10 good reasons why you should consider Active Birth Pools

Our ongoing dedication to serving the needs of mothers and midwives fuelled by a driving passion for design, quality and performance has resulted in today’s Active Birth Pools, widely regarded as the best in the world.

Here’s why…

1.  We’re uniquely qualified to be of service – we’ve achieved success by keeping things simple and focusing on our core principles of safety, value and performance.

2. Our water birth pools are built to last for decades and guaranteed for life 

3. Active Birth Pools are fabricated in a material that is far superior to those used by other manufacturers

4. Mothers have a greater possibility of experiencing a normal physiological labour and natural birth

5. Proprietary features set our pools apart – our pools have evolved to the point where they are in a class of their own.

6. Midwives say that our pools are the most supportive, comfortable and easy to use

7. Our pools are the pinnacle of ergonomic design – every shape, every curve, every varying degree of rounded corner – there is a reason behind them.

8. It’s easy for mothers to get in and out of our pools

9. Midwives have safe, practical options for dealing with emergency evacuations

10. We’re rated No.1 for health and safety – we’ve set the benchmark standards that others try to follow.

Please visit our Gallery to see why mothers and midwives love our water birth pools.

Built to last for decades and guaranteed for life

Active Birth Pools are built to last for decades and guaranteed for life.

Though more expensive than other birthing pools on the market, Active Birth Pools deliver superior long-term value, better results and greater end-user satisfaction.

Active Birth Pool – Fernandez Hospital, Hyderabad India

Our experience over the past 35 years has given us the expertise to provide our clients with highly efficient service and post sales support wherever they are.

Our customers receive extra-ordinary long-term life cycle value. Value that’s comprehensive in scope and places priority on results, safety and quality of care.

Our water birth pools outperform all others on the market.

Water Birth Pools that we supplied in the 1980’s are still in use today.

Below – the Venus Pool circa. 1992 at the Royal Berkshire Hospital

royal-berkshire-hospital

Though it’s 25 years old the pool still looks great with years of service ahead.

You can plainly see that this is the precursor to todays state-of-the art Venus Pool.

The overall shape and size are pretty much the same, but the design and manufacture are now much more sophisticated and refined.

Below – the Venus Pool circa. 2017 at Pinderfields Hospital

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A combination of advanced ergonomic design, superior materials and high-end manufacturing methods have resulted in todays Active Birth Pools – truly in a class of their own.

Below – the Venus Pool with multi-colour LED lighting at the award winning Meadow Birth Centre

We guarantee that our water birth pools for hospitals will provide comprehensive long-term life cycle value

  • Mothers have a better experience of labour and birth
  • Midwives are safeguarded from risk and enjoy higher levels of job satisfaction
  • Hospitals optimise resources and save money

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Features that set our pools apart

Over the past 34 years we have supplied 1,000’s of water birth pools to hospitals world-wide.

We have worked closely with end users and industry experts to continually develop and improve our capabilities.

This unrivalled wealth of experience enables us to design water birth pools of superior quality that are acknowledged as the industry standard.

Our approach is fuelled by a passion for optimising safety and performance.

As a result of advances in design, materials and manufacture our water birth pools have evolved to the point where they are in a class all their own.

Our innovative approach to design results in pools that are highly functional and appealing from both a psychological and physical perspective.

The curvaceous forms allow midwives and mothers to interact intuitively with each other and the pool.

Thanks to the unique properties of Ficore® – we have been able to realise sophisticated designs that place Active Birth Pools at the top of the industry.

The extra-wide, rounded rim that flows around our pools is key to their success.

The bullnose shape rim flows over and down hugging the form of the pool  to the floor in one seamless piece of ultra-high grade composite resin.

These distinctive features set our pools apart and make them most comfortable, practical, safe and user-friendly available.

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No. 1 for support, comfort and ease of use

Midwives find our water birth pools incredibly practical and comfortable.

They tell us that they are ‘fab’ and pleasure to use.

Mothers simply tell us that, ‘they love our pools’.

They benefit from complete freedom of movement and unparalleled safety, comfort and support.

We’ve spent decades observing the way that mothers and midwives move in and around the pool and considered how to best serve their needs.

Our passion for excellence has led us to study ergonomic design theory and work closely with midwives, health and safety and manual handling experts.

This has enabled us to design water birth pools that are are incredibly comfortable, practical and easy-to-use.

Key to the success and comfort of our pools is the material we use.

Active Birth Pools are made from a unique material called FICORE®. It’s ultra-smooth, highly polished finish is tactile, warm to the touch and less slippery.

The superior properties of Ficore allow us to sculpt complex, sensuous forms making our pools incredibly comfortable, appealing, practical and easy to use.

Notice how comfortable the midwife is in the above photo?

She is fully supported, safeguarded and at ease.

Her feet are grounded, her body upright and aligned and her arms are resting comfortably on the wide round rim.

It simply does not get any better than this!

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The pinnacle of ergonomic design

Form is based on function and pared down to the essence of aesthetic utility. Design is based upon the dynamics of mothers and midwives as they interact with the pool and each other.

Every shape, every curve, every varying degree of rounded corners…
there is a reason behind them.

Active Birth Pools encourage mothers to move freely and naturally.
They instinctively find the best positions and discover that the pool provides constant comfort and support wherever they are.

Complete freedom of movement coupled with the relaxing effects of warm water and release of oxytocin significantly increases the possibility for mothers to experience physiological labour.

Active Birth Pools are made from a unique material called FICORE® composite. Ficore is far superior to acrylic and fibreglass, the materials commonly used to produce water birth pools.

It’s unique properties allow us to sculpt complex, curvaceous forms that make our pools incredibly comfortable, appealing, practical and easy to use.

We are pioneers, innovators and trend setters.

The design of our birth pools has continuously evolved over the past 35 years.

The combination of ergonomic design, specialised materials, engineering and manufacture that go into our pools make them the “Rolls Royce” of water birth pools.

As Steve Jobs said…

“It takes a lot of hard work to make something simple, to truly understand the underlying challenges and come up with elegant solutions.”

 

In mid-90’s we met with health service ergonomist Sue Hignett to discuss ways our water birth pools could be improved to better serve the needs of mothers and midwives.

This lead to the ground-breaking innovations in design, materials and manufacture that have culminated in todays range of award winning Active Birth Pools.

Our new water birth pools take the 5 points outlined on Pg. 2 of the article (below) to new levels of sophistication thanks to the properties of the unique material (Ficore® composite) we now use.

We no longer advocate the use of multi-step units as this has proven to present manual handling risks. The pools are now lower and have wider rims which gives mothers better options for getting in and out of the pool.

The new range of water birth pools is not only much more beautiful, but more comfortable, safer and easy to use.

Click here for a PDF of this article

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Highly Commended at Building Better Healthcare awards

At the ‘Building Better Healthcare’ awards ceremony the Active Birth Pool was highly commended in the award for best internal building product.

In their comments the judges praised the quality of  our design and manufacturing process and went on to say that they found the Active Birth Pool very appealing.

active-birth-pool-award
All aspects of design, engineering and manufacture were focused on develop a water birth pool of unparalleled beauty, quality, functionality and durability that is backed by an extraordinary life-time year guarantee.

Foremost consideration was given to how mothers and midwives relate to and interact with the pool employing ergonomic principles to design for the interaction and dynamic at play.

Mothers have the space to move freely and comfortably and are supported in the postures natural to a physiological labour and birth.

The “signature” extra-wide rims with broad “bull-nosed” shaped edges flowing into the skirting panel and down to the floor are an important feature of the Active Birth Pool that sets it apart.

The wide flat rim allows mothers to lean forward, resting on their forearms in comfort – one of the most natural and effective positions during labour.

It provides secure, safe, stable support for women to enter and leave the pool and for midwives and partners to lean or rest on while attending the mother.

The handrails, which are set into the profile of the rim, provide perfect support for the mother in upright positions.

The critical issue of emergency evacuation has been resolved by incorporating features into the pool to give midwives several options for evacuating the mother that are in compliance with Health & Safety and Manual Handling regulations.

The Labour Support and Safety Seats are distinguishing features of the Active Birth Pool

1) This physiologically designed labour support seat has proven to help the mother’s pelvis and birth canal open in preparation for a natural, physiological birth.

2) The distinctive rim level safety seat provides a wide comfortable platform for the mother to lean on, a safe means for emergency evacuation and is ideal for midwives to monitor the mother without her having to stand up or leave the pool.

active-birth-pools-feature-48

The unique seamless one-piece construction incorporates a deeply sculpted concave skirting panel to allow midwives to work in comfort with their legs well under the pool.

The new Active Birth Pool is fabricated in Ficore® composite, a proprietary material that was specially developed for baths and designed to negate the risk of problems associated with other materials.

Ficore is 50% harder than acrylic and fibreglass (which other birth pools are made from) and highly resistant to chemicals.

Despite the rigidity and hardness of the surface it is extremely smooth, tactile and warm to the touch.

Its high insulation factor enables the Active Birth Pool to maintain its temperature up to six times longer than standard acrylic or fibreglass birth pools.

To help mothers control, define and personalise the delivery room, the Active Birth Pool is equipped with multi-colour chromotherapy LED lighting and integral bluetooth sound.

Our ingenious Integral Bluetooth Sound System allows the mother to wirelessly connect her phone and listen to the music of her choice.

Two integral speakers turn the birth pool into a highly refined audio loudspeaker.

When you examine the new Active Birth Pool you’ll immediately notice the superior finish and signature design elements.

Look a little closer and the quality of the components such as the drainage system, the support structure that underpins the pool, the fittings on the access panel, the lighting system, handrails and metal work becomes apparent.
active-birth-pool-form
If you are looking for a water birth pool to install in a maternity unit the incomparable new Active Birth Pool should be your first choice.

Handmade and custom built to order by a team who together have over 85 years experience in the design and production of high-end baths the new Active Birth Pool will provide decades of service and be an invaluable aid to mothers who want to have a natural birth.

The Active Birth Pool conforms to regulations issued by the Department of Health and the guidelines set forth in the Water Birth Safety Initiative.

Note: the above article was taken from “Building Better Healthcare” magazine – November 2015

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We’re uniquely qualified to be of service

If you’re looking for a water birth pool we’re uniquely qualified to be of service.

We’ve been dedicated to providing top quality water birth pools since 1987.

We helped pioneer the use of water for labour and birth by providing the pools that made this revolution in maternity care possible.

1990 John Radcliffe Hospital, Oxford

We’ve achieved success by keeping things simple and focusing on our core principles of Safety, Value & Performance.

A passion for excellence and commitment to supporting midwives and helping mothers have a better experience of labour and birth defines our approach.

Mothers and midwives love our water birth pools.

Mothers benefit from complete freedom of movement and unparalleled comfort & support .

Midwives report better results, and say that our pools are fabulous and a pleasure to use.

We’ve supplied 1,000’s of pools over the past 33 years and worked with end-users, specialists and manufacturers to develop and improve our capabilities.

Our unrivalled knowledge and wealth of experience enable us to provide water birth pools that minimise risk, optimise results and maximise value.

We have achieved success by caring about every detail and keeping things simple.

The combination of highly specialised design and superior materials make Active Birth Pools the No.1 choice world-wide.

“I can’t tell you how much your pools have revolutionised birth. ”

C. Wilson Midwife Dewsbury District Hospital

“Brilliant, like the wide rim so mums can sit on the side and swivel their legs around to get in and out, much safer. ” 

A. Bentley NHS Midwife

“When asked about the history of birthing pools in hospitals I mention the day when Keith Brainin realised that special bath tubs might be designed and commercialised to meet the needs of labouring women.”

Michel Odent – author, obstetrician and water birth pioneer

 “The pool met all of my expectations. I’m convinced that the water helps you stay in control in the final stages.”

S. Stone – Maida Vale, W. London

 “Your birth pool made my labour so much easier I’d recommend it to every pregnant mother for her birth.”

Jill Ireland – Bristol

“You clearly have a tub that is far superior to all the tubs we have found in the US -not only for patient comfort, but also for provider convenience.”

Karen Werrbach Director, Women’s Health Institute Rush-Copley Medical Center

“Thank you for the awesome pools. My one regret is not trying out one myself before we opened the birth centre! Many thanks!”

Consultant Midwife Greenwich Birth Centre

We love your active birth pools, so much so we have one in every room on our birth centre ”

Jo Talbot Chorley & Preston Birth Centre Manager

Have used Active Birth Pools a lot in my career. They allow flexibility for women to change position. Watched the company grow over the years. Amazing what they have facilitated for women. Successful company too. Waterbirth anyone?”

H. Young Midwife Taunton and Somerset NHS Trust

“Thank you Keith… our new Venus Pool looks stunning!”

Jan Butler Consultant Midwife Rosie Hospital, Cambridge

“ The water birth pool was extremely comfortable and supportive and made such a difference – I don’t know what I would have done without it”

Sarah Copeland, Birmingham

“Let me introduce you to Keith Brainin who provided us with our Princess Pools in both of our birth centres. His pools are brilliant and the service that he provides is excellent.”

 Dr Tracey Cooper Consultant Midwife Lancashire Teaching Hospitals

“The new Venus Birth Pools have become the focal point of our birthing suites and are helping attract clients. Midwives and nurses have overwhelmingly applauded the birth pool’s design and safety.

They report the knee space, water depth, light, the wide rim and the seat in the pool as outstanding improvements over the original tubs, enhancing their ability to effectively provide care and drastically improve the clients experience.”

Amy Johnson-Grass,  Midwife, Nutritionist, Naturopathic Doctor, President of the American Association of Birth Centers

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Light and Sound

Light and sound have a profound affect on the atmosphere and ambiance of the birth room.

Our new light and sound systems provide you with a simple way of transforming the environment, making it more conducive for physiological labour and natural birth.

Best of all….

our new light and sound systems are safe, economical and easy to use.

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Superior material results in superior performance

Choice of material is fundamental to the success of a water birth pool.

Active Birth Pools are fabricated in Ficore® composite, a proprietary material of extra-ordinary properties that was developed to minimise problems associated with other materials.

ficore

A cross section of FICORE® composite

If you compare Ficore with Acrylic or Fibreglass (the materials other birth pools are made from) you’ll notice the difference.

Ficore is a composite of eight different elements chemically fused during manufacturing, then heat cured at high temperature to create a material that is light in weight but ‘heavy’ in performance.

Hospital water birth pools made from Ficore® composite have many advantages including:

  1. Superior heat retention
  2. Much higher degree of strength and durability
  3. Less slippery
  4. More tactile
  5. Warm to the touch
  6. Easily repaired if damaged
  7. More resistant to bacteria

Warm to the touch

You’ll notice a significant difference in temperature between Ficore  and the other materials.

Ficore is warmer due to the fact that it is composite resin that is much denser than acrylic and fibreglass.

Due to Ficore’s high insulation factor and double-wall construction Active Birth Pools maintain water temperature up to seven longer than other birth pools.

Structural and engineering advantages

If you hold two equivalent size samples in your hands and compared them you’d notice that the sample of Ficore is heavier, harder and much more rigid.

The surface of Ficore is isophthalic neo-pentyl-glycol that is 50% harder (stronger) than the materials other birth pools are made from.

Active Birth Pools fabricated in Ficore have an extremely high degree of structural integrity and will not flex, buckle, bow, or change shape under pressure.

Ficore’s unique qualities allow us to manufacture intricately shaped pools that fully serve the needs of mothers and midwives.

Extremely smooth and tactile 

The finish of our pools is highly polished, ultra-smooth, tactile and very pleasant to touch.

This makes them more appealing physically and approachable psychologically.

This makes our water birth pools extremely comfortable and helps mothers relax and feel at ease.

Incredibly high adhesion factor

When we talk about adhesion factor we are referring to slip resistance.

Run your fingers across the surface of an Active Birth Pool and you’ll immediately be impressed with how ‘sticky’ it is.

Compared to other materials Ficore® has a significantly higher adhesion factor.

Given the circumstances and environment this gives our water birth pools a crucial advantage.

Durability

Ficore is more impervious to damage than other bath materials.

However, if it is damaged, it can be completely repaired as new – unlike many alternative materials.

Ficore is able to withstand both continuous heat or hot water and thermal shock of alternating hot and cold water.

An Active Birth Pool manufactured in Ficore meets or exceeds all relevant regulations and will withstand the rigours of heavy hospital use and disinfection with caustic chemicals.

Click here for a copy of our Ficore Data Sheet

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Active Birth Pools Videos

“A simple pool of water”

The story behind these amazing water birth pools.

We look at the history and thinking behind Active Birth Pools and why mothers and midwives the world over make us their No. choice.

 

“Freedom of Movement”

Shows how mothers instinctively relate to our water birth pools and move naturally to find the most comfortable and supportive positions.

 

 

Entering the pool made simple and safe

Educational videos for midwives

Active Birth Pools sponsored these educational videos for All4 Maternity to help midwives gain knowledge and understanding about the use of water for labour and birth.

Emersion in water in labour and birth – Part One
Emersion in water in labour and birth – Part Two
For more videos + foreign language productions visit our YouTube Channel

Client List

Active Birth Pools: Client List

Please Note: listings tagged Ficore® are water birth pools from our new range as illustrated on our website and in our brochures.

