby into air does not. A baby drowned, that's why women in Ireland didn't give birth under water.

vibe666 · 14-07-2014 5:03pm

pwurple wrote: »

Human babies breathe air.

We have lungs, not gills or blowholes.
That's about the end of the thought required tbh.

that's actually one of the dumbest posts i think i've ever seen posted on boards.ie since *someone* :rolleyes: tried to convince everyone that transdermal patches were completely useless because human skin was non-permeable.

lazygal wrote: »

It's neither safe nor unsafe according to that link. I think pushing a baby out into water introduces a level of risk, like drowning, that pushing a baby into air does not. A baby drowned, that's why women in Ireland didn't give birth under water.

pretty much every baby that was ever born spent up to 9 months prior to being born sitting in a sealed bag of amniotic fluid without drowning. another few minutes isn't going to make a huge amount of difference and has a lot of positive effects for both the mother and child. there could have been other complications that lead to that baby's death, it smacks of a knee jerk reaction without proper investigation tbh.

what we have right now is a very small number of negative reports, a large number of positive (although to some degree anecdotal) reports and a need for more study in the area.

Having said that, there is a recent Cochrane Review supporting labouring in water and calling for more study into the area of water birthing AND the Royal College of Obstetricians and Gynaecologists/Royal College of Midwives have made a joint statement in support of labouring AND birthing in water, which i doubt they would be doing unless they were pretty sure of themselves.

http://www.rcog.org.uk/files/rcog-corp/uploaded-files/JointStatmentBirthInWater2006.pdf

pwurple · 14-07-2014 5:42pm

vibe666 wrote: »

that's actually one of the dumbest posts i think i've ever seen posted on boards.ie since....

So.... Humans don't breathe air?

Whatcha snorting today?

Edit, what on earth has your bizaar claim that substances with a large molecular mass are absorbed into the bloodstream through skin without a solvent got to do with waterbirths?

vibe666 · 14-07-2014 6:06pm

pwurple wrote: »

So.... Humans don't breathe air?

Whatcha snorting today?

You really don't know when you're on to a bad thing do you?

Humans yes.

Babies in utero attached to umbilical cords fully immersed in amniotic fluid on the other hand who have NEVER even been in contact with air, never mind breathing it don't however and transferring them from one liquid to another, they are quite capable of continuing to do so.

That's not even going into the innate ability of all babies to hold their breath underwater, as anyone who has taken their infants to waterbabies will tell you.

vibe666 · 14-07-2014 6:09pm

pwurple wrote: »

Edit, what on earth has your bizaar claim that substances with a large molecular mass are absorbed into the bloodstream through skin without a solvent got to do with waterbirths?

It's got everything to do with you continually making idiotic claims pretending you know what you are talking about when you very clearly don't, as you seem intent on repeatedly proving yourself.

Dolbert · 14-07-2014 6:13pm

The baby in the water birth case in Cavan drowned in the moments between his head being born and the rest of his body. Quite simply, and according to the coroner, this was the only reason for his death. How is pwurple being stupid when this has happened in recent memory?

vibe666 · 14-07-2014 6:36pm

Dolbert wrote: »

How is pwurple being stupid when this has happened in recent memory?

she is posting stupid, entirely inaccurate comments, a reasonably recent death doesn't do anything to negate the stupidity of what she is saying.

Jerrica · 14-07-2014 6:53pm

The Cavan case is tragic, but I don't feel it fair to use it as an example of what could be a *typical* outcome of water births. In utero babies are in a fluid environment, the breathing reflex doesn't kick in until they hit air, and while passing through and out of the vaginal canal they would still (I think) be subject to the laryngeal or gag reflex so the drowning argument doesn't tend to hold true.

Birthing in water isn't natural, but then neither is cutting a baby out of the womb surgically, or using artificial prostaglandin to stimulate labour or using an epidural to manage pain, but these are all accepted practices.

Having said that I'm totally on board for labouring in water but I can't see strong enough evidence on either side to prove the safety and efficacy of a water birth. I do think it's great to see the Coombe being so open to alternative approaches to birthing though, and providing a better choice for women.

SanFran07 · 14-07-2014 11:18pm

This is quite a thorough overview of the current evidence around the safety of waterbirth.

http://evidencebasedbirth.com/waterbirth/

The Coombe are actively promoting waterbirth as an option for healthy mums. Given our very litigious maternity services I doubt they came to this decision lightly. Mums are informed of the risks - just as they are informed of the risks of epidurals so they can make an informed decision. There are currently pools in CUMH, Waterford, Coombe, Cavan and Drogheda. A few years ago the NHS recommended that every maternity unit has a birth pool

Interestingly Dr Alan Finan Consultant Pediatrician from Cavan who was involved in the tragic Cavan case openly supports a return to waterbirth in the North East MLUs.

"Dublin City Coroner Dr Brian Farrell said he accepted the view of pathologist Dr Peter Kelehan that the baby died of a near drowning event due to aspiration of fresh water with resulting low sodium levels (hyponatremia) and profoundly insufficient levels of oxygen in blood or tissue (hypoxia.)

The coroner acknowledged that the evidence heard at inquest does not "completely outrule" a "prenatal hypoxic event" (or an event prior to birth which deprived the baby of oxygen,) but that on "on the balance of probabilities -- death is due to an acute near drowning event."

Dr Alan Finan, consultant pediatrician attached to Cavan General who treated Harry after his birth, told a previous hearing of the inquest that he believed the baby had experienced "a neurological insult before delivery".

http://www.independent.ie/irish-news/family-relives-birthing-pool-death-tragedy-26452869.html

ShaShaBear · 15-07-2014 3:52pm

Wasn't it said on the case of the Cavan baby that there were minor neurological defects that could have been the cause of the baby breathing water before they normally do in the case of a water birth?

From what I remember reading, the coroner said that the cause of death officially was drowning, but he could not definitively say that it would have happened regardless, or that these "defects" were the reason for it. AKA, no-one was at fault.

I'm actually giving birth in the Cavan MLU and will be in the pool for as long as I can manage. However, knowing that a baby isn't all that will come out of me is what would prevent me from staying in the tub with my OH. I'll have my baby on solid ground any day of the week

Edit: SanFran07 has it covered!

pwurple · 15-07-2014 5:16pm

Thanks for the link sanfran07. Fairly thorough. I hadn't even considered all the non-drowning risks they included in Table 2 with the list of babies deaths from legionella, pseudomonas aueroginosa meningitis, infection from the mother's fecal matter in the pool, etc. What is the policy if the woman has a bowel movement in the pool during labour in the coombe?

The pool are great, Very comfortable for labour alright and a fantastic option to have. I still wouldn't put my own comfort in the pushing stage labour ahead of a risk to my baby, but as long as women are properly informed and can make their own decision, then that's what matters.

SanFran07 · 15-07-2014 5:38pm

Any fecal matter would be removed with a net. Some colonisation from mum's bacteria is healthy but generally not if baby was ill and took a breath. Before we start 'pulling' the plug on waterbirth in Ireland again though it would be good to see our hospitals moving towards some kind of evidence based care for healthy women in labour. We know too much now to continue the outdated and dangerous practices of routine breaking of waters, overuse of the Synto drip, coached pushing, episiotomies....

Waterbirth may also reduce GBS infections in newborns and given that most women don't know their Group B status at the end of pregnancy it could be protective.

Lots to consider.

Waterbirths in the Coombe - finally!

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