Understanding the barriers and facilitators related to birthing pool use from organisational and multi-professional perspectives: a mixed-methods systematic review

Abstract

Aims To identify and synthesize the evidence regarding the facilitators and barriers relating to birthing pool use from organizational and multi-professional perspectives. Design A systematic integrated mixed methods review was conducted. Data sources MEDLINE, CINAHL, PsychINFO, EMCARE, PROQUEST and Web of Science databases were searched in April 2021, March 2022 and April 2024. We cross-referenced with Google Scholar and undertook reference list searches. Review methods Data were extracted from studies meeting the inclusion criteria. Barriers and facilitators to birthing pool use were mapped and integrated into descriptive statements further synthesized to develop overarching themes. Results Thirty seven articles (29 studies) were included—quantitative (12), qualitative (8), mixed methods (7), and audits (2), from 12 countries. These included the views of 9,082 multi-professionals (midwives, nurses, obstetricians, neonatologists, students, physicians, maternity support workers, doulas and childbirth educators). Additionally, 285 institutional policies or guidelines were included over 9 papers and 1 economic evaluation. Five themes were generated: The paradox of prescriptiveness, The experienced but elusive practitioner, Advocacy and tensions, Trust or Trepidation and It’s your choice, but only if it is a choice. These revealed when personal, contextual, and infrastructural factors were aligned and directed towards the support of birth pool use, birthing pool use was a genuine option. Conversely, the more barriers that women and midwives experienced, the less likely it was a viable option, reducing choice and access to safe analgesia. Conclusion The findings demonstrated a paradoxical reality of water immersion with each of the five themes detailing how the “swing” within these factors directly affected whether birthing pool use was facilitated or inhibited.

Introducing waterbirth in a university hospital setting in Sweden: A qualitative study of midwives’ experiences

“…The midwives expressed a fear of increased interventions and a pathological approach on waterbirth if obstetricians got involved. Obstetricians’ involvement in normal birth creates for midwives a sense of being controlled and directed 20 . Midwives’ decision making and autonomy in handling normal birth might be impacted by this practice.…”

“…It is well known that midwives play a crucial role in facilitating physiological births, yet their actions and practices are influenced by the ward culture and local guidelines 4 , 19 . Restrictive guidelines may hinder midwives’ ability to assist waterbirths and limit women’s autonomy and decision-making 20 , 21 . Considering this, the aim of this study was to explore factors affecting midwives’ provision of waterbirth at a university birthing clinic in Sweden.…”