1.    Aberdeen Maternity Hospital – Optimal Birth Pool and Active Birth Beanbag
2.    Abingdon Hospital Oxford – Deluxe Birth Pool
3.    Access Lifestyle Sri Lanka –  Princess Birth Pool Ficore ®
4.    Active Birth Centre London – Oval, Circular and Hexagonal Portable Birth Pools
5.    Active Korea Corporation, Korea – Active Birth Pool
6.    Addenbrookes Hospital – 10 x Active Birth Pools and Venus Birth Pool Ficore®
7.    Adrien Alldridge Nottingham – Oval Portable Birth Pool
8.    Aga Khan Development Network, Kenya – Space Saver Birth Pool
9.    AIMS (Edinburgh) Scotland – Oval Portable Birth Pool
10. Airedale General Hospital – Amaryllis Birth Pool, Active Birth Pool
11. Aktiv Fodsel, Norway – Hexagonal Portable Birth Pool
12. Aktivinen Synntys, Finland – Elliptical Birth Pool
13. Akureyri Hospital, Iceland – Princess Pool and Active Birth Pool
14. Al Zahra Hospital, Dubai – Active Birth Pool Ficore©
15. Alain Cromwell Hospital, Abu Dhabi – Active Birth Pool
16. Albany Midwifery Practice London – Hexagonal Portable Birth Pool
17. Alice Charlwood, Wiltshire – Oval Portable Birth Pool
18. Alison Borman Somerset – Hexagonal Portable Birth Pool
19. All Saints Hospital Kent – Deluxe Birth Pool
20. Alnwick Hospital – Active Birth Pool
21. Altnagelvin Hospital – Oval Portable Birth Pool and Active Birth Pool
22. American Hospital, Dubai – – Active Birth Pool – Ficore ®
23. Andrew Ryland Chertsey – Oval Portable Birth Pool
24. Angelika Rodler Austria – Hexagonal Portable Birth Pool
25. Anne Govan County Kerry – Hexagonal Portable Birth Pool
26. Apple Tree  Birth Center, Rapid City – 2 x Venus Birth Pools – Ficore ®
27. Aqua Birth Pools, Switzerland – Hexagonal  & Oval Portable Birth Pool
28. Arbroath Infirmary Scotland -Deluxe Birth Pool
29. Argyll and Bute Hospital – Deluxe Birth Pool & Active Birth Beanbag
30. Arran War Memorial Hospital – Active Birth Beanbag
31. Ashington General Hospital Northumberland – Elliptical Birth Pool
32. Ashurst Hospital – Active Birth Pool
33. Ayrshire Central Hospital – Deluxe Birth Pool
34. Ayrshire Maternity Unit – Active Birth Beanbags
35. Baldwin Midwifery Service, New York, USA – Oval Portable Birth Pool
36. Barkantine Health Centre London – Deluxe Birth Pool & Active Birth Pool
37. Barnet Hospital – Three Active Birth Pools and Oval Portable Pool
38. Basildon Hospital Willow Ward – Active Birth Pool & Oval Portable Birth Pool
39. Basingstoke Hospital –  Active Birth Mats and Beanbags
40. Basingstoke Hospital – Active Birth Mats, Beanbags and Kneeling Pads
41. Bassetlaw Hospital – Active Birth Pool
42. Bedford Hospital Herts – Active Birth Pool and Deluxe Birth Pool
43. Belfast City Hospital Northern Ireland – Oval Portable Birth Pool
44. Belford Hospital – Active Birth Beanbag, Oval Portable Birth Pool & Active Birth Pool
45. Bellshill Maternity Hospital Lanarkshire – Deluxe Birth Pool
46. Berwick Hospital – Active Birth Pool
47. Betsey Mercogliano – Midwife New York, USA – Hexagonal Portable Birth Pool
48. Birch Hill Hospital, Lanarkshire – Deluxe Birth Pool
49. Birmingham Women’s Hospital – Original Birth Pool, Deluxe Birth Pool, Active Birth Pool
50. Birth Centre of Kanda, Japan – Hexagonal Portable Birth Pool
51. Blackburn Birthing Unit – Active Birth Pool
52. Blackpool Victoria Hospital – 2 x Active Birth Pools and Active Birth Pool – Ficore ®
53. Bliss, Birth & Wellness Centre, Palm Beach Florida – Active Birth & Venus Birth Pool – Ficore ®
54. Borders General Hospital – Original Water Birth Pool
55. Bournemouth General Hospital – Deluxe Birth Pool
56. Bradford Royal Infirmary, West Yorkshire – Deluxe Birth Pool
57. Brecon War Memorial Hospital – Active Birth Pool
58. Breconshire War Memorial Hospital, Powys – Corner Birth Pool
59. Bridgewater Community Hospital – 2 x Princess Birth Pools
60. Bridgnorth Community Hospital – Princess Pool Ficore©
61. Brierley Midwife Team London – Hexagonal Portable Birth Pool
62. Bristol Maternity Hospital – Deluxe Birth Pool
63. Broomfield Hospital – 2 x Active Birth Pools
64. Buckland Hospital Kent – Oval Portable Birth Pool and Deluxe Birth Pool
65. Burjeel Hospital, Abu Dhabi – Active Birth Pool – Ficore ®
66. Burnley General Hospital – Active Birth Mats and Kneeling Pads and Princess Birth Pool
67. Burnley General Hospital Lancashire – Deluxe Birth Pool, Active Birth Pool, Princess Birth Pool
68. Buxton Hospital Derbyshire – Deluxe Birth Pool
69. Caerphilly Wales Christina Fletcher – Hexagonal Portable Birth Pool and Oval Portable Birth Pool
70. Caithness General Hospital – Active Birth Beanbag and Deluxe Birth Pool
71. Calderdale Royal Hospital – Active Birth Pool and Active Birth Beanbag
72. Calvary Healthcare, Australia – Two Princess Birth Pools
73. Campbeltown Maternity Unit – Active Birth Beanbag and Oval Portable Birth Pool
74. Campbeltown Maternity Unit – Oval Portable Birth Pool
75. Castle Hill Hospital Yorkshire – Deluxe Birth Pool
76. Causeway Hospital, Ireland – Venus Birth Pool Ficore ®
77. Cavan General Hospital Ireland – Deluxe Birth Pool
78. Central Manchester University Hospital – Active Birth Beanbags & mat
79. Centro Di Maternita, Italy – Oval Portable Birth Pool
80. Channecy Genevois – France – Venus Birth Pool Ficore ®
81. Channecy Genevois, France  – Venus Birth Pool Ficore©
82. Charleston Birth Place, South Carolina – Active Birth Pool – Ficore ®
83. Chelsea and Westminster Hospital – Deluxe Birth Pool, Elliptical Birth Pool and 4 Venus Birth Pools
84. Cheltenham General Hospital – Deluxe Birth Pool
85. Chesterfield Royal Hospital – Active Birth Pool
86. Chippenham Maternity Hospital – Oval Portable Birth Pool and two Deluxe Birth Pools
87. Chipping Norton Hospital – Oxon Corner Birth Pool and two Original Water Birth Pools
88. Chorley and South Ribble Hospital –  Two Princess Birth Pools
89. Chorley Hospital – 3 x Princess Birth Pools – Ficore ®
90. Christchurch London – Oval Portable Birth Pool
91. Christiane Schwarz – Hexagonal Portable Birth Pool
92. City Hospital Birmingham – Active Birth Pool, Active Birth Beanbag and Mat
93. Clarence Medical Centre – Active Birth Beanbag, Mat and Kneeling Pads
94. Clenoch Birthing Suite Galloway Community Hospital – Active Birth Beanbag
95. Clevedon Hospital – Active Birth Kneeling Pads
96. Clinica Acuario, Spain- Elliptical Birth Pool
97. Clinical Center of Mother and Child Healthcare in Ashgabat,Turkmenistan – Active Birth Pool Ficore©
98. Clinique Saint Joseph, Belgium – Deluxe Birth Pool
99. Colchester Hospital- Eleven Active Birth Mats
100.               Conquest Hospital East Sussex – Deluxe Birth Pool
101.               Constanze Weigle Stuttgart Germany – Hexagonal Portable Birth Pool
102.               Coombe Hospital, Dublin – Optimal Birth Pool
103.               Corbar Maternity Unit Chesire – Deluxe Birth Pool and Hexagonal Portable Birth Pool
104.               Cork University Hospital – Active Birth Mat and Kneeling Pad
105.               Corniche Hospita, Abu Dhabi– Active Birth Pool – Ficore ®
106.               Cossham Hospital, Bristol – Four Active Birth Pools
107.               Craigavon Area Hospital Northen Ireland – Deluxe Water Birth Pool
108.               Crawley Hospital West Sussex – Hexagonal Portable Birth Pool
109.               Cresswell Maternity Wing Dumfries and Galloway Royal Infirmary – Princess Birth Pool
110.               Crosshouse Hospital Ayrshire – Active Birth Pool
111.               Crowborough Hospital – Two Active Birth Beanbags
112.               Crowborough War memorial Hospital – Active Birth Beanbags
113.               Croydon University Hospital Birthing Centre – Two Princess Pools
114.               Cumberland Infirmary – Princess Water Birth Pool Ficore ®
115.               Cumberland Infirmary – Two Optimal Water Birth Pools and a Deluxe Birth Pool
116.               Daisy Hill Hospital, Ireland – Princess and Venus II Birth Pools, Deluxe Birth Pool
117.               Darent Valley Hospital – Hexagonal Portable Birth Pool and Amaryllis Birth Pool
118.               Darley Birth Centre Matlock – Active Birth Pool
119.               Dartford Gravesham General Hospital Kent – Active Birth Pool
120.               De Montford University – Active Birth Pool Ficore©
121.               De Oerbron Netherlands – Oval Portable Pool
122.               Derby City Hospital Derby – Active Birth Pool
123.               Derriford Hospital Devon – Active Birth Pool
124.               Devizes Community Hospital Wiltshire – Oval Portable Birth Pool
125.               Dewsbury & District Hospital, W. Yorkshire – 2 x Active Birth Pools Ficore ®
126.               Dewsbury District Hospital Mid Yorkshire – Elliptical Birth Pool
127.               Diana Princess of Wales Hospital Grimbsy – Space Saver Pool, Active Birth Pool, Deluxe Birth Pool
128.               Doncaster Royal Infirmary – Active Birth Pool
129.               Douglas County Hospital Minnesota USA – Deluxe Birth Pool
130.               Downshire Hospital, Downpatrick – Two Active Birth Mats
131.               Dumfries & Galloway Royal Infirmary Scotland – Oval Portable Birth Pool
132.               Dunfermline Maternity Hospital Fife – Oval Portable Pool
133.               Dunoon General Hospital – Active Birth Beanbag and Mat
134.               E. Meadows Gloucester – Oval Portable Birth Pool
135.               Ealing Hospital – Active Birth Pool and Active Birth Beanbags
136.               East Lancashire Hospital – Princess Pool
137.               Edgeware Community Hospital – Active Birth Pool
138.               Edinburgh Royal Infirmary Scotland – Corner Birth Pool
139.               Edinburgh Royal Infirmary Scotland – Space Saver Birth Pool
140.               Edith Cavell Hospital Peterborough – Active Birth Pool
141.               Elaine Batchelor Bucks – Hexagonal Portable Birth Pool
142.               Elemental Birth Edinburgh – Oval Portable Birth Pool
143.               Elliot Hospital, New Hampshire USA – Deluxe Birth Pool
144.               Enniskillen Hospital – Two Original Birth Pools
145.               Epsom General Hospital – Three Princess Birth Pools
146.               Epsom General Hospital, Surrey – Elliptical Birth Pool
147.               Fabrice de Villeneuve, France – Hexagonal Portable Birth Pool
148.               Fernandez Hospital, Hyderabad India – Active Birth Pool Ficore ®
149.               Forth Park Hospital – Active Birth Beanbag and Oval Portable Birth Pool
150.               Forth Valley Acute Hospital – Two Optimal Compact Birth Pools
151.               Fraserburgh Hospital – Deluxe Birth Pool
152.               Frimley Park Hospital   – Berkshire  – Venus Birth Pool Ficore ®
153.               Frimley Park Hospital – One Princess Birth Pool, Four Active Birth Mats
154.               Frimley Park Hospital Surrey – Active Birth Pool and Princess Birth Pool
155.               Frome Community Hospital – Deluxe Birth Pool
156.               Frome Victoria Hospital Wiltshire – Oval Portable Birth Pool
157.               Fundatia Columbeanu Romania – Active Birth Pool
158.               Geburtshaus Luna Biel – Switzerland – Active Birth Pool Ficore ®
159.               Geburtshaus Luna Biel, Switzerland – Active Birth Pool Ficore©
160.               Gentle Birth and Education Centre, Nigeria – Hexagonal Portable Birth Pool
161.               George Elliot Hospital – Active Birth Pool Ficore® and Princess Birth Pool Ficore®
162.               George Elliot Hospital Nuneaton – Oval Portable Birth Pool, Active and Princess Birth Pool Ficore®
163.               Gilbert Bain Hospital – Active Birth Beanbag and Deluxe Birth Pool
164.               Glan Clwyd Hospital – Princess Birth Pool Ficore ® with sound and light
165.               Glan Clwyd Hospital Denbigh – Active Birth Pool
166.               Glangwili Hospital – Active Birth Pool
167.               Glangwili Hospital – Two Active Birth Pools
168.               Glasgow Maternity Hospital Scotland – Deluxe Birth Pool
169.               Glasgow Royal Infirmary – Active Birth Pool and Deluxe Birth Pool
170.               Glasgow Royal Infirmary Scotland – Deluxe Birth Pool
171.               Gloucester Royal Hospital – Oval Portable Pool
172.               Good Birth Company – Oval and Hexagonal Portable Birth Pools
173.               Good Hope Hospital, Birmingham – Two Active Birth Pools
174.               Gosford Hospital – NSW Wales, Australia – 10 x Venus Birth Pools Ficore ®
175.               Gosport War Memorial Hospital, Hampshire – Space Saver Birth Pool
176.               Great Western Hospital – Labour Support Stool
177.               Great Western Hospital, Swindon – Two Active Birth Pools
178.               Greenwich District Hospital, London – Oval Portable Birth Pool
179.               Gudrun Olof Jonsdottir, Iceland – Hexagonal Portable Birth Pool
180.               Guys & St Thomas Hospital – London – 2 x Venus Birth Pool Ficore ®
181.               Guys and St Thomas Hospital – 2 x  Venus Birth Pools Ficore©
182.               Halcyon Birth Centre, Sandwell – Three Active Birth Pools
183.               Halifax General Hospital – Deluxe Birth Pool
184.               Hammersmith Hospital London – Deluxe Birth Pool, Elliptical Birth Pool and Venus Birth Pool Ficore®
185.               Harada Corporation, Japan – Hexagonal Portable Birth Pool
186.               Harrogate NHS Trust Yorkshire – Deluxe Birth Pool and Active Birth Pool Ficore©
187.               Harwich Fellowship of the Sick, Essex – Corner Birth Pool
188.               Health Foundations Family Health & Birth Centre, Minnesota USA – Venus Birth Pool Ficore®
189.               Heartlands Hospital – Active Birth Pool
190.               Heatherwood Hospital Berkshire – Deluxe Birth Pool
191.               Hebammenpraxis-Geburtshau, Austria – Active Birth Pool – Ficore ®
192.               Hebammenpraxis-Geburtshaus Natascha van Riet, Austria – Active Birth Pool – Ficore ®
193.               Heilbrigðisstofnun Austurlands, Iceland – Venus Water Birth Pool Ficore ®
194.               HELIOS Klinikum, Pforzheim Germany – Active Birth Pool – Ficore ®
195.               Helston Community Hospital Cornwall – Deluxe Birth Pool
196.               Hemel Hempstead Hospital Herts – Deluxe Birth Pool
197.               Henrietta Hen, Norway – Hexagonal Portable Birth Pool
198.               Hereford County Hospital – Elliptical Birth Pool
199.               Hexham General Hospital – Active Birth Pool
200.               High River General Hospital, Canada – 3 x Venus Birth Pools Ficore ®
201.               Higherland Surgery Staffs – Oval Portable Birth Pool
202.               Hillingdon Hospital – Optimal Water Birth Pool, Active Birth Mat and Beanbag
203.               Hinchingbrooke Hospital – Deluxe Birth Pool and Active Birth Beanbag
204.               Holbæk Hospital, Denmark – Venus Birth Pool and Amaryllis Birth Pool
205.               Homerton Hospital, – 3 Princess Birth Pools, Portable Birth Pools, Elliptical Birth Pool, Active Birth Pool
206.               Honiton Hospital Devon – Optimal Water Birth Pool
207.               Hope Hospital, Salford- Princess Birth Pool and Active Birth Pool
208.               Hopital Aubenas – France 1 x Venus Pool Ficore ®
209.               Hopital Aubvenas – France – Venus Birth Pool Ficore ®
210.               Horton General Hospital Oxon – Elliptical Birth Pool
211.               Hospital of St John and St Elizabeth London – Deluxe Birth Pool
212.               Hospital Parc Tauli, Barcelona, Spain – Deluxe Birth Pool
213.               Huddersfield Royal Infirmary active birth pool w/ skirting panel
214.               Hull & East Yorkshire Women’s and Children’s Hospital – Active Birth Pool
215.               Hull Royal Infirmary – 3 x Princess Birth Pools Ficore ® – 1 x Active Birth Bed
216.               Hull Royal Infirmary Yorkshire – Deluxe Birth Pool
217.               Hvidovre Hospital – Denmark – Active Birth Pool Ficore ®
218.               Hythe Hospital Hampshire – Deluxe Birth Pool
219.               Ichilov Hospital Israel – Hexagonal Portable Birth Pool
220.               Ikeda Midwife Centre, Japan – Hexagonal Portable Birth Pool
221.               Inverclyde Royal Hospital – Active Birth Pool, Active Birth Beanbag and Kneeling Pads
222.               Ipswich Hospital – Original Birth Pool, Active Birth Beanbag and Mats
223.               J Mabbott – Oval Portable Birth Pool
224.               James Paget Hospital – Two Active Birth Beanbags and Three Princess Pools
225.               Jane Evans Harpenden Herts – Hexagonal Portable Birth Pool
226.               Jax Allen, Bristol – Hexagonal Portable Birth Pool
227.               Jennie O’Brien Derry – Oval Portable Birth Pool
228.               Jill Benjoy-Miller, London – Oval Portable Birth Pool
229.               John Radcliffe Hospital – Two Princess Birth Pools
230.               John Radcliffe Hospital Oxfordshire – Deluxe Birth Pool and two Princess Birth Pools
231.               Jonathon and Stacey Fisher, Israel – Hexagonal Portable Birth Pool
232.               Joseftal Hospital Israel – Hexagonal Portable Birth Pool
233.               JPUH NHS – Active Birth Mat and Beanbag
234.               Jubilee Maternity Hospital, Ireland – Oval Portable Birth Pool
235.               Julie Dinsdale South London – Oval and Hexagonal Portable Birth Pools
236.               Julie Philips Abingdon – Oval Portable Birth Pool
237.               Kainuu Central Hospital Finland  – Active Birth Pool Ficore ®
238.               Kaleeya Hospital East Freemantle, Australia – Deluxe Birth Pool
239.               Karen Landsbert-Noon, Belgium – Hexagonal Portable Birth Pool
240.               Karen Perry Cambs. – Hexagonal Portable Birth Pool
241.               Karratha Health Campus, Western Australia – 2 x Venus Birth Pools Ficore©
242.               Kasia Flemming – Hexagonal Portable Birth Pool
243.               Kätilöopisto Maternity Hospital, Finland – 4 x Active Birth Pools Ficore ®
244.               Kauppatalo Hansel Oy, Finland – Oval Portable Birth Pool
245.               Kent and Canterbury Hospital – Active Birth Beanbag, Mat and Kneeling Pad and Active Birth Pool
246.               Kerang Hospital, Australia – Princess Birth Pool
247.               Kerang Hospital, Australia – Princess Birth Pool
248.               Kettering General Hospital – Active Birth Pool and Princess Pool Ficore®
249.               Kidderminster General Hospital Worcestershire – Deluxe Birth Pool
250.               King George Hospital Essex – Oval Portable Birth Pool
251.               Kings College Hospital, London – Active Birth Pool, Original Birth Pool and Oval Portable Birth Pool
252.               Kings Lynn and Wisbech Hospital Norfolk – Elliptical Birth Pool
253.               Kings Mill Hospital – Active Birth Pool
254.               Kingston Hospital Surrey – Deluxe Birth Pool and Active Birth Pool
255.               Kolding Sygehus, Denmark – 3 x Princess Birth Pools – Ficore ®
256.               Kymenlaakson Hospital Finland –  Active Birth Pool Ficore ®
257.               Lagan Valley Hospital, Antrim, Ireland – Three Space Saver Pools
258.               Lancashire Teaching Hospital – Two Princess Pools
259.               Law Hospital Lanarkshire – Deluxe Birth Pool
260.               Leicester General Hospital – Two Princess Pools and Oval Portable Pool
261.               Leicester Royal Infirmary – Deluxe Birth Pool, two Princess Pools and Oval Portable Pool
262.               Lewisham Hospital – Active Birth Beanbag and Kneeling Pads and Active Birth Pool
263.               Lincoln County Hospital – Active Birth Pool
264.               Lister Hospital – One Active Birth Beanbag and four Active Birth Mats
265.               Lister Hospital – Three Active Birth Pools and Hexagonal Portable Birth Pool
266.               Llandough Hospital – Active Birth Pool
267.               LLandrindod Wells Memorial Hospital, Powys – Venus Water Birth Pool Ficore ®
268.               Llanfrechfa Grange Hospital – – Active Birth Pool – Ficore ®
269.               Llanidloes War Memorial Hospital, Powys – Active Birth Beanbag
270.               Lochgilphead Hospital Argyll – Active Birth Pool
271.               London Kings College UAE – Active Birth Pool Ficore ® with sound and light
272.               London Kings Hospital, Dubai – Active Birth Pool – Ficore ®
273.               Lorn and Islands Hospital Argyll – Deluxe Birth Pool
274.               Luise Daemen Switzerland – Oval Portable Birth Pool
275.               Luton & Dunstable Hospital – Active Birth Pool Ficore®
276.               Luton and Dunstable Hospital  – Active Birth Pool Ficore ®
277.               Luton and Dunstable Hospital – Active Birth Beanbag and Active Birth Pool
278.               Lymington Hospital – Deluxe Birth Pool
279.               Lynn Massey Erps Kwerps – Hexagonal Portable Birth Pool
280.               M. Suzuki Memorial Hospital, Japan – Active Birth Pool
281.               M.P. Shah Hospital, Nairobi, Kenya – Active Birth Pool – Ficore ®
282.               Macclesfield District General Hospital – Active Birth Pool
283.               MacKinnon Memorial Hospital – Active Birth Beanbag
284.               Maidstone Hospital Kent – Active Birth Beanbag and Mats, Deluxe Birth Pool and Two Active Birth Pools
285.               Makati Medical Centre, Manila Philippines – Active Birth Pool Ficore®
286.               Malaga Hospital, Spain – Space Saver Pool
287.               Manchester Royal Infirmary – Two Princess Pools and Deluxe Birth Pool
288.               Manor Hospital Walsall – Deluxe Birth Pool
289.               Mater Hospital Belfast – Two Original Birth Pools and Elliptical Birth Pool
290.               Mayday Hospital – Deluxe Birth Pool and Space Saver
291.               Meadow Birth Centre  – One Active Birth Pool and two Venus Birth Pools – Ficore ®
292.               Meadow Birth Centre Worcestershire Royal Hospital – Active Birth Pool Ficore© and Venus Birth Pool Ficore©
293.               Mediclinic City Hospital, Dubai – Active Birth Pool – Ficore ®
294.               Mediclinic Park View Hospitals UAE- Active Birth Pool Ficore ® with sound and light
295.               Mediclinic Parkview Hospital, Dubai – Active Birth Pool – Ficore ®
296.               Medway Maritime Hospital – Active Birth Mats, Beanbags and three Active Birth Pools
297.               Melanie Aqua Birth Pool Hire Dorset – Oval Portable Birth Pool
298.               Mid Argyll Hospital – Hexagonal Portable Birth Pool
299.               Milton Keynes Hospital – Active Birth Pool
300.               Miyazaki Birth Centre Japan – Hexagonal Portable Birth Pool
301.               Monadnock Community Hospital New Hampshire USA – Deluxe Birth Pool
302.               Morgreen Hospital Hampshire – Deluxe Birth Pool
303.               Moscow Veronica Maslova – Hexagonal Portable Birth Pool
304.               Mothers office Japan – Oval Portable Birth Pool
305.               MPP RNH Gibraltar – Oval Portable Birth Pool
306.               Musgrove Park Hospital – Active Birth Pool
307.               Musgrove Park Hospital, Taunton – Venus Birth Pool – Ficore ®
308.               Nakajima Midwife Clinic, Japan – Hexagonal Portable Birth Pool
309.               Natalie Perry Dorking – Hexagonal Portable Birth Pool
310.               National Maternity Hospital, Dublin – Princess Birth Pool – Ficore ®
311.               Neath General Hospital West Glamorgan – Deluxe Birth Pool
312.               Neath Port Talbot Hospital Wales – Active Birth Pool
313.               Nevill Hall Hospital Monmouth – Active Birth Pool
314.               New Acute Hospital, Enniskillen, Ireland – Active Birth Beanbags
315.               New Cross Hospital, Wolverhampton – Deluxe Birth Pool, 3 Active Birth Pools & Space Saver Birth Pool
316.               New Downe Hospital – Deluxe Birth Pool
317.               New Forest Birth Centre: Two Active Birth Mats and Three Active Birth Pools
318.               New Norfolk and Norwich Hospital – Deluxe Birth Pool
319.               New Orkney Hospital – Active Birth Pool Ficore ®
320.               New Romford Hospital Essex – Deluxe Birth Pool
321.               New Victoria Hospital, Kirkaldy – Two Active Birth Pools
322.               Newham General Hospital London – Deluxe Birth Pool
323.               Newham University Hospital- Ten Princess Birth Pools and Active Birth Pool,
324.               Newton Abbot Community Hospital- Deluxe Birth Pool
325.               Nicholas Nauman Rome – Hexagonal Portable Birth Pool
326.               Nichole Remy Germany – Hexagonal Birth Pool
327.               Ninewells Hospital Scotland – Deluxe Birth Pool
328.               Nobles Hospital Isle of Man – Deluxe Birth Pool
329.               Norfolk and Norwich Hospital – Princess Birth Pool, Amaryllis Birth Pool
330.               North Devon District Hospital – Active Birth Pool
331.               North Manchester General Hospital – Oval Portable Birth Pool
332.               North Middlesex Hospital – Four Active Birth Pools
333.               North Middx Hospital London –  Active Birth Pool Ficore ®
334.               North Tees General Hospital Cleveland – Active Birth Pool
335.               North Tyneside General Hospital – Active Birth Pool
336.               North Wales NHS Trust Gwynedd – Oval Portable Birth Pool
337.               Northampton General Hospital – Three Amaryllis Pools and Active Birth Pool
338.               Northern General Hospital Sheffield – Oval Portable Birth Pool, Active Birth Pool, Deluxe Birth Pool
339.               Northfield Hospital, Minnesota – Active Birth Pool – Ficore ®
340.               Northumberland Hospital – Two Active Birth Pools
341.               Northumbria Hospital – Two Active Birth Pools
342.               Northwick Park Hospital – Active Birth Pool
343.               Northwick Park Hospital Middlesex – Deluxe Birth Pool
344.               Nottingham City Hospital – Active Birth Pool and Oval Portable Pool
345.               Nyree Wright London – Hexagonal Portable Birth Pool
346.               Oakwood Midwifery Practice London – Hexagonal Portable Birth Pool
347.               Oban, Lorn & Islands Hospital – Active Birth Beanbag
348.               Okehampton Hospital Devon – Deluxe Birth Pool
349.               Ommelander Ziekenhuis Groningen, Netherlands – Active Birth Pool Ficore©
350.               Ormskirk and District Hospital Lancashire – Elliptical Birth Pool
351.               Orpington Hospital Kent – Active Birth Pool
352.               Oulaskanaan Aluesairaala Norway – Hexagonal Portable Birth Pool
353.               Our Lady of Drogheda Ireland – Deluxe Birth Pool
354.               Our Lady of Lourdes Hospital, Eire – Original Birth Pool
355.               Padraicin Ni Mhurdu Dublin – Hexagonal Portable Birth Pool
356.               Päijät-Häme Central Hospital – Finland – 1 x Venus Pool Ficore ®
357.               Paulton Maternity Hospital Bristol – Deluxe Birth Pool
358.               Pembury Hospital – Active Birth Pool and Oval Portable Pool
359.               Penrice Hospital Cornwall – Deluxe Birth Pool
360.               Penrith Maternity Unit – Active Birth Pool and Hexagonal Portable Birth Pool
361.               Perth Royal Infirmary – Deluxe Birth Pool
362.               Peterhead Community Hospital –2 x Venus Birth Pools Ficore ®
363.               Petersfield Hospital – Active Birth Beanbag and Active Birth Pool
364.               Pilgrim Hospital – Active Birth Pool
365.               Pinderfields General Hospital, North Yorkshire – Active Birth Pool
366.               Pinderfields Hospital – 2 x Venus Water Birth Pools Ficore ®
367.               Pinderfields Hospital, Wakefield – 2 x Venus Pools Ficore ®
368.               Plymouth Hospital Devon – Active Birth Pool
369.               Pontefract General Infirmary – Active Birth Mat and Kneeling Pad
370.               Pontefract Hospital – Active Birth Mat and Active Birth Pool
371.               Poole Hospital – Four Princess Birth Pools and Active Birth Pool
372.               Portland Hospital London – Active Birth Pool
373.               Portsmouth Hospital – Active Birth Beanbags and Active Birth Pool
374.               Preston Acute Hospital Lancashire – Oval Portable Birth Pool
375.               Prince Charles Hospital, Merthyr Tydfil – 4 x  Active Birth Pool Ficore©
376.               Princess Alexandra Hospital, Harlow Essex – 2 Original Water Birth Pools, Princess Birth Pool, Active Birth Pool,
377.               Princess Elizabeth Hospital Guernsey – Active Birth Pool Ficore®
378.               Princess of Wales Hospital – Princess Birth Pool – Ficore ®
379.               Princess of Wales Hospital – Deluxe Birth Pool
380.               Princess Royal Hospital Kent – Active Birth Pool
381.               Princess Royal Maternity Hospital Glasgow – Active Birth Beanbag
382.               Princess Royal, Telford – 2 x Princess Birth Pools – Ficore ®
383.               Queen Alexandra Hospital – Active Birth Mats and Kneeling Pads
384.               Queen Alexandra Hospital – Six Active Birth Beanbags
385.               Queen Alexandra Hospital Portsmouth – Deluxe Birth Pool
386.               Queen Alexandra Hospital, Plymouth – Venus Pool Ficore ®
387.               Queen Charlottes & Chelsea – Elliptical Birth Pool, Active Birth Pool, Deluxe Birth Pool and Active Birth Pool Ficore©
388.               Queen Elizabeth Hospital Project, London – Four Active Birth Pools and one Venus Birth Pool – Ficore ®
389.               Queen Elizabeth Hospital, Kings Lynn – Venus & Princess Pool Ficore ®
390.               Queen Elizabeth Hospital, London – Four Active Birth Pools and Elliptical Birth Pool
391.               Queen Elizabeth Hospital, Tyne and Wear – Active Birth Pool
392.               Queen Elizabeth II Hospital Herts – Deluxe Birth Pool
393.               Queen Elizabeth Queen Mother Hospital – Active Birth Pool – Ficore ®
394.               Queen Mary’s Hospital Kent – Space Saver and Oval Portable Birth Pool
395.               Queen Mother’s Hospital Glasgow – Active Birth Beanbag
396.               Queens Hospital – Active Birth Beanbag and Mat and Amaryllis Birth Pool
397.               Queens Park Hospital Lancashire – Active Birth Pool
398.               Ras Al Khaimah – UAE- Active Birth Pool Ficore ® with sound and light
399.               Rep Of Ireland – Deluxe Birth Pool
400.               Robb Mason, Nottingham – Oval Portable Birth Pool
401.               Roberta Jess Co Armagh – Oval Portable Birth Pool
402.               Rochford Hospital Essex – Oval Portable Birth Pool
403.               Romsey Hospital Hants – Deluxe Birth Pool
404.               Rossendale Hospital – Active Birth Pool
405.               Rothsay Victoria Hospital – Active Birth Beanbag
406.               Rotunda Hospital, Dublun – Active Birth Pool Ficore ®
407.               Royal Alexandra Hospital – Active Birth Beanbag and Active Birth Pool
408.               Royal Bolton Hospital Lancashire – Active Birth Pool
409.               Royal Bournemouth Hospital – Two Venus Birth Pools
410.               Royal Cornwall  – 4 x Venus  Birth Pools Ficore ®
411.               Royal Derby Hospitasl – Active Birth Pool
412.               Royal Devon and Exeter Hospital – Deluxe Birth Pool and Active Birth Beanbag and Mat
413.               Royal Free Hospital London –  Venus Birth Pool Ficore ®
414.               Royal Free Hospital London – Deluxe Birth Pool
415.               Royal Glamorgan Hospital  – Active Birth Pool Ficore ® with sound and light
416.               Royal Glamorgan Hospital Mid Glamorgan – Two Deluxe Birth Pools
417.               Royal Gwent Hospital, Newport, Wales – Princess Birth Pool – Ficore ®
418.               Royal Hallamshire Hospital, Sheffield – 2 x Venus Birth Pools  Ficore ®
419.               Royal Hampshire County Hospital – Two Active Birth Pools, Active Birth Mats and Beanbags
420.               Royal Infirmary, Edinburgh – Six Original Water Birth Pools
421.               Royal Lancaster Infirmary – Active Birth Beanbag and Mat
422.               Royal London Hospital – 2 x Active Birth Pools Ficore ®
423.               Royal London Hospital – Deluxe Birth Pool and Active Birth Pool
424.               Royal Maternity Hospital Northern Ireland – Deluxe Birth Pool
425.               Royal Maternity Hospital, Belfast – 16 x Venus Birth Pools – Ficore ®
426.               Royal Preston Hospital – Four Princess Birth Pools
427.               Royal Preston Hospital – Four Princess Birth Pools, Active Birth Pool,
428.               Royal Preston Hospital – Six Active Birth Mats, Four Beanbags, Four Kneeling Pads
429.               Royal Shrewsbury – Active Birth Pool and Princess Pool Ficore©
430.               Royal Surrey Hospital – Venus Birth Pool, 2 Princess Pools, Active Birth Pool,Deluxe Birth Pool
431.               Royal Surrey Hospital – Venus II Birth Pool
432.               Royal Sussex Hospital – 2 Venus Birth Pools, Deluxe Birth Pool, 2 Princess Birth Pools and Hexagonal Portable Pool
433.               Royal United Hospital Wiltshire – Oval Portable Birth Pool
434.               Royal Victoria Hospital Belfast – Deluxe Birth Pool
435.               Royal Victoria Hospital Kent – Deluxe Birth Pool
436.               Royal Victoria Infirmary, Newcastle – Active Birth Pool
437.               Rush Green Hospital Essex – Oval Portable Birth Pool
438.               Russells Hall Hospital – Active Birth Mat, Beanbag and Active Birth Pool
439.               RVI Midwifery Led Unit, Newcastle – Five Active Birth Pools
440.               S.A. Comunale Akron, Ohio – Four Active Birth Pools Ficore ®
441.               Sabine Friese-Berg, Germany – Hexagonal Portable Pool
442.               Sage Femme London – Hexagonal Portable Pool
443.               Salisbury District Hospital – Two Active Birth Pools and Deluxe Birth Pool and Active Birth Beanbags
444.               Samuel Johnson Hospital Staffordshire – Deluxe Birth Pool
445.               Sandwells Hospital – Active Birth Mat, Beanbag and Active Birth Pool
446.               Sarah Bull, Stockport – Hexagonal Portable Birth Pool
447.               Scarborough Hospital– Active Birth Mat and Active Birth Pool
448.               Scottish Healthcare Edinburgh – Elliptical Birth Pool
449.               Scunthorpe General Hospital North Lincolnshire – Space Saver Birth Pool and Active Birth Pool
450.               Seiko Kamiya, Japan – Oval Portable Birth Pool
451.               Setagaya Birth House, Japan – Oval Portable Birth Pool
452.               Shayne Berger, Israel – Hexagonal Portable Birth Pool
453.               Sheba Medical Centre Tel Aviv, Israel – Two Active Birth Pools Ficore ®
454.               Shepton Mallet Hospital, Somerset – Oval Portable Birth Pool
455.               Simpson Centre for Reproductive Health, Edinburgh – Active Birth Beanbag
456.               Singleton Hospital Wales – Active Birth Pool
457.               Solihull Hospital – Two Active Birth Pools
458.               South Cleveland Hospital Middlesbrough – Deluxe Birth Pool
459.               South Jutland Hospital – Two Active Birth Pools
460.               South Jutland Hospital, Denmark – Two Active Birth Pools
461.               South Tyneside District Hospital – Active Birth Pool
462.               Southampton General Hampshire – Active Birth Pool
463.               Southend Hospital Essex – Oval Portable Birth Pool
464.               Southern General Hospital Glasgow – Deluxe Birth Pool, Original Birth Pool and Active Birth Beanbag
465.               Southmead Hospital Bristol – Active Birth Pool & – Active Birth Pool Ficore ®
466.               Spencer Hampton, Nottingham – Oval Portable Pool
467.               Splashdown Water Birth Services – Oval Portable Birth Pool
468.               SREE LAKSHMI GAYATRI HOSPITALS (P) LTD India – Active Birth Pool Ficore ®
469.               Sri Ramakrishna Hospital, India – Active Birth Pool Ficore©
470.               St Georges Hospital – Elliptical Birth Pool, Active Birth Pool and Deluxe Birth Pool
471.               St Helens and Knowsely Hospital – Active Birth Pool and Active Birth Mat and Beanbag
472.               St Helier Hospital Surrey Active Birth Beanbags, Kneeling Pads and Oval Portable Birth Pool
473.               St James University Hospital – Active Birth Mats
474.               St Johns Hospital, Howden, West Lothian – Oval Portable Birth Pool
475.               St Lawrence’s Hospital Cornwall – Deluxe Birth Pool
476.               St Mary’s Hospital, Isle of Wight – Active Birth Pool Ficore©
477.               St Mary’s Hospital, Isle of Wight – Deluxe Birth Pool
478.               St Mary’s Hospital, London – Venus Birth Pool – Ficore ®
479.               St Mary’s Hospital, Paddington – Two Venus Birth Pools and Oval Birth Pool
480.               St Mary’s Maternity Unit, Leicester – Deluxe Birth Pool
481.               St Michaels Hospital – Active Birth Pool – Ficore ®
482.               St Michaels Hospital Essex – Two Active Birth Pools
483.               St Michaels Hospital, Bristol – Two Active Birth Pools, Active Birth Mats and Active Birth Pool Ficore©
484.               St Richards Hospital Chichester – Active Birth Beanbag and Mat, Deluxe Birth Pool and Active Birth Pool
485.               St. John’s Hospital, Livingston – Three Active Birth Pools
486.               St. Johns Hospital, Livingston – Three Active Birth Pools, Kneeling Pads and Active Birth Beanbag
487.               St. Lukes Hospital, Kilkenny, Ireland  – Active Birth Pool Ficore ®
488.               St. Lukes Medical Centre, Philippines – Active Birth Pool
489.               St. Mary’s Hospital Portsmouth – Original Birth Pool
490.               St. Peters Hospital Chertsey – Original Water Birth Pool, Active Birth Beanbags and Kneeling Mats
491.               St. Vincent’s Private Hospital, Australia – Active Birth Pool – Ficore ®
492.               St.-Agnes-Hospital Bocholt, Germany – Princess Birth Pool Ficore ®
493.               Staffordshire General Hospital – Active Birth Pool
494.               Stanley Royd Hospital Yorkshire – Oval Portable Pool
495.               Stepping Hill Hospital – Deluxe Birth Pool and Hexagonal Portable Pool
496.               Stepping Hill Hospital, Stockport – Active Birth Pool Ficore ®
497.               Stichting De Kleine Dolfijn, Netherlands – Oval Portable Pool
498.               Stirling Royal Infirmary – Active Birth Beanbag and Space Saver Birth Pool
499.               Stockport Birth Centre – Deluxe Birth Pool
500.               Stoke Mandeville Hospital – Active Birth Pool
501.               Stonegrove Hospital, Sheffield – Active Birth Pool
502.               Storkereden – Denmark – Active Birth Pool Ficore ®
503.               Storkereden, Copenhagen – Active Birth Pool Ficore ®
504.               Stroud Maternity Unit – Active Birth Mats, Optimal Compact Birth Pool, Hexagonal Portable Pool
505.               Sue Townend, West Yorkshire – Hexagonal Portable Pool
506.               Sunderland Royal Hospital – Active Birth Beanbag, Mat and Active Birth Pool
507.               Sunshine Coast University Hospital (VIC) – 4 x Active Birth Pools Ficore ®
508.               Sutton Hospital – Space Saver Pool
509.               Sydney Adventist Hospital, Australia – Two Princess Pools
510.               Sygehus Sønderjylland Aabenraa, Denmark – 4 x Active Birth Pools Ficore ®
511.               Tampere Hospital – Finland – 5 x Princess Pools Ficore ®
512.               Taunton and Somerset Hospital, Somerset – Active Birth Pool
513.               Telford Hospital – Princess Birth Pool and Active Birth Pool
514.               The Birth Centre London – Corner Birth Pool
515.               The Women Unit University Hospital Wales – Active Birth Pool
516.               The Womens Hospital Liverpool – Active Birth Pool, Active Birth Pool Ficore©, and two Princess Birth Pools Ficore©
517.               Thiele and Fendel, Germany – Active Birth Pool
518.               Torbay Hospital – Venus Water Birth Pool Ficore ®
519.               Torbay Hospital Devon – Deluxe Birth Pool
520.               Towers Hospital, Leicester – Deluxe Birth Pool
521.               Tristar Centennial Medical Center, Nashville, Tenn. – 2 x Active Birth Pools – Ficore ®
522.               Trowbridge Hospital – Deluxe Birth Pool and Oval Portable Pool
523.               Tunbridge Wells Hospital – Active Birth Beanbag
524.               Tyrone and Fermanagh Hospital, Northern Ireland – Oval Portable Pool
525.               Ulster Community Hospital, County Down – Oval Portable Pool and Hexagonal Portable Pool
526.               Ulster Hospital – Venus Water Birth Pool Ficore ®
527.               Ulster Hospital, Northern Ireland – Elliptical Pool, Deluxe Birth Pool and Active Birth Pool
528.               United Bristol Hospital – Active Birth Pool
529.               Universitair Medisch Centrum Groningen, Holland – 2 x Active Birth Pools  Ficore ®
530.               Universitair Ziekenhuis Leuven, Belgium – Six Active Birth Pools Ficore ® with light and sound
531.               University College Hospital, London – 4 x Active Birth Stools
532.               University College Hospital, London – Versatile Birth Pool and Active Birth Pool
533.               University Hospital Lewisham – Active Birth Pool
534.               University Hospital Norfolk – Deluxe Birth Pool
535.               University Hospital of Hartlepool – Active Birth Pool
536.               University Hospital of North Durham – Active Birth Beanbag and Mat
537.               University Hospital Stockton – Active Birth Pool
538.               University Hospital Wales – Active Birth Pool
539.               University Hospital, Coventry – Two Amaryllis Birth Pools and Two Original Birth Pools
540.               University Maternity Hospital, Limerick – Venus Birth Pool Ficore©
541.               Vaasa Central Hospital, Finland – Venus Birth Pool Ficore©
542.               Vale of Leven Hospital – Active Birth Pool and Beanbag
543.               Victoria Hospital Norfolk – Oval Portable Birth Pool
544.               Victoria Hospital Staffordshire – Deluxe Birth Pool
545.               Wallingford Hospital – Two Princess Birth Pools
546.               Walsall Hospital – Three Active Birth Pools
547.               Walsgrave Hospital Coventry – Active Birth Pool
548.               Wansbeck general Hospital – Two Active Birth Pools
549.               Wantage Community Hospital – Original Water Birth Pool
550.               Warrington Hospital  – 2 x Active Birth Pools 2 x Princess Pools, – Ficore ®
551.               Warrington Hospital – Two Active Birth Pools
552.               Warwick Hospital – Active Birth Pool, Mat and Beanbag
553.               Water Creations, Derry – Oval and Hexagonal Portable Birth Pools
554.               Waterford Regional Hospital, Ireland – Two Original Birth Pools
555.               Watford General Hospital – Deluxe Birth Pool, Active Birth Pool and Active Birth Mat
556.               Wentworth Douglas Hospital, USA – Active Birth Pool
557.               Wessex Maternity Centre Hampshire – Deluxe Birth Pool
558.               West Cumberland Hospital – Deluxe Birth Pool and Venus Birth Pool
559.               West Cumberland Hospital – Venus Birth Pool
560.               West Dorset General Hospital – Deluxe Birth Pool
561.               West Middlesex Hospital –Optimal Water Birth Pool, Active Birth Pool and Deluxe Birth Pool
562.               West Suffolk Hospital – Active Birth Pool
563.               Western Isles and Queen Elizabeth Queen Mother Hospitals – Active Birth Pool Ficore©
564.               Western Isles Hospital – Active Birth Beanbag
565.               Western Isles Hospital – Active Birth Pool – Ficore ®
566.               Westmead Hospital, Australia – Active Birth Beanbags and Mats
567.               Weston General Hospital Weston Super Mare – Active Birth Pool, Beanbags, Active Birth Mat
568.               Wexford General Hospital, Ireland – Active Birth Pool – Ficore ®
569.               Wexham Park Hospital – Deluxe Pool, Amaryllis Birth Pool and Active Birth Pool.
570.               Whipps Cross Hospital – Deluxe Birth Pool and Space Saver Birth Pool
571.               Whipps Cross Hospital, London – 3 x Active Birth Pools, 1 x Venus Pool – Ficore ®
572.               Whipps Cross Hospital, London – Princess Pool Ficore ®
573.               Whipps Cross University Hospital – Princess Birth Pool Ficore ®
574.               Whiston Hospital – 2 x Princess Birth Pool Ficore ®
575.               Whittington Hospital –  Two Princess Birth Pools and Four Deluxe Birth Pools
576.               William Harvey Hospital – Active Birth Mat, Active Birth Pool and Elliptical Birth Pool
577.               William Julien Courtauld Hospital Essex – Oval Portable Pool
578.               Wishaw General Hospital – Original Birth Pool and Active Birth Beanbag
579.               Wishaw Hospital Lanarkshire – Deluxe Pool
580.               Wishaw Hospital, Lanarkshire – Active Birth Pool Ficore ®
581.               Withybush General Hospital – Active Birth Pool and Deluxe Birth Pool
582.               Worcester Hospital – Venus Birth Pool Ficore©
583.               Worcester Hospital – One Active Birth Pool and two Venus Birth Pools – Ficore ®
584.               Wycombe Hospital Bucks – Active Birth Pool
585.               Wythenshawe Hospital – Active Birth Beanbag and Mat and seven Active Birth Pools
586.               Yeovil District Hospital – Active Birth Pool and Active Birth Beanbag
587.               Ysbyty Aneurin Bevan – 3 x Original Water Birth Pools
588.               Yuriko Tatsuno Tokyo – Oval Portable Pool

 

 

Dealing with emergencies

Active Birth Pools give midwives safe, practical options for dealing with emergencies.

The evacuation a collapsed woman is potentially hazardous and poses risk of injury to mother and midwife.

If the need for an emergency evacuation arises the midwife should:

  1. summon help
  2. stabilise the mother
  3. turn the taps on to raise the water to rim level.

The buoyancy of the water reduces the relative weight of the mother by approximately 33% making it easier to move her and effect safe evacuation.

Midwives should float/move the mother onto a seat or support and hold her safely until help arrives.

Basics:

  1. The mother should be screened to ensure that she meets the inclusion criteria prior to entering the birth pool.
  2. Continuous risk assessment is essential to reduce the incidence of emergencies in the pool.
  3. At the first sign of a contraindication the mother should be asked to get out of the water and assisted from the pool for monitoring and care.
  4. If the mother is unable to leave the pool under her own power or has collapsed an emergency evacuation will need to be conducted.
  5. A trolley should be available
  6. for the mother to be moved onto.
  7. Care must be taken that proper lifting techniques are employed to avert strain & injury.

Example 1: Emergency evacuation utilising the labour support seat

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The mother has been moved onto and held on the labour support seat

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The midwives guide the mother onto rim by sliding her up the side of the pool

Once on the rim she can be easily transferred onto a trolley

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Example 2) Emergency evacuation utilising the safety seat

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The mother is moved into position under the safety seat

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The midwives glide her up the side of the pool

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Onto the safety seat,

and then onto the rim for transfer onto the trolley

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Active Birth Pools are portable hoist compatible

Manual Handling advisors may insist that women are evacuated from the birth pool with a hoist and that this facility is provided for.

Active Birth Pools are designed to accommodate a portable hoist should the need arise.

Clinical Guidelines – Royal Cornwall Hospital

Clinical Guidelines – Royal Worcester Hospital

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It’s easy to get in and out of our pools

In a wet environment there is increased risk of slipping.

Issues relating to Health and Safety, Manual Handling and plain common sense must be considered.

Manual handling experts strongly advise against the use of step units 

Multi-step units are commonly used but, they present critical safety risks, even if they have a handrail.

To have mothers in strong labour climb up, step over the rim and down into the pool is not safe or practical.

These step units take up too much space, obstruct movement around the pool and are a trip hazard.

The Active Birth Pools way

The extra-wide rim and step unit make easy and safe for mothers to get in and out of our water birth.

Provision of a compact, single step gives the mother a height advantage.

She can step up – sit on the extra-wide rim and swivel into the water.

There is no climbing – she is grounded at all times and safeguarded from risk.

A simple, safe and economical solution.

We’ve posted a short video on YouTube showing  just how easy it is for mothers to get into our water birth pools –please have a look

Related information:

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Plans

CAD and 3D modelling plans available upon request – please contact us.

Active Birth Pool

Active Birth Pool II

Active 360

Venus Water Birth Pool

Venus II Water Birth Pool

Princess Water Birth Pool

Related information:

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Delivery and Installation

Delivery, Moving and Handling

Mainland UK Deliveries

Active Birth Pools delivered within the mainland UK are wrapped in protective packaging and placed in double walled boxes with corrugated sides.

The pools are delivered by our dedicated carrier on a week commencing basis.

If you require delivery on a specific date or at a specific time please contact us for a quote.

Box Size and Weight

  • Active Birth Pool:  1880 x 1690 x 790mm 100 kg
  • Venus Birth Pool: 1960 x 1390 x 790mm 90 kg
  • Princess Birth Pool: 1640 x 1140 x 790mm 80 kg

The carrier will deliver your birth pool to the receipt and distribution point.

You’ll be responsible for moving it to the room where it will be installed.

The pool should be moved from the delivery point in its cardboard box by turning it gently on its side onto a movers dolly or two.

This will enable it to be easily moved along corridors and through doorways.  Once the pool is in the room where it will be installed carefully open the cardboard box and remove the protective packaging.

Outside Mainland UK and International Deliveries

Active Birth Pools that are delivered outside the mainland UK are wrapped in protective packaging and placed in timber framed crates with plywood sides that conform to ISPM15 and are stamped accordingly.

Crate Size and Weight

  • Active Birth Pool:  1910 x 1720 x 890mm 225 kg
  • Venus Birth Pool: 1950 x 1420 x 890mm 185 kg
  • Princess Birth Pool: 1670 x 1170 x 890mm 145 kg

The birth pool should be unpacked from the timber crate but left in its protective packaging for moving from the delivery point to the room where it will be installed.

The pool should be gently turned on its side onto a padded movers dolly or two to  enable it to be easily moved along corridors and through doorways. It’s best to handle the pool by the rim as this is the strongest point.

Installation

Prior to moving the birth pool into position against the wall the plumbing (taps and drainage) and electrical services should be in place ready for final connection to the pool.

Taps

Fix a 3/4″ thermostatically controlled mixer tap with a 150mm spout on an IPS panel 25 cm above the rim of the pool (rim height 75cm).

We suggest that you consider the Rada Sense Bath T3 (or similar) as it is a digital tap that not only enables you to programme the http://activebirthpools.com/wp-content/uploads/2015/10/Rada-1.pdfwater temperature but also the fill time.

A filling time of 20 – 25 minutes is acceptable.

Drainage

The pool is supplied with a bespoke brass 40mm pop up waste that is operated by a control that is fixed to the rim.

The waste is connected to a P Trap  and a McAlpine T25 adaptor

Height from the floor to the centre of the T25 adaptor is 11cm

From the T25 adaptor you can utilise of a wide variety of commonly available parts to connect to the pipework of the buildings drainage system.

When electrical and plumbing services are in place and ready for the final connection to the pool’s systems the pool should be moved into position and fixed to the floor.

Final connection of services can be carried out through the access panel when the pool is secured in place.

Fixing the birth pool to the floor

All feet MUST be in solid contact with the floor.

If the floor is not level or smooth be sure to adjust the feet or level the floor so that all of the feet are in firm contact with the floor and there is no rocking or movement.

The bottom flange of the outer panel should be in contact with the floor but is not the primary support structure of the pool and must not bear the full weight of the filled birth pool.

The water birth pool is supplied with 3 x 100 mm x 30 mm fixing brackets.

You’ll find the brackets taped to the pool just inside the access panel that can be opened with a 10mm Allen Key.

It is essential these brackets are securely fixed to the floor with suitable hardware to immobilise the pool and prevent it from moving when empty.

Failure to secure the pool to the floor with the fixing brackets will endanger the end user and VOID the guarantee.

Locating and fixing the brackets

Step 1: All Models:

Mark the central position of the water birth pool on the wall that it is being fitted on.

Step 2:  Active Birth Pool – front fixing bracket

Measure 1220 mm from the centre point on the wall and mark this as the point to locate the bracket so that the long flat piece is projecting away from the wall and the raised short section faces forward into the room.

Fix the bracket to the floor using suitable hardware.

Front bracket right centre – Back bracket lower left

Step 2: Venus Birth Pool – front fixing bracket

Measure 1070 mm from the centre point on the wall and mark this as the point to locate the bracket so that the long flat piece is projecting away from the wall and raised short section faces forward into the room.

Fix the bracket to the floor using suitable hardware.

Front bracket right centre – Back bracket lower left

Step 2: Princess Birth Pool Pool – front fixing bracket

Measure 1020 mm from the centre point on the wall and mark this as the point to locate the bracket so that the long flat piece is projecting away from the wall and raised short section faces forward into the room.

Fix the bracket to the floor using suitable hardware.

Front bracket right centre – Back bracket upper left

Step 3: All Models

Place the birth pool at least 60 mm away from the rear wall before moving it onto the bracket and flush against the wall.

Push the birth pool towards the wall so that the flange of the pool slides under the bracket.

This secures the front of the pool to the floor.

Step 4: All Models – back fixing bracket

The 2nd fixing bracket should be fixed in position on the bottom flange of the pool below the access panel as indicated in the images above.

You will see that a hole has been drilled in the flange. Line the bracket up with this hole. You can fix the pool to the floor with a raw plug and suitable hardware to guarantee that it is secure.

The long flat piece should be fixed to the floor with suitable hardware so that the short section is holding the flange securely to the floor.

Step 5: All Models

Seal the water birth pool to the floor and wall using a suitable sealant to prevent ingress of water and dirt.

Multi-Colour LED Lighting

Installation

Connect the light to a circuit breaker, then to the power supply.

The system should be protected by a 6 AMP RCD with 30 -32 MA Sensitivity.

The LED is transformed down to 12 volts and has a power rating of 2.5 watts.

A separate means of Isolation should be provided for future maintenance.

Operating voltage 220/230 volts – 50/60 hertz

Operating instructions

The system is operated by the control pad on the rim of the pool.

To activate the system press the button once.

The white light will come on.

To choose another colour continue to press the button and the system will cycle through the range of colours – light blue, blue, purple, magenta, red, pink, orange, yellow, apple green and green.

To turn the system off press and hold the button down for 2 seconds.

The light should be switched off when the pool is not in use.

Bluetooth Sound System

Connect the factory fitted bluetooth sound system to a circuit breaker and then to the power supply.

The system is always on standby waiting for users to pair and connect.

It’s operated directly from the users mobile phone or bluetooth enabled device and has no controls of its own.

N.B. If there is more than one birth pool with bluetooth sound being installed in the same unit you will need to fit a remote switch to enable the users to turn the system on and off.

This is to prevent people accidentally activating the system instead of the one in their room.

Transducer speaker

  • Frequency Range 20Hz-20KHz.
  • Maximum Power Output 50W at 4 Ohm.

Bluetooth Amplifier

  • Transmission Range 5m to 10m.
  • Maximum Power Output 2ch X 20W.
  • Operating voltage 220/230 volts – 50/60 hertz
  • Transformed Voltage 12 Volt DC / 3 amp.
  • Waterproof Rating IP67.

Cleaning and Care:

Safety comes 1st!

Active Birth Pools  are Rated No.1 for water safety and infection control standards.

This is because the material we use (Ficore) is 5 x harder than other materials and is immune to the effects of disinfection with 10,000ppm hypo-chlorite.

Seamless one-piece construction and the absence of surface mounted metal work deny micro-organisms the environment they need to propagate.

Active Birth Pools Cleaning and Disinfection Guidelines

This is a two-step procedure – first cleaning of the pool and surround, then disinfection of the pool and surround.

  1. Prior to emptying the pool remove debris and larger particles from the water with a sieve to prevent it from blocking or obstructing the outlet.
  1. Use the standard infection control precautions (plastic apron, disposable gloves and eye protection) when cleaning the pool. Ensure the area is well ventilated.
  1. Cleaning – use a non-abrasive detergeant with non-abrasive sponge or cloth to thoroughly clean the pool. Ensure the tap is cleaned first, so as not to transfer micro-organisms from the “dirty” pool area to the cleaner tap region. Rinse well with warm water.
  1. Disinfecting – use chlorclean or similar hypochlorite disinfectant following the directions on the packet for mixing the solution to the correct concentration for disinfecting the birth pool and surround.  Do not use bleach as it is highly corrosive and could cause damage to the fittings.
  1. Apply the solution to the tap and spout prior to disinfecting the pool.
  1. There are 3 methods for disinfecting the pool that are commonly used in hospitals:

1) Fill the pool with cold water and add the requisite amount of disinfectant – leave for ten minutes.

The advantage of this method is that it is 100% effective but wasteful of water, time consuming and uses a large amount of disinfectant

2) Make up 2-3 litres of solution and pour it around the inside of the rim. Then use a new disposable mop or cloth to spread the disinfectant over the surface of the pool. Leave for ten minutes.

The advantage of this method is that it is economic in terms of time and cost but relies upon the person carrying out the task to ensure that 100% of the pools surface is disinfected.

3) Fill a spray bottle with disinfectant and thoroughly spray the surface of the pool and surround. Then use a new disposable mop or cloth to spread the disinfectant over the surface of the pool. Leave for ten minutes.

The advantage of this method is that it is economic in terms of time and cost but relies upon the person carrying out the task to ensure that 100% of the pools surface is disinfected

  1. Open the drain outlet and empty the pool of the disinfectant.
  1. Using cold water, rinse the tap then the pool to remove all traces of the disinfectant, to prevent any residue being left on the pool surface.
  1. Dry the entire surface of the pool using a new cloth or disposable mop head.
  1. Keep the drain outlet closed when not in use.

If you are duty flushing the taps with hot water/steam add a few inches of cold water to the pool first.

Damage resulting from higher water temperatures, steam cleaning or use of products not approved by Active Birth Pools will not be covered by our guarantee.

Protocols from hospitals using Active Birth Pools.

How to restore your old birth pool to pristine condition:

We’ve been supplying water birth pools to hospitals since 1989.

Many of the pools we supplied in the 90’s are still in active service!

We occasionally receive reports that the pools are not looking as clean and bright as they originally were.

Not to worry.

There is a product called tide mark cleaner that was developed for spas and swimming pools.

You can either use it to remove stains or brighten up the appearance of the pool when necessary.

It will restore your pool to pristine condition.

Here’s a link:

http://www.amazon.co.uk/Waterline-Cleaning-removes-lines-cleaner/dp/B006DFD7VK

Related information:

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Cleaning and Care

Safety comes 1st!

Active Birth Pools  are Rated No.1 for water safety and infection control standards.

This is because the material we use (Ficore) is 5 x harder than other materials and is immune to the effects of disinfection with 10,000ppm hypo-chlorite.

Seamless one-piece construction and the absence of surface mounted metal work deny micro-organisms the environment they need to propagate.

Active Birth Pools Cleaning and Disinfection Guidelines

This is a two-step procedure – first cleaning of the pool and surround, then disinfection of the pool and surround.

  1. Prior to emptying the pool remove debris and larger particles from the water with a sieve to prevent it from blocking or obstructing the outlet.
  1. Use the standard infection control precautions (plastic apron, disposable gloves and eye protection) when cleaning the pool. Ensure the area is well ventilated.
  1. Cleaning – use a non-abrasive detergeant with non-abrasive sponge or cloth to thoroughly clean the pool. Ensure the tap is cleaned first, so as not to transfer micro-organisms from the “dirty” pool area to the cleaner tap region. Rinse well with warm water.
  1. Disinfecting – use chlorclean or similar hypochlorite disinfectant following the directions on the packet for mixing the solution to the correct concentration for disinfecting the birth pool and surround.  Do not use bleach as it is highly corrosive and could cause damage to the fittings.
  1. Apply the solution to the tap and spout prior to disinfecting the pool.
  1. There are 3 methods for disinfecting the pool that are commonly used in hospitals:

1) Fill the pool with cold water and add the requisite amount of disinfectant – leave for ten minutes.

The advantage of this method is that it is 100% effective but wasteful of water, time consuming and uses a large amount of disinfectant

2) Make up 2-3 litres of solution and pour it around the inside of the rim. Then use a new disposable mop or cloth to spread the disinfectant over the surface of the pool. Leave for ten minutes.

The advantage of this method is that it is economic in terms of time and cost but relies upon the person carrying out the task to ensure that 100% of the pools surface is disinfected.

3) Fill a spray bottle with disinfectant and thoroughly spray the surface of the pool and surround. Then use a new disposable mop or cloth to spread the disinfectant over the surface of the pool. Leave for ten minutes.

The advantage of this method is that it is economic in terms of time and cost but relies upon the person carrying out the task to ensure that 100% of the pools surface is disinfected

  1. Open the drain outlet and empty the pool of the disinfectant.
  1. Using cold water, rinse the tap then the pool to remove all traces of the disinfectant, to prevent any residue being left on the pool surface.
  1. Dry the entire surface of the pool using a new cloth or disposable mop head.
  1. Keep the drain outlet closed when not in use.

If you are duty flushing the taps with hot water/steam add a few inches of cold water to the pool first.

Damage resulting from higher water temperatures, steam cleaning or use of products not approved by Active Birth Pools will not be covered by our guarantee.

Protocols from hospitals using Active Birth Pools.

 

How to restore your old birth pool to pristine condition

We’ve been supplying water birth pools to hospitals since 1989.

Many of the pools we supplied in the 90’s are still in active service!

We occasionally receive reports that the pools are not looking as clean and bright as they originally were.

Not to worry.

There is a product called tide mark cleaner that was developed for spas and swimming pools.

You can either use it to remove stains or brighten up the appearance of the pool when necessary.

It will restore your pool to pristine condition.

Here’s a link:

http://www.amazon.co.uk/Waterline-Cleaning-removes-lines-cleaner/dp/B006DFD7VK

Related information:

 

Improved Water Birth Pool Design

In mid-90’s we met with health service ergonomist Sue Hignett to discuss ways our water birth pools could be improved to better serve the needs of mothers and midwives.

This lead to the ground-breaking innovations in design, materials and manufacture that have culminated in todays range of award winning Active Birth Pools.

Design is based upon the dynamics of mothers and midwives as they interact with the pool and each other. Every shape, every curve, every varying degree of rounded corner – there is a reason behind them.

Our new water birth pools take the 5 points outlined on Pg. 2 of the article (below) to new levels of sophistication thanks to the properties of the unique material (Ficore® composite) we now use.

We longer advocate the use of multi-step units as this has proven to present manual handling risks. The pools are now lower and have wider rims which gives mothers better options for getting in and out of the pool.

The new range of water birth pools is not only much more beautiful, but more comfortable, safer and easy to use.

Click here for a PDF of this article

Related Articles:

Rated No. 1 for health and safety

The material we use is key to the performance and success of our water birth pools .

Seamless one-piece construction denies micro-organisms the environment they need to propagate.

Innovative ergonomic design provides maximum comfort, support and safety for mothers and midwives as they interact with each other and the pool.

It’s easy for mothers to get into our pools. They simply sit on the extra-wide rim and swivel in.

We’ve even devised a way for midwives to facilitate emergency evacuations that has become standard practice world-wide.

Many water birth pools on the market are equipped with features that at first might seem like an advantage, but in reality present serious safety and infection control risks.

Things to look out for…

(We’re not showing images of other birth pools to illustrate the points below as this could be contentious.)

Re-circulating water systems

Re-circulating or pumped systems with jets such as whirlpools and  jacuzzi present the perfect conditions for the growth of micro-organisms.

Water systems like these present the highest levels of risk as they produce aerosols.

Aerosols are generated when the water surface is broken – for example, by falling water droplets, splashing, or by bubbles breaking at the surface.

Once introduced to these systems, Legionella and Pseudomonas thrive and can become aerosolised and then inhaled.

Integral Plumbing Systems

Plumbing systems like these utilise flexible and non-flexible piping, overflow drains, handheld showers, pumps, hoses, heaters, surface mounted fittings and filters.

 These systems are impossible to clean, disinfect or monitor and therefore present an extremely high Infection Control Risk.

Stagnant water within the system is an ideal breeding ground for bacteria.

UK regulations state that water birth pools fitted with thermostatically controlled  mixer taps plumbed directly into the hospitals water supply.

Hand held showers

Handheld showers present a significant infection control risk.

If the shower head falls in the pool it may be contaminated with bacteria that could breed and be passed on next time the shower is used.

Department of Health regulations clearly stipulate that handheld showers and bath/shower mixers are not installed for use with water birth pools as they present a Fluid Category 5 risk to the mains water supply.

N.B. There are systems available that enable you to detach the hose and shower head from the tap. These are permissible as long as the shower fittings are detached when the pool is in use and only employed afterwards for cleaning.

Pumped heating systems

Heating systems for water birth pools are not necessary and present unacceptable infection control risks.

Water is pumped through a heat exchanger and then back into the pool creating the ideal environment for bacteria to breed.

These systems present one of the highest infection control risks and should not be utilised.

Bacteria filters and disinfection systems

Some water birth pools are equipped with these devices in an attempt to mitigate the risk of infection and bacteria infestation that are inherent in built-in plumbing systems.

Bacteria filters and disinfection systems can not be relied upon and will not guarantee adequate hygiene standards.

Overflow drains

Overflow drains harbour bacteria and can serve as a conduit for cross infection.

Regulations are very clear on this point.

Overflow drains should not be fitted to water birth pools as they constitute a constant infection control risk.

Surface mounted metalwork

Metalwork such as grab rails, taps and handles are an obstacle that comes between mother and midwife.

These fittings ALL present a serious infection control risk as the space between the surface of the pool and the fitting are perfect for bacteria.

Remember – bacteria are microscopic – even though the fitting may appear flush to the surface of the pool there is space for bacteria!

The Active Birth pools approach:

Thanks to the amazing properties of Ficore composite (the material we make our pools from) we’re able to bind the hand rails directly into the fabric of our pools.

Our lighting and drainage fittings are of the highest quality and have been inspected and passed by infection control specialists world-wide.

Double step units

In breech of Manual Handling protocols.

Mothers must not climb up and step over the sides of the pool to enter the water.

When not in use these step units present an obstacle and trip hazard.

Doors

There is no reason for a water birth pool to have a door and many reasons why they should not.

Doors are mistakenly used for two reasons:

  1. To facilitate emergency evacuations
  2. To help mothers get in and out of the pool

Doors present an extremely high risk of infection and should be banned from use in water birth pools for this reason alone.

The door seal (typically foam or rubberised material) is the perfect breeding ground for bacteria.

From manual handling perspective doors are not practical or fit for purpose. They actually complicate emergency evacuations and put mothers and midwives at risk.

The Active Birth Pools approach:

Click here to find out how our birth pools give midwives safe, practical options for handling emergency evacuations.

Click here to find out how safe and simple it is for mothers to get into an Active Birth Pool.

Height adjustable pools

Manufacturers of these pools say that height adjustment makes midwives more comfortable and less likely to strain or injure themselves.

They are completely wrong!

Given the choice of standing or sitting comfortably in a stationary position for an extended period of time we all choose to be seated.

It’s that simple.

If you look at photos of midwives standing by elevated birth pools you’ll see that they are often uncomfortable.

If you look at photos of midwives sittingby the pools you’ll notice how the solid, vertical sidewall prevents them from getting their legs under the pool.

They are forced to sit with their legs and feet splayed wide  apart which  is not only uncomfortable but places considerable strain on her lower back.

If you’re considering a pool with one of these systems I suggest that you talk with midwives who’ve used them, look at photos and videos of them in action and then consider how much better off you’d be with an Active Birth Pool.

From a mothers standpoint I can’t imagine how she feels sitting in a big elevated bath tub in the middle of the room with people standing around her.

Mothers need to be grounded to give birth not hydraulically lifted.

The Active Birth Pools approach:

The crucial elements that make the difference are the rounded extra-wide rim and flowing concave skirting panel.

Look at the midwife in the photo above.

Notice how comfortable the she is?

Grounded with her feet forward, body upright, head aligned and arms resting comfortably on the wide round rim.

Fully supported, safeguarded and at ease.

And lets not forget partners and attendants who might sit for hours by the pool.

With Active Birth Pools they are perfectly pitched to support their partner and share the experience.

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The world’s first specially designed water birth pools

In 1987 Keith Brainin, Founder and Director of Active Birth Pools developed the world’s first specially designed water birth pool.

A portable pool fabricated from four sections of fibreglass and a waterproof liner designed for home or hospital use.

In 1988 Yehudi Gordon (obstetrician, active & water birth pioneer) asked Keith to design and supply a purpose built birthing pool for the birth unit at the Garden Hospital in North London.

Keith met with obstetricians, midwives and health and safety experts to discuss the considerations that needed to be taken into account.

Issues regarding material, plumbing, infection control, manual handling and shape & size were evaluated.

We followed Michel Odent’s sage advice of making the pool “Big enough but not too big – deep enough but not too deep”.

Midwife Jennifer Starisky supporting a women in labour in front of the world's first water birth pool

1989 Garden Hospital, London

In 1995 Keith met with Sue Hignett, a health service ergonomist who told me that she had some suggestions to make as to how my birth pools could serve mothers and midwives better.

Studies had revealed that by making the rim wider and removing the skirting panel we would dramatically improve the comfort and usability of our water birth pools.

Click Here for a copy of the case study ‘Improving Birthing Pool Design’ published by the Chartered Institute of Ergonomics & Human factors.

1996 NHS Hospital, England

As you can see in the photo above the pool now has the extra-wide rim and cut away profile that are the hallmarks of an Active Birth Pool.

Moving forward to the present….

Fabrication in Ficore composite has enabled us to full realise the potential of the design.

With flowing forms and soft curves this is beyond a doubt the paragon of birth pool design and manufacture!

2015 Meadow Birth Centre, Worcester Hospital

A greater possibility of normal physiological labour and birth

The keyword that defines our approach to water birth pool design is ‘Active’.

If we look up the definition of ‘Active Birth’  we get, “Childbirth during which the mother is encouraged to move around freely and assume any position which feels comfortable”.

Active Birth Pools provide mothers with the space and depth to move freely in the postures natural to labour and birth.

As she moves, she intuitively discovers features that provide support and make her more comfortable.

Other birth pools have elaborately moulded interiors that can be described as an “obstetric chair in a bath”.

These birth pools typically have very little floor space or room to move.

As Sheila Kitzinger wrote in her article ‘The clock, the bed, the chair’ published in 2003:

“Even a recent innovation, the birth pool, does not always permit free movement. In theory, a pool allows a woman, supported by water, to move unencumbered.

Or so it might be thought.

Though published research often refers to mobility as an advantage of being in a pool, some pools are elaborate constructions with seats, handgrips and foot-rests, and movement in them is restricted.”

The pool dictates the position the mother should be in by placing her in a semi-recumbent posture with hand holds and foot rests to fix the arms and legs.

Mothers are positioned in the classic lying back with legs wide-open position but happen to be immersed in water.

The seats in these water birth pools are typically tilted backwards. The mother is immobilised in a position with her pelvis tilted upwards resulting in her  pelvic outlet being up to 30% smaller.

This puts pressure on the sacrum which flexes upward, into a curved position that restricts the diameter of the pelvic outlet inhibiting the baby’s descent.

The birth canal is placed in an “uphill” orientation, forcing the mother to push upward against gravity to give birth to her  baby.

These seats and moulded fittings greatly reduce the space the mother has to move in and restricts her ability to use the positions most beneficial.

The benefits of labouring in water are largely negated. The possibility of a physiological labour and natural birth is greatly reduced.

By contrast the Active Birth Pool gives mothers plenty of room to move with an unobstructed floor area that measures 1200 x 800mm.

A water birth pool should have features and design elements that support the mother as she changes position rather than dictate the position she is in.

Mothers experience maximum advantage of the benefits that water offers to help increase the likelihood of a physiological labour and natural birth.

‘Freedom of Movement video’ 

To see how mothers benefit from complete freedom of movement click on the link above.

This short home made video shows how the mother relates to the pool and the natural flow of movement that ensues. It has been hugely popular on YouTube.

Related information:

Water Birth Safety Initiative

Hospitals in the United Kingdom began allowing women to use specially designed pools of water for labour and birth during the 1980’s.

The wide-spread popularity and acceptance of water birth pools as a standard part of the maternity care package necessitated the development of guidelines & regulations to define standards and ensure they’re met.

The United Kingdom Department of Health has published a panoply of water safety directives that apply to water birth pools.

Policies and recommendations set forth in the Water Birth Safety Initiative are based upon these publications.

The Water Birth Safety Initiative (WBSI) calls for development of international standards modelled on the UK’s so that women the world over can benefit from the use of water for labour and birth safeguarded from risk.

The WBSI calls for the implementation of stricter protocols and sets forth recommendations for equipment standards.

The guidelines set forth in the WBSI are intended to serve as a framework of standards for birth pool suppliers, hospitals and midwives to work with to establish  safe codes of practice.

Guidelines for Water Birth Pools Installed in Hospital

Water is more prone to bacteria growth after it leaves the public water distribution system and enters a building’s plumbing.

There it finds warmer temperatures, stagnation, and smaller pipes, valves and fittings.

Biofilm that forms on valves and fittings and pipe walls not only feeds bacteria but also protects them from the hot water and chlorine that typically would kill free-floating organisms.

Large systems with complex piping networks — like those found in hospitals, hotels and large apartment buildings — are especially prone to bacteria growth.15

Water Birth Pools that are installed in hospitals have the benefit of being maintained by staff to ensure that protocols are established, met and maintained.

Consideration and due diligence with regard to the prospective purchase of water birth pools and the assessment of pools already in use needs to be taken to ensure that the associated plumbing and electrical systems meet relevant safety standards.

The United Kingdom’s Department of Health and National Health Service has an exemplary safety record achieved by establishing rigorous sets of guidelines and regulations for the design, installation, use and maintenance (cleaning/disinfection) of water birth pools.

In the UK water birth pools are classed as a Category Fluid 5 water risk which represents a serious health hazard due to the concentration of pathogenic organisms, radioactive or very toxic substances, e.g. containing faecal material or other human waste; butchery or other animal waste or pathogens.

Water Birth Pools must be installed in compliance with water regulations as set forth in The Water Supply (Water Fittings) Regulations 1999.11

The 7 sins of water safety

To ensure high standards are met it is strongly advised that you do not use a water birth pool that has any of these features:

  1. Overflow drains
  2. Internal water inlets
  3. Hand-held showers
  4. Systems with flexible hoses or extended pipes
  5. Integral or secondary plumbing systems
  6. Any type of recirculating or pumped water systems such as whirlpool, jacuzzi, spa, bubbling, filtering etc
  7. Heating systems

1) Overflow drains

Overflow drains harbour bacteria and can serve as a conduit for cross infection.

Regulations are very clear on this point – overflow drains should not be installed on water birth pools as they constitute a constant infection control risk much more significant than the possible risk of damage due to water overflowing.11,12

Some digital taps on the market can be set for filling time thus obviating the risk of the pool overflowing.

2) Internal water inlets

Internal water inlets act in place of taps to fill the pool.

They are installed on the inside of the pool just above the water line and connected with pipework to a thermostatic valve.

If the water level rises there is a high risk of back flow enabling bacteria to enter the system creating a risk of cross infection.7

3) Handheld showers

Handheld showers present a significant infection control risk due to the fact that they can fall in the pool and be contaminated with bacteria that could breed and be passed on next time the shower is used.

Department of Health regulations clearly stipulate that handheld showers and bath/shower mixers are not installed for use with water birth pools. 13

Handheld showers present a Fluid Category 5 risk to the mains water supply.

It must not be possible to submerge the showerhead in the water due to risk of cross infection.

In order to comply with category 5 water regulations covering back siphonage, a class AUK3 air gap would be required, which generally prevents the use of handsets, unless there is a separate break tank installed in the hospital plumbing system.

4) Systems with flexible hoses or extended pipes

Systems that employ flexible piping, have branch pipes or hold stagnant water present a potential hazard and must not be used with water birth pools.

It is impossible to clean, disinfect or monitor these systems.

They have been proven to be a source of Legionella and Pseudomonas. 14

Weekly flushing recommendations recommended by the department of health cannot be executed with such systems, and the effectiveness of this cannot be monitored due to the inacessibility of the closed system.

5) Integral or secondary plumbing systems

Integral, secondary or proprietary plumbing systems are fitted to some water birth pools.

As these systems can employ flexible and non-flexible piping, overflow drains, handheld showers and are often pumped or recirculating they present a significant infection control risk and should be banned from use.

Regulations stipulate that water birth pools are filled from thermostatically controlled wall mounted mixer taps plumbed directly into the hospitals water supply with the minimum of pipework.

Not only do secondary or integral plumbing systems present unacceptable risks, they are impossible to clean, disinfect or monitor and therefore present an extremely high and unacceptable infection control risk.

They must not be present on pools used for labour and birth. 10

6) Recirculating or pumped water systems

Recirculating or pumped water systems such as whirlpool, jacuzzi, spa, bubbling, filtering etc. have the perfect environmental conditions to be a potential source for the growth of microorganisms, including legionella bacteria and must not be installed on water birth pools.

Water systems that are able produce aerosols represent the highest levels of risk.

Aerosols can be generated very easily when the water surface is broken -for example, by falling water droplets, splashing, or by bubbles breaking at the surface.

Once introduced to artificial water systems, Legionella can thrive in warm water (30 – 35 °C) and has been shown to be present on flexible seals and metal surfaces within plumbing systems used in domestic potable water supplies.

Inadequately maintained spa pools (birth pools with pumped or recirculating systems) provide ideal conditions to support the growth of legionellae and other microorganisms, which may then become aerosolised and subsequently inhaled.15


7) Heating systems

Heating systems for water birth pools are not necessary and present unacceptable infection control risks.7

There are two types of heating systems in use:

1. Recirculating system with a heat exchanger

Water is pumped out of the pool and through a heat exchanger and then flows back into the pool.

These systems present one of the highest infection control risks and should not be installed on a water birth pool under any circumstances. (covered by points 4, 5 and 6 above).

2. Electric heating systems

Similar to under floor heating found in homes do not present an infection control risk.

But, they do present an unacceptable health and safety risk and should therefore not be installed in water birth pools.

These systems consist of a network of cables embedded in the fabric of the birth pool that are attached to the power supply through a thermostat.

The heat is transmitted from the cables through the floor of the pool and then transferred to the water.

The inherent problem with these systems is that the water is relied on to take the heat away from the material.

If a woman remains motionless the heat becomes concentrated and a “hotspot” develops which can result in the woman being burned.

Recommendations

Plumbing for filling and emptying water birth pools should be simple, straight forward and kept to the minimum.

A set of taps (see below) mounted on the wall 15cm above the rim and a drainage system similar to that of a normal bath is all that is required.

Rim mounted taps present two areas of risk:

1. Women may hit their head on taps that are mounted on the rim of the pool causing injury.

In the throes of labour a woman is not as cognisant of her surroundings as she normally is.

She needs to be protected from the potential harm that could result from hitting her head or other part of her body on the spout.

2. Risk to the taps and pool caused by the labouring woman grabbing onto the spout for support could easily cause damage to the fitting or fabric of the pool.

Filling the birth pool

Water Birth Pools should be filled directly from the hospitals main water supply through a ¾ Thermostatic Mixing Valve (TMV).

To comply with UK National Health Service regulations the valve must have TMV3 approval for use in Healthcare and Commercial situations and certify that it conforms to the performance requirements of the Department of Health.16

To kill legionella and other bacteria, water in hospitals systems is heated to 60 – 80 °C.

Water temperature entering the birth pool should be limited by the TMV to 44 °C to prevent scalding.

The added benefit of using a TMV connected directly to the hospitals main water supply is that it can be set to automatically flush itself of stagnant water twice a day and be thermally disinfected periodically.

dsc_2965

The use of a TMV ensures a safe water supply.

Digital thermostatic mixing valves with enhanced thermal performance that incorporate these features are ideal:

1) Programmable control to accurately mix and maintain the temperature of the water flowing into the birth pool and limit the temperature of the water to 44 °C to prevent scalding.17

2) Programmable fill duration to fill the pool to the desired depth and then turn off.

This is important as water birth pools are not allowed to have overflow drains installed and this feature will prevent the pool from overflowing when unattended.

3) Programmable duty flushing to ensure that water does not stagnate within the tap and associated pipe work, effectively controlling the multiplication of legionella & other bacteria in infrequently used outlets.

Flushing duration is in line with HSE L8 recommendations.18

4) Programmable high-temperature thermal disinfection to destroy the proteins in viruses and bacteria and render them as dead or inert.

Thermal disinfection works by achieving a moist heat which is set at a specific temperature for a set amount of time.

Viruses and bacteria are very sensitive to heat and they will die if exposed to higher temperatures. 19

Emptying the Pool

Water from a birth pool needs to be treated as Fluid category 5 waste representing a serious health hazard due to the concentration of pathogenic organisms derived from fecal material or other human waste and emptied directly into the hospital’s waste water system.20

The pipework needs to have a trap or U bend fit as close to the waste/drain as possible.

The drainage fitting or waste should seal neatly into the drain.

The drainage fitting should be cleaned and flushed through with disinfectant and then dried as part of the cleaning protocol.

The waste should be kept closed when the pool is not in use.

There should be NO flexible pipe used in the drainage pipework.21

The waste should be remotely operated (i.e. pop up waste with rim mounted control) and of the best quality, preferably high-grade brass, to resist the corrosive action of chlorides and other disinfectants.

DSC_2915

End notes

The Water Birth Safety Initiative was conceived by Keith Brainin to motivate and enable birth pool suppliers and health care professionals to raise standards and implement protocols to make water birth safe.

References

[1] Healio – Infectious Disease News. (2014, December 26). Legionellosis death after water birth sparks call for stricter infection control protocols. http://www.healio.com/infectious-disease/practice management/news/online/%7Bfe352169-755d-4d21-9bb2-abb8ae209f89%7D/legionellosis-death-after-water-birth-sparks-call-for-stricter-infection-control-protocols

[2] Inquisitr. (2015, January 16). Oregon Water Birth Leaves Baby Disabled, Lawsuit Wants Labor Options Banned. http://www.inquisitr.com/1761136/oregon-water-birth-leaves-baby-disabled-lawsuits-wants-labor-options-banned/

[3] GOV.UK. Alert after Legionnaires’ disease case in baby, 2014. https://www.gov.uk/government/news/alert-after-legionnaires-disease-case-in-baby

[4] The Guardian. Legionnaires’ disease in baby is linked to heated birthing pool, June 17, 2014.http://www.theguardian.com/society/2014/jun/17/legionnaires-disease-heated-birthing-pool-baby-public-health

[5] Guidance from the  Water Regulations Advisory Scheme (WRAS) https://www.wras.co.uk/consumers/advice_for_consumers/what_are_the_water_regulations_/

[6] M.W. LeChevallier, 2003 World Health Organization (WHO). Conditions favouring coliform and HPC bacterial growth in drinking- water and on water contact surfaces. Heterotrophic Plate Counts and Drinking-water Safety. Edited by J. Bartram, J. Cotruvo, M. Exner, C. Fricker, A. Glasmacher. Published by IWA Publishing, London, UK. ISBN: 1 84339 025 6.

[7] www.gov.uk. Public Health England advice on home birthing pools, 2014.  https://www.gov.uk/government/news/public-health-england-advice-on-home-birthing-pools

[8] Health and Safety Executive. (2013). Legionnaires’ disease: Technical guidance [3.4], 2013. http://www.hse.gov.uk/pubns/priced/hsg274part3.pdf

[9] United Lincolnshire Hospitals NHS Trust UK. Cleaning, Disinfection and Sterilization Guidelines for Re-Usable Medical Devices 2010.
http://www.activebirthpools.com/wp-content/uploads/2014/05/Lincolnshire-CLEANING-DISINFECTION-AND-STERILIZATION-GUIDELINES-FOR-RE-USABLE-MEDICAL-DEVICES.pdf

[10] http://www.eurosurveillance.org. Case of legionnaires’ disease in a neonate following an home birth in a heated birthing pool. England, June 2014 http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20857

[11] Water Regulations Advisory Scheme (WRAS). Fluid Categories. https://www.wras.co.uk/consumers/resources/glossary/fluid_categories/

[12] WHBN 00-10 Welsh Health Building Note. Part C: Sanitary assemblies2014, http://www.wales.nhs.uk/sites3/documents/254/WHBN%2000-10%20Part%20C.pdf

[13] Department of Health, Children, young people and maternity services. Health Building Note 09-02: Maternity care facilities, 2009.
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/147876/HBN_09-02_Final.pdf

[14] Freije, Matthew R. Some waterborne bacteria are tough, 2010. http://www.watertechonline.com/articles/some-waterborne-bacteria-are-tough

[15] Woolnough, Kevin. Legionella Expert Calls for Greater Vigilance, 2014. http://www.eurofins.co.uk/news-archive/legionella-expert-calls-for-greater-vigilance.aspx

[16] BEAMA. TMV Standards and regulations, 2013. http://www.beama.org.uk/en/product-areas/heating-hot-water–air-movement/thermostatic-mixing-valves/tmva-faqs-on-thermostatic-mixing-valves/tmv-standards-and-regulations.cfm

[17] Health and Safety Executive. Managing the risks from hot water and surfaces in health and social care, 2012. http://www.hse.gov.uk/pubns/hsis6.pdf

[18] Health and Safety Executive. Legionnaires’ disease The control of legionella bacteria in water systems, 2013. http://www.hse.gov.uk/pubns/priced/l8.pdf

[19] Health and Safety Executive. Managing legionella in hot and cold water systems. http://www.hse.gov.uk/healthservices/legionella.htm

[20] SMS Environmental – the water experts. Fluid Categories. http://www.sms-environmental.co.uk/fluid_categories.html.

[21] Nottingham University Hospitals NHS Trust. Legionella Management and Control Procedures, 2014.

Bibliography

  • Ashford and St. Peter’s Hospitals, Women’s Health and Paediatrics Division (Abbey Birth Centre). Operational Policy and Clinical Guide, 2014.
  • BASINGSTOKE AND NORTH HAMPSHIRE NHS FOUNDATION TRUST . CLEANING, DISINFECTION AND STERILISATION POLICY. Prod. Helen Campbell. BASINGSTOKE AND NORTH HAMPSHIRE, BASINGSTOKE AND NORTH HAMPSHIRE, 2010.
  • BEAMA. TMV Standards and regulations. 2013. http://www.beama.org.uk/en/product-areas/heating-hot-water–air-movement/thermostatic-mixing-valves/tmva-faqs-on-thermostatic-mixing-valves/tmv-standards-and-regulations.cfm (accessed 2014 йил 24-09).
  • Buckinghamshire Healthcare NHS Trust. Water birth and use of water in labour guideline. Prod. Miss G Tasker and Audrey Warren. 2013.
  •  Dekker, Rebecca. “Evidence on the Safety of Water Birth.” http://evidencebasedbirth.com/. 2014. http://evidencebasedbirth.com/waterbirth/ (accessed 2014 10-09).
  • Department for Environment, Food and Rural Affairs. Water Supply (Water Fittings) Regulations 1999 Guidance Document relating to Schedule 1: Fluid Categories and Schedule 2: Requirements For Water Fittings. 1999. http://archive.defra.gov.uk/environment/quality/water/industry/wsregs99/documents/waterregs99-guidance.pdf.
  • Department of Health. Children, young people and maternity services Health Building Note 09-02: Maternity care facilities. 2009.

—. “Health Building Note 00-09: Infection control in the built environment.” www.gov.uk. 2002. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/170705/HBN_00-09_infection_control.pdf (accessed 2014 6-12).

—. “Health Technical Memorandum 64: Sanitary assemblies.”  2006. http://www.wales.nhs.uk/sites3/documents/254/HTM%2064%203rded2006.pdf (accessed 2014 10).

—. “Water systems Health Technical Memorandum 04-01: Addendum” .2013. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/140105/Health_Technical_Memorandum_04-01_Addendum.pdf (accessed 01 2014-10).

 —. “Water systems Health Technical Memorandum 04-01: The control of Legionella , hygiene, “safe” hot water, cold water and drinking water systems”. 2006.

  • DH, Estates & facilities. Water systems Health Technical Memorandum 04-01: Addendum . Department of Health, Department of Health.
  • Elizabeth R Cluett, Ethel Burns. Immersion in water in labour and birth. 2009.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000111.pub3/abstract (accessed 2013 13-05).
  • Elyse Fritschel, Kay Sanyal, Heidi Threadgill, and Diana Cervantes. Emerging Infectious Diseases.CDC. Centers for Disease Control and Prevention. CDC. 2014. http://wwwnc.cdc.gov/eid/article/21/1/14-0846_article (accessed 2015 5-January).
  • Freije, Matthew R. Some waterborne bacteria are tough . 2010. http://www.watertechonline.com/articles/some-waterborne-bacteria-are-tough (accessed 2015 20-01).
  • GOV.UK. Alert after Legionnaires’ disease case in baby. 2014. https://www.gov.uk/government/news/alert-after-legionnaires-disease-case-in-baby (accessed 2014 3-12).
  • GOV.UK. Public Health England advice on home birthing pools. 2014. https://www.gov.uk/government/news/public-health-england-advice-on-home-birthing-pools (accessed 2014 03-August).
  • Healio – Infectious Disease News. Legionellosis death after water birth sparks call for stricter infection control protocols. 2014. http://www.healio.com/infectious-disease/practice-management/news/online/%7Bfe352169-755d-4d21-9bb2-abb8ae209f89%7D/legionellosis-death-after-water-birth-sparks-call-for-stricter-infection-control-protocols (accessed 2015 07-01).
  • Health and Safety Executive. Legionnaires’ disease The control of legionella bacteria in water systems. 2013. (accessed 2014 07-07).

—. “Legionnaires’ disease: Technical guidance.”  2013. http://www.hse.gov.uk/pubns/priced/hsg274part3.pdf (accessed 2014 20-10).

—. Managing legionella in hot and cold water systems. http://www.hse.gov.uk/healthservices/legionella.htm (accessed 2015 07-01).

—. “Managing the risks from hot water and surfaces in health and social care.”  2012. http://www.hse.gov.uk/pubns/hsis6.pdf (accessed 2014 20-11).

  •  Health Facilities Scotland. Consultation draft of SHTM 04-01 Water Safety for Healthcare Premises Part G: Operational Procedures and exemplar Written Scheme 2013. Health Facilities Scotland.
  •  Inquisitr. Oregon Water Birth Leaves Baby Disabled, Lawsuit Wants Labor Options Banned. 2015.http://www.inquisitr.com/1761136/oregon-water-birth-leaves-baby-disabled-lawsuits-wants-labor-options-banned/ (accessed 2015 16-01).
  •  Laura Franzin, Carlo Scolfaro, Daniela Cabodi, Mariangela Valera, and Pier Angelo Tovo. Legionella pneumophila Pneumonia in a Newborn after Water Birth: A New Mode of TransmissionOxford Journals, November 2001: 104.
  • Legionella Control. Birthing Pool Death Linked To Legionnaires disease. https://legionellacontrol.com/blog/166-birthing-pool-death-linked-to-legionnaires-disease (accessed 2014 27-11).
  •  Legislation.gov.uk. The Water Supply (Water Fittings) Regulations 1999.The National Archives. 1999. http://www.legislation.gov.uk/uksi/1999/1148/contents/made (accessed 2015 05-01).
  •  M.W. LeChevallier, World Health Organisation. Conditions favouring coliform and HPC bacterial growth in drinkingwater and on water contact surfaces . 2003.
  •  N Phin, T Cresswell, F Parry-Ford on behalf of the Incident Control Team. CASE OF LEGIONNAIRES’ DISEASE IN A NEONATE FOLLOWING A HOME BIRTH IN A HEATED BIRTHING POOL, ENGLAND, JUNE 2014.http://www.eurosurveillance.org. 2014. http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20857 (accessed 2015 10-01).
  •  Nottingham University Hospitals. LEGIONELLA MANAGEMENT AND CONTROL PROCEDURES. May 8, 2014.
  • Rosanna A. Zanetti-Daellenbach, Sibil Tschudin, Xiao Yan Zhong, Wolfgang Holzgreve, Olav Lapaire, Irene Ho ̈sli. Maternal and neonatal infections and obstetrical outcome in water birth . Prod. Women’s University Hospital Basel. Spitalstrasse, Basel: European Journal of Obstetrics & Gynecology and Reproductive Biology , 2006 28-August.
  • SMS Environmental – the water experts. Fluid Categories. http://www.sms-environmental.co.uk/fluid_categories.html.
  • Takuhito Nagai, Hisanori Sobajima, and Mitsuji Iwasa. A fatal newborn case of Legionella pneumophila pneumonia occurring after water birth in a bathtub with an all day circulating system, June 1999 – Nagoya City.http://idsc.nih.go.jp/. 2000. http://idsc.nih.go.jp/iasr/21/247/de2474.html (accessed 2014 17-06).
  • Takuhito Nagai, Hisanori Sobajima, Mitsuji Iwasa, Toyonori Tsuzuki, Fumiaki Kura, Junko Amemura-Maekawa, and Haruo Watanabe. Neonatal Sudden Death Due to Legionella Pneumonia Associated with Water Birth in a Domestic Spa Bath. 2002.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC154682/ (accessed 2014 3-12).
  • The Guardian. Legionnaires’ disease in baby is linked to heated birthing pool . 2014. http://www.theguardian.com/society/2014/jun/17/legionnaires-disease-heated-birthing-pool-baby-public-health (accessed 2014 18-June).
  • U.S. Department of Health and Human Services Centers for Disease Control and Prevention (CDC) Atlanta, GA 30333. Guidelines for Environmental Infection Control in Health-Care Facilities . 2003.
  • UNITED LINCOLNSHIRE HOSPITALS NHS TRUST. CLEANING, DISINFECTION AND STERILIZATION GUIDELINES FOR RE-USABLE MEDICAL DEVICES. Lincolnshire, 2010 January.
  • Water Regulations Advisory Scheme. Fluid Categories . https://www.wras.co.uk/consumers/resources/glossary/fluid_categories/ (accessed 2014 3-12).
  • which.co.uk. Having a water birth and using birth pools. http://www.which.co.uk/birth-choice/articles/using-water-in-labour.
  • Woolnough, Kevin. Legionella Expert Calls for Greater Vigilance. http://www.eurofins.co.uk/news-archive/legionella-expert-calls-for-greater-vigilance.aspx (accessed 2015 17-01).

Please feel free to distribute and share this document crediting  © K. D. Brainin (Active Birth Pools) 2015

Water Safety Management

When it comes to the creation and care of water birth facilities nothing is more important.

Micro-organisms breed freely in warm moist environments and must be prevented from propagating.

Below a list of guidelines to help you create a safe water birth facility.

Related information:

 

 

Inside the birth pool factory

The reason that our hospital water birth pools are the very best in the world is twofold:

  1. The quality of our designs determines the comfort, function and beauty of our water birth pools.
  2. The quality of engineering, manufacture and service that Design and Form bring to fabrication of Active Birth Pools makes them second to none!

Design and Form manufacture to order by hand using a proprietary material they developed to make up for the inadequacies of commonly used materials.

Seamless, one-piece fabrication in Ficore composite puts Active Birth Pools in a class of their own.

 

 

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Water Birth Pools: The economic reality and impact

I wrote this article a few years ago.

It seems particularly relevant now.

Claire+Riding

Recent news has highlighted the restrictive financial environment that maternity units will be expected to operate in.

Yet, at the same time midwives are charged with the important task of improving the quality of care and services.

David Cameron has said, “The whole aim of these NHS reforms is to make sure we get the value for the money we put in.”[1]

In the same article, Stephen Dorrell, former Health Secretary commented that, “In real terms, the NHS budget was being broadly maintained, but we’re having to find ways of doing more with the same amount of money.”[2]

The only way of improving maternity services is by optimising facilities, saving money wherever practical and normalising childbirth to a far greater extent.

Studies have shown that women who are supported during labour need to have fewer painkillers, experience fewer interventions and give birth to stronger babies.

After their babies are born, supported women feel better about themselves, their labour and their babies.

A focus on normalising birth results in better quality, safer care for mothers and their babies with an improved experience.

Increasing normal births is associated with shorter (or no) hospital stays, fewer adverse incidents and admissions to neonatal units and better health outcomes for mothers.

It is also associated with higher rates of successful breastfeeding and a more positive birth experience.

These changes benefit not only women and their families but also maternity staff.  Midwives are able to spend less time on non-clinical tasks and more on caring for women and their babies.

Psychologically speaking, and in particular for first time mothers, the less intervention and a more hands on approach with one-to-one support means that mothers will leave hospital feeling held and therefore far better prepared for motherhood.

This again has a domino effect, not just on the welfare of the infant, but also circumventing the need for costly government and LA interventionist approaches in particular for younger mothers post-partum.

What increases the likelihood of normal births?

It is also known that some factors help to facilitate straightforward birth without evidence of additional risks, including one-to-one support, immersion in water for low-risk women, planning for a home birth, care from known midwives, more extensive training of junior doctors, employment of consultant midwives focusing on normality, and support on the labour ward from consultant obstetricians[3].

How can midwives make a case for purchasing birth pools?

The need for more water birth facilities is evident.  The problem is that financial controllers are under pressure to save money.

They will not be easily convinced of the necessity unless you clearly stress that purchasing pools should not be viewed as a cost but rather to make the case that they are a valuable investment and will enable your unit to optimise resources, improve the quality of care and yield a return of significant financial savings.

A birth pool is a simple, inexpensive piece of medical equipment that can have a major impact on the quality of care and cost of having a baby.

The bed is no longer the primary focus of the room: having birth pools in hospitals and delivery suites facilitates pain relief encourages relaxation and therefore confidence and promotes mobility along with soft furnishings such as beanbags.

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Importantly, this results in significant financial savings! 

Our cost study has revealed that savings of up to £700.00 per birth can be achieved.

For example, St Richards Hospital in Chichester has three of our birth pools as well as our soft furnishings.

They recently reported their first successful VBAC in the pool for a woman who had previously had twins by c-section.

Depending on complications, a c-section costs between £1,370 and £1,879 in contrast to a normal delivery that is usually between £735 and £1,097.[4]

The experience of hospitals that have birth pools demonstrates that the cost of installing a pool is soon recouped by the savings achieved through reduced use of medical methods of pain relief and shorter hospital stays.

Wherever possible, women should have the opportunity to labour in water, as this is often far more comfortable.

The NHS has advised hospitals to ensure facilities are in place for this: three pools for 1,000 births a year is seen as adequate provision[5].

 

[1] BBC: 19/01/11
[2] BBC 19/01/11 taken from BBC Radio 4 Today programme
[3] Hodnett ED, Gates S, Hofmeyr GJ, Sakala C.  Continuous support for women during childbirth. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD003766. DOI: 10.1002/14651858.CD003766.pub2
[4] NHS Institute, 2009
[5] NHS Guidelines on Childbirth 26 September 2007

Related information:

Celebrating our 30th Anniversary

Over the past 30 years we have achieved success by caring about every detail and keeping things simple, safe and fit for purpose.

1987: World’s 1st specially designed portable water birth pool

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1988: Garden Hospital, London – World’s 1st specially designed hospital water birth pool

Midwife Jennifer Starisky supporting a women in labour in front of the world's first water birth pool

1990: Ether Burns and Sheila Kitzinger campaign to get a water birth pool installed in the John Radcliffe Hospital – the 1st in an NHS Hospital

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1992 – Deluxe Water Birth Pool, Royal Berkshire Hospital

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1995

A turning point in the development of water birth pools as ergonomic design principles are employed for the 1st time.

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2003

We’ve advanced the quality of design & manufacture and introduced new pools.

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2005: Space Saver Birth Pool

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2007: Active Birth Pool

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2007: Optimal Water Birth Pool

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2009: Amaryllis Water Birth Pool

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2010: Versatile Water Birth Pool

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2011: Princess Pool

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2013: Venus Water Birth Pool

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Our new range of water birth pools are a quantum leap forward in every respect

2014: Active Birth Pool

2014: Venus Water Birth Pool

2015: Princess Water Birth Pool

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2015: Winner – Building Better Healthcare Awards

In their comments the judges praised the quality of our design and manufacturing.

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2017:  30th Anniversary!

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How to restore your old birth pool to pristine condition

We’ve been supplying water birth pools to hospitals since 1989.

Many of the pools we supplied in the 90’s are still in active service!

We occasionally receive reports that the pools are not looking as clean and bright as they originally were.

Not to worry.

There is a product called tide mark cleaner that was developed for spas and swimming pools.

You can either use it to remove stains or brighten up the appearance of the pool when necessary.

It will restore your pool to pristine condition.

Here’s a link:

http://www.amazon.co.uk/Waterline-Cleaning-removes-lines-cleaner/dp/B006DFD7VK

For information about cleaning and disinfection procedures please click here.

 

 

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The use of water for labour and birth

Health Times: Karen Keast

Water is a life force in more ways than one – it covers more than 70 per cent of our earth and we drink it to survive.

When it comes to using water for childbirth, water birth is still a contentious issue that divides healthcare professionals and organisations alike.

The fact that it’s contentious at all surprises some of Australia’s leading midwives, writes Karen Keast.

There are legends of Egyptian pharaohs being born in water and of South Pacific women giving birth in shallow seas.

The first written report of a water birth in the western world occurred in France in 1803, when a mother experiencing a long and difficult labour was helped to give birth in a tub of warm water.

In the 1970s, Igor Tjarkovsky, a boat builder, investigated the therapeutic benefits of water and installed a glass tank in his home for women to use for childbirth.

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French obstetrician Michel Odent went on to pave the future of water birth.

After a mother, using water to ease the pain of her labour, accidentally gave birth in the water, he went on to install a plastic paddling pool in a hospital so more women could enjoy the benefits of water birth while reducing their need for painkillers.

Only a small proportion of women in Australia choose to give birth in water each year although the exact number of water births is not known.

Griffith University Professor Jenny Gamble, a practising midwife of 30 years, says water births have come a long way in Australia but there is still a long way to go.

Professor Gamble recalls when a new maternity wing opened up at a Brisbane hospital, the then director general who was touring the facility instructed the plugs from the tubs to be removed.

“In his own way, he was saying water births might be a bad thing,” she says.

“Those days are gone. Water has become more accessible to women. There’s quite a lot of evidence to say that water is safe for women.

“More and more hospitals are putting in big tubs and there’s a range of deep tubs. It’s coming but it’s all too slow.”

Advocates of water birth say its benefits include the relaxing effect of warm water and feelings of weightlessness, buoyancy and ease of movement which help to alleviate pain naturally.

Western Sydney University Professor Hannah Dahlen, a privately practising midwife and spokesperson for the Australian College of Midwives, says evidence shows water immersion may also help improve blood flow in the uterus, lower blood pressure, provide less painful contractions and result in shorter labours and fewer interventions.

Professor Dahlen last year published a study in the Journal of Midwifery examining the outcomes of 6144 Australian women who had normal vaginal births in a birth centre over a 12-year period.

Her research compared women giving birth in water with those who gave birth in six other positions out of the water – kneeling or all fours, squatting, side lying, using a birth stool, standing and, the most common birth position in the country – semi-seated.

Professor Dahlen found those who gave birth on a birth stool had almost a one-and-a-half time’s higher rate of major perineal trauma and more than twice the rate of haemorrhage after delivery compared with water birth.

There was no difference in major perineal trauma and haemorrhage after delivery between women who gave birth in water and those who had a semi-seated position.

While those babies born in a semi-seated position had a four-and-a-half time’s higher incidence of five minute APGAR scores less than seven.

APGAR scores, which rate the newborn’s breathing effort, heart rate, muscle tone, reflexes and skin colour, of less than seven at five minutes after birth indicate medical intervention was needed to resuscitate the baby.

“Some studies have shown better outcomes but basically I found no difference to other birth positions,” she says.

“There was no evidence of harm. We want to do more research in Australia.

“We have no evidence to date that it’s harmful but we need more and more evidence to show it’s safe.”

Professor Dahlen says a water birth also provides women with a sense of protected space.

“They talk about how they felt there was a barrier; they felt it was a cocoon where they could feel safe,” she says.

Professor Dahlen says one common concern about water births is that the baby could drown but she says babies are born with a diving reflex, or bradycardic response, that causes them to hold their breath under water.

Professor Dahlen says despite mounting evidence proving the benefits of water birth, they still remain contentious in Australia.

“I have never understood it. I find it fascinating that water is so scary.”

Professor Gamble agrees.

“We’re talking about water, just water – not epidurals, not heavy duty drugs,” she says.

“Thank goodness hospitals are moving towards increasing their remodelling of their maternity suites to include tubs but quite frankly it’s a lot of fuss for something as simple as warm water.”

Professor Gamble says water births are common practice at planned home births, and are used during labour or active birth.

“Some women want to get in and get out for birth, some want to labour in the water and some hop in just for the birth – anything goes.”

Perhaps, most importantly, Professor Dahlen says water births are not about the baby.

“That’s what people get wrong,” she says.

“It’s about the mother and if you have a really happy and relaxed and stress free mother you actually have a baby that’s advantaged – they are born and very placid.

“They don’t often cry – they come up and blink.

“They are breathing fine. They come up all lovely and warm and then go to their mother’s chest.

“I really love water births.”

Related information:

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A way to make labour shorter, easier and more comfortable

“Introducing a deep pool of water to the birthing room is a way to make your labour shorter, easier and more comfortable.

It increases your sense of privacy and helps to make your baby’s entry to the world gentle and free from trauma, whether the birth occurs in or beside the pool”

Janet Balaskas – “Water Birth”

During your labour relaxing in a deep pool of warm water can be a wonderful aid.

It’s using a pool mainly for this reason – even if you are not planning a water birth.

A birth pool may help you to manage pain effectively in labour and considerably reduce your need for medical pain relief.

Studies have shown that fewer epidurals are needed when women use a water birth pool.

You are supported by the buoyancy of the water.

This allows you to relax easily and more deeply.

This helps you to cope with contractions and rest more comfortably in between them.

By saving energy you’re less likely to become tired or exhausted.

It’s easier for you to use upright or squatting positions in water than it is on land and to move freely from one position to another as you explore what works best for you.

You are likely to have an increased feeling of privacy and security in the pool.

If you enter the pool at the right time (5-6cms dilation) you can expect a boost in the secretion of the hormone oxytocin.

This will stimulate strong contractions.

The ‘oxytocin wave” when you enter the pool in strong labour lasts for approximately two hours.

You are likely to dilate rapidly during this time.

You may choose to have your baby in water

Welcoming your baby in water can be a joyous and wonderful experience.

However, you may choose to leave the pool for the birth itself.

It’s best for you to keep an open mind, rather than to have a fixed plan to give birth in water, even though the idea may be very appealing.

If you progress well in the pool during labour, or if your birth happens soon after you enter the water, you may wish to stay in the pool for the birth.

Your baby can be born under water without increased risk provided there is good midwifery care and there are no known complications.

Your baby is gently brought to the surface before taking his first breath.

Related information:

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Immersion in water for labour and birth – Cluett and Burns

Enthusiasts suggest that labouring in water and waterbirth increase maternal relaxation, reduce analgesia requirements and promote a midwifery model of care.

Critics cite the risk of neonatal water inhalation and maternal/neonatal infection.

Objectives

To assess the evidence from randomised controlled trials about immersion in water during labour and waterbirth on maternal, fetal, neonatal and caregiver outcomes.

Search methods—We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (30 June 2011) and reference lists of retrieved studies.

Selection criteria

Randomised controlled trials comparing immersion in any bath tub/pool with no immersion, or other non-pharmacological forms of pain management during labour and/or birth, in women during labour who were considered to be at low risk of complications, as defined by the researchers.

Data collection and analysis

We assessed trial eligibility and quality and extracted data independently. One review author entered data and the other checked for accuracy.

1990 Sheila Kitzinger, Ethel Burns & Joyce Timms sit around the  first Water Birth Pool installed in NHS Hospital at the John Radcliffe Hospital

Main results

This review includes 12 trials (3243 women): eight related to just the first stage of labour: one to early versus late immersion in the first stage of labour; two to the first and second stages; and another to the second stage only.

We identified no trials evaluating different baths/ pools, or the management of third stage of labour.

Results for the first stage of labour showed there was a significant reduction in the epidural/spinal/ paracervical analgesia/anaesthesia rate amongst women allocated to water immersion compared to controls (478/1254 versus 529/1245; risk ratio (RR) 0.90; 95% confidence interval (CI) 0.82 to 0.99, six trials).

There was also a reduction in duration of the first stage of labour (mean difference −32.4 minutes; 95% CI −58.7 to −6.13).

There was no difference in assisted vaginal deliveries (RR 0.86; 95% CI 0.71 to 1.05, seven trials), caesarean sections (RR 1.21; 95% CI 0.87 to 1.68,eight trials), use of oxytocin infusion (RR 0.64; 95%CI 0.32 to 1.28,five trials), perineal trauma or maternal infection.

There were no differences for Apgar score less than seven at five minutes (RR 1.58; 95% CI 0.63 to 3.93, five trials), neonatal unit admissions (RR 1.06; 95% CI 0.71 to 1.57, three trials), or neonatal infection rates (RR 2.00; 95% CI 0.50 to 7.94, five trials).

Of the three trials that compared water immersion during the second stage with no immersion, one trial showed a significantly higher level of satisfaction with the birth experience (RR 0.24; 95% CI 0.07 to 0.80).

A lack of data for some comparisons prevented robust conclusions. Further research is needed.

Authors’ conclusions

Evidence suggests that water immersion during the first stage of labour reduces the use of epidural/spinal analgesia and duration of the first stage of labour.

There is limited information for other outcomes related to water use during the first and second stages of labour, due to intervention and outcome variability.

There is no evidence of increased adverse effects to the fetus/neonate or woman from labouring in water or waterbirth.

However, the studies are very variable and considerable heterogeneity was detected for some outcomes.

Further research is needed.

Click here for PDF of the full study

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The history of Water Birth

There have been accounts of women labouring and giving birth in water mostly amongst peoples living near a source of shallow warm water such as the South Pacific islanders.

In most traditional societies the rituals and practices of childbirth have, until recent times, been a matter of secrecy and handed down through generations of women.

There are oral traditions of similar practices among the Maori, the Indians of Central America, and the Ancient Greeks and Egyptians.

In 1805, the first account the use of water in Europe was documented.

A French woman, who had laboured for two days before being encouraged to get into a warm bath by her enlightened doctor then progressed to give birth to a healthy baby within an hour.

Sadly, for millions of women at the time there was no recognition of the importance of this event.

Aside from this, there are no accounts of a tradition of childbirth in water in Europe or other northerly regions.

The reason for this may be a simple matter of climate and plumbing.

Only with the widespread availability of artificially heated water and portable and installed birthing pools in comparatively recent times, has giving birth in water become a real option for women anywhere in the world.

Waterbirth was pioneered in the 1960’s by the Russian researcher Igor Tjarkovsky.

Using a large aquarium he installed a glass tank in his own home in Moscow in which many mothers gave birth .

Stunning photographs of these extraordinary births were published in the west and inspired the first water births.

For today’s generation of mothers, the key figure in the use of water for labour and birth is the French obstetrician Michel Odent.

In 1977 Odent installed a pool in the hospital at Pithiviers , not with the idea of promoting birth in water, but primarily as an additional option for pain relief and rest during long or difficult labours.

He has said ‘the reason for the birthing pool is not to have the baby born in water but to facilitate the birth process and to reduce the need for drugs and other interventions.’

Odent published his findings in the Lancet and his recommendations in this article provided the basis for the first midwifery guidelines for waterbirths.

Odent, M.  Birth under water.  The Lancet. December 24/31, 1983. pp 1476-1477

Inspired by news of what was happening in Moscow and France, the earliest waterbirths in the West took place at home in pools that were often improvised by the couples themselves and attended by independent midwives.

The parents created birthing pools using any large waterproof container they could find – including refuse skips, cattle troughs, inflatable paddling pools or garden ponds lined with a plastic sheet.

This happened simultaneously in several parts of the world and began to cause ripples in the world of obstetrics.

When reports and images of the first waterbirths were published, the world looked on in amazement.

The women who chose this way of birthing and their attendants were variously regarded as crazy, deluded, foolhardy or inspired.

The medical establishment rallied to condemn or at least call the practice into question, citing theoretical risks of infection and fears of the baby drowning.

Such fears have been largely appeased by the work of Dr Paul Johnson, neonatal physiologist at the John Radcliffe Hospital, Oxford.

His research on the mechanisms that trigger breathing in the newborn provided scientific confirmation of the safety of birth underwater at body temperature for babies who are not at risk.

He described how the baby is protected against the possibility of breathing while underwater in the few seconds between emerging from the birth canal and being lifted out of the water.

This response is known as the ‘dive reflex’.

Johnson, P.  Birth under water – to breathe or not to breathe. British Journal of Obstetrics and Gynaecology, vol 103, no 3, March 1996. pp 202-208

In 1999 Ruth E. Gilbert and Pat A. Tookey of the Institute of Child Health, London, published a hugely important study in the BMJ that effectively provided the ‘green light’ for labour and delivery in water.

It was a study of the outcomes for all babies born in water in the UK in a two-year period between 1994 and 1996.

A total of 4,032 waterbirths were included in the study (about 0.6 per cent of all deliveries).

All 1500 consultant paediatricians in the British Isles were asked if they knew of cases of perinatal death or admission to special care within 48 hours of labour or delivery in water.

The study showed that there was no increased risk to health for babies born in water as compared with babies born to other low-risk women on land.

Since then a burgeoning of interest in the use of water in labour in the UK has led to the development of a unique concentration of knowledge and expertise within the mainstream maternity system.

Positive encouragement to the use of water in labour and childbirth has come from the Royal College of Midwives, which recommends that midwives should develop the knowledge and skills to assist women at a waterbirth .

Water labour and birth is an option which is limited to ‘low risk’ women having an uncomplicated birth following a healthy pregnancy.

In the UK the issues of safe practice have been addressed by the health authorities, Royal College of Midwives, midwifery supervisors and one or two obstetricians.

A significant body of research studies and several important surveys have been undertaken.

Development has been more carefully and diligently monitored than many of the obstetric procedures that are widely used.

Against this backdrop, more of the managers of maternity services in the UK are increasingly being persuaded that the option of using water in labour and for birth should be available to all women.

The extent of the use of birth pools in the UK increased.

Pools are now used in hospitals as well as independent birth centres, some of which specialize in waterbirths, and in the community at home births with both independent and NHS midwives.

The Edgware Birth Centre in North London is an example of a new type of forward-thinking NHS birth unit.

Typically 70 per cent of women who give birth at the centre use water during labour and 50 per cent give birth in water.

Since it’s inception outcomes show far fewer interventions than for low-risk births at a conventional hospital birth unit.

This is a model of care which would transform our maternity services if widely adopted.

In October 2000 the UK’s Royal College of Midwives estimated that 50 per cent of maternity units provided facilities for labour or birth in water.

The usage of pool varied between 15 and 60 per cent, which may be an indicator of the significance of the role of the midwife in supporting and encouraging women to consider the use of water.

Since then the number of UK hospitals and birth centres with installed pools has risen to closer to 60 per cent.

However, that does not necessarily mean that the pools are being fully or enthusiastically utilized or that the pool is always available.

It’s not uncommon for women to be discouraged from using them or to be told that trained midwives are not available.

Sometimes stringent protocols around the use of a pool can limit it’s usefulness and frustrate both mothers and midwives.

Women who want to use a pool are often also told that this may not be possible if the pool is already in use.

It’s time for such problems to be addressed and for all women to have the possibility of using a birth pool wherever they choose to give birth.

Water birth is one of the greatest innovations in childbirth of our times and can no longer be regarded as a passing fad.

The use of epidurals today has reached epidemic proportions and contributes significantly to the high caesarean and intervention rate and is also very costly, requiring a high level of expert attendance.

The simple expedient of a pool of warm water is by now a proven way to confine the use of epidurals to those women who really need them and improve safety and quality of the birth experience.

 

 
 

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Nothing helps mothers cope with pain in labour more effectively

Water birth pools play a vital role in helping mothers experience physiological labour and natural birth.

Nothing helps mothers cope with pain more effectively.

If mothers are not going be reliant on analgesia for pain relief they need other options.

Mothers who enter a pool of warm water in established labour find that they are better able to cope with the pain.

Immersion in warm water has been unequivocally proven to be of great benefit both physiologically and psychologically.

Women have a greater sense of fulfillment and accomplishment and babies experience a non-traumatic birth.

Aside from the obvious benefits to mothers and babies, midwives experience greater job satisfaction and hospitals save money & optimise resources.

Nearly a third of women benefited from the use of a water birth pool in the UK in 2014 (National Maternity Survey 2014).

With up to 60% of mothers open to natural birth now is the time to consider making this safe, effective, low cost option more widely available.

On land mothers contend with the force of gravity which limits movement as labour progresses and they tire.

Many women do not have the fitness to maintain upright postures for lengths of time. (Gupta JK, Hofmeyr GJ, Smyth R 2007).

Mothers who are overweight or obese are often unable to cope with the physical demands.

The transition from the land to water helps revive & energise mothers giving them a new lease on life and sense of purpose.

The buoyancy of water supports the mother reducing her relative weight by approx. 33% (Archimedes Principle).

This allows her to move in ways not possible on land.

To explore and benefit from the postures natural to labour & birth .

The calming, relaxing effect of the warm water promotes the flow of oxytocin.

This powerful hormone plays a huge role in childbirth.

It causes the uterus to contract and triggers the ‘fetal ejection reflex’.

Immersion in water has a beneficial physiological effect on hormone secretion, including oxytocin surges which can advance dilation and stimulate contractions (Odent 2014).

Related information:

Setting up a water birth facility

Hospitals in the United Kingdom have been evolving clinical guidelines for the use of water for labour and birth for over 3o years.

The protocols for operational policy that they’ve developed are widely regarded as the benchmark standard internationally.

Below a collection of guidelines and publications to help you create a water birth facility.

Clinical Guidelines – Royal Cornwall Hospital

Clinical Guidelines – Royal Worcester Hospital

Guideline for the Management of Women Requesting Immersion in Water  – Norfolk and Norwich University Hospitals

Operational Policy and Clinical Guidelines – Abbey Birth Centre

Birthspace: An evidence-based guide to birth environment design – Queensland Centre for Mothers and Babies

Use of water for labour and birth – Hywel DDA Local health Board

Guidelines for use of pool during labour and delivery – East Cheshire NHS Trust

Guiding principles for midwifery care during normal labour – Barking, Havering and Redbridge NHS Trust

Waterbirth care during labour for low risk women – Sandwell and West Birmingham Hospitals

Waterbirth Guidelines – Midwifery Led Unit, Wirral Hospital

Choosing a Water Birth – East and North Hertfordshire

Birthing pool use of labour and delivery – Wansbeck General Hospital

Water birth and use of water in labour guideline – Buckinghamshire Healthcare

Water for labour and birth guideline – Northern health and Social Care Trust

Immersion in water during labour and birth – NHS Forth Valley

Intrapartum care midwifery led unit – Wirral Women & Children’s Hospital

Guidelines for water birth within the hospital and at home – Dartford & Gravesham NHS

Disinfection and Sterilisation policy (infection control) – Basingstoke and North Hampshire NHS FT

Related information:

Reasons to consider a water birth

Bridge to Health –  Sian Smith

When considering their birth plan, more and more women are choosing to include the use of water at some stage.

In fact, around 30% of women now plan to use this method either for birthing their baby or as a natural way to reduce some of the intense sensations (pain!) associated with labour.

Here are some of the reasons why:

Water is relaxing!

Being able to bob around in a large pool of warm water is the perfect environment to help you stay calm and relaxed, in a situation most would normally consider pretty stressful.

For many, sliding into a warm bath is the ‘go to’ choice of relaxation after a hard day, so what better way to help you through one of the most physically demanding and memorable experiences of your life?

Additionally, a calmer birth may be less stressful for your baby, as moving from an environment of warm amniotic fluid to one of warm water is a gentle way of introducing them to their new surroundings.

Water is a natural pain reliever

The relaxing effects of water help encourage the body to produce its own pain-fighting substances.

This is beneficial both for Mum and baby; for Mum staying relaxed helps stimulate her natural production of oxytocin (the’ love hormone’ that helps the uterus contract) and endorphins, the ‘feelgood’ hormones that help work as a natural pain reliever.

For baby, a happy and relaxed Mum is more likely to birth quickly with a reduced need for medical intervention.

It reduces stress and anxiety

It is not just the water that helps to relax you. With a waterbirth, often the entire surroundings are altered to create a calming ambience e.g. dimmed lights and hushed voices.

This enables you to go into your own world much more easily than if in a harshly lit room with strange people popping in and out.

Additionally, this type of relaxation helps encourage deep abdominal breathing, preventing you from becoming tense which may make contractions feel more intense.

It reduces the risk of perineal tearing

The warmth of the water helps to promote increased blood flow to the vagina and perineum (the area between the vagina and anus that is susceptible to tearing during childbirth).

This increases flexibility of the tissues and can reduce the likelihood of tearing when birthing the baby’s head.

It allows you to adopt a more ‘active’ birth position

A reason that some women choose a water birth is that it allows you to retain some control throughout the labour process –being aware of the contractions and sensations your body is experiencing, with a reduced chance of medical intervention.

Additionally, the sensation of ‘weightlessness’ that being in the water provides, enables you to move around much more freely than your body has allowed you to for a while!

You are free to adopt almost any position that feels comfortable for you.

The classic image of a labouring woman is that of her laying on her back with her legs in stirrups.

Whilst this is the case for many, it is actually a fairly difficult way to birth your baby as you have to work against gravity to push the baby’s head UP and over the lowest part of the spine – the coccyx.

The best way to counteract this is to work with gravity and adopt a more ‘active’ squatting or modified squatting position.

Being in the water allows you to stay in these positions for longer, as you can lean against the side of the birthing pool for support.

Remaining fit, healthy and active will also help you have as smooth a pregnancy as possible.

Your Osteopath can advise you on exercises that are suitable throughout pregnancy, specifically core, pelvic and lower limb strengthening exercises that will help you be able to adopt active birth positions and use the correct muscles to birth your baby as efficiently as possible.

It is safe!

Of course, water births are not suitable for everyone – the main criteria is that Mum and baby must be healthy, the baby must be in a head-down position, and the pregnancy must be between 37 and 42 weeks.

But as the majority of pregnancies are healthy, a water birth can offer a natural and more in control option to the labour choices a woman has.

And finally, one of the most frequently asked questions regarding waterbirths appears to be ‘will my baby drown underwater?’… to which the answer is no!

The baby receives all of its oxygen via the placenta and hormones circulating through the baby ensure this occurs until the baby is lifted out of the water.

It is also known as the ‘foetal dive reflex’ and allows babies to be underwater for short periods of time up until around 6 months old.

Related information:

The buoyancy of water helps mothers benefit from upright positions

Studies have shown that upright labour positions are associated with a reduced second stage, fewer episiotomies or instrumental intervention in contrast to mothers labouring on their backs.

Many women also feel empowered in an upright position, and experience a sense of control over their labour.

On land women need to contend with the force of gravity that limits their ability to assume upright postures especially as labour progresses and they feel tired.

Many women do not have the fitness or stamina to maintain upright postures for lengths of time.

The transition from the land to water helps revive and energise the mother giving her a new lease on life and sense of purpose.

The buoyancy of water supports the mother reducing her relative weight by approx. 33% (Archimedes Principle) allowing her to easily explore the full range of beneficial upright positions in comfort and move in ways that were not possible on land.

The space, depth and design features of Active Birth Pools allow women to move freely to find and be supported in the upright positions that are most comfortable and beneficial for a physiological labor to unfold.

Related information:

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Michel Odent – the birthing pool test

This article first appeared in Midwifery Today, Issue 115, Autumn 2015.

There are many reasons to avoid last-minute cesarean sections that are decided at a phase of real emergency.

They are usually preceded by signs of fetal distress and they are often performed in poor technical conditions.

Furthermore, they are associated with negative long-term outcomes.

For example, according to an American study, women with a full-term second stage cesarean have a spectacular increased rate of subsequent premature births (13.5%) compared to a first-stage cesarean (2.3%) and to the overall national rate (7–8%) (Levine et al. 2014).

There are also serious reasons to avoid prolonged pharmacological assistance during labor, since the probable long-term effects of its different components (particularly drips of synthetic oxytocin) have never been evaluated through valuable scientific studies.

When a woman enters the pool in hard labor, there is an immediate pain relief, and therefore an immediate reduction in the levels of stress hormones.

Since stress hormones and oxytocin are antagonistic, the main short-term response is usually a peak of oxytocin and therefore a spectacular progress in the dilation.

We must add reasons to avoid, when it is possible, prelabor cesareans.

Apart from impaired lung maturation, it appears that the state of stress deprivation associated with “birth without labor” has a great variety of effects on the child, such as a lack of maturation of its olfactory sense (Varendi, Porter and Winberg 2002), which is a guide towards the nipple as early as the hour following birth (Odent 1977; Odent 1978).

Low levels of specific informational substances in the blood of stress-deprived neonates suggest effects on metabolic pathways and development of certain brain structures (Hermansson, Hoppu and Isolauri 2014; Simon-Areces et al. 2012).

It appears also that the milk microbiome and the gut flora of infants are disturbed in a specific way after birth by prelabor cesareans (Azad et al. 2013; Dogra et al. 2015), which is the mode of medicalized birth that disturbs breastfeeding more than all others (Prior et al. 2012; Zanardo et al. 2012).

Unexpectedly, it has been revealed recently that the risk of placenta previa in subsequent pregnancies is statistically significant only if the cesarean has been performed before the labor starts (Downes et al. 2015).

Finally, we are reaching a phase in the history of midwifery and obstetrical practices when an in-labor non-emergency cesarean appears in many cases as the best alternative to drugless childbirth.

In such a context, we understand the need for a new generation of tests in order to decide early enough during labor that the vaginal route is acceptable, without waiting for the phase of real emergency (Odent 2004).

The Basis for the Birthing Pool Test

The birthing pool test is the typical example of a tool adapted to futuristic strategies. It is based on a simple fact.

When a woman in hard labor enters the birthing pool and gets immersed in water at the temperature of the body, a spectacular progress in the dilation is supposed to occur within an hour or two.

If the already well-advanced dilation remains stable in spite of water immersion, privacy (no camera!) and dim light, one can conclude that there is a major obstacle. There is no reason for procrastinations. It is wiser to perform right away an in-labor non-emergency cesarean.

In the early 1980s, I had already mentioned in a mainstream medical journal (Odent 1983) the reason why we originally introduced the concept of birthing pools in the context of a French state hospital.

I had also described the most typical scenario: “We tend to reserve the pool for women who are experiencing especially painful contractions (lumbar pain, in particular), and where the dilatation of the cervix is not progressing beyond about 5 cm. In these circumstances, there is commonly a strong demand for drugs.

In most cases, the cervix becomes fully dilated within 1 or 2 hours of immersion…” At that time, I could only refer to most cases.

Afterwards, I analyzed the outcomes in the rare cases when the dilation had not progressed after an hour or two in the bath. I realized that finally a cesarean had always been necessary, more often than not after long and difficult first and second stages.

This is how I started to tacitly take into account what I had not yet called the birthing pool test.

More recently it happened that I mentioned the birthing pool test during information sessions for doulas.

This is how I learned from a series of reports about births in London hospitals.

It is obvious that many long and difficult labors with the usual range of drugs preceding an emergency cesarean would be avoided if the birthing pool test had been interpreted.

One of these anecdotes is particularly significant.

A woman in hard labor arrived in a maternity unit with her doula while the dilation of the cervix was already well advanced.

Soon after, she entered the birthing pool.

More than an hour later, the dilation had not progressed.

The doula, who was aware of the birthing pool test, was adamant that this woman could not safely give birth by the vaginal route.

A senior doctor was eventually called and diagnosed a brow presentation.

A brow presentation is difficult to diagnose in early labor and is incompatible with the vaginal route. In this case, the doula knew that a cesarean would be necessary, although she could not explain why.

The birthing pool test implies that an internal exam has been performed just before immersion so that, if necessary, a comparison will become possible after an hour or two.

This is an important practical detail, because midwives who are familiar with undisturbed and unguided births in silence, semi-darkness and privacy usually can follow the progress of labor with other criteria than a repeated evaluation of the dilation of the cervix.

Today, we can offer a physiological scenario explaining why immersion in warm water (set to the temperature of the body) makes the contractions more effective during a limited period of time.

When a woman enters the pool in hard labor, there is an immediate pain relief, and therefore an immediate reduction in the levels of stress hormones.

Since stress hormones and oxytocin are antagonistic, the main short-term response is usually a peak of oxytocin and therefore a spectacular progress in the dilation.

After that, there is a long-term complex response, which is a redistribution of blood volume.

This is the standard response to any sort of water immersion.

There is more blood in the chest (Norsk and Epstein 1988).

When the chest blood volume is increased, certain specialized cells in the atria release a peptide commonly called ANP (atrial natriuretic peptide) that interferes with the activity of the posterior pituitary gland (Gutkowska, Antunes-Rodrigues and McCann 1997).

We can all observe the effects of a reduced activity of our posterior pituitary gland after being in a bath for a while: we pass more urine.

This means that the release of vasopressin—a water retention hormone—is reduced.

In fact, the chain of events is not yet completely clarified (Mukaddam-Daher et al. 2002).

We have recently learned that oxytocin—the love hormone—has receptors in the heart (!) and that it is a regulator of ANP (Gutkowska et al. 1997).

In practice, we need to remember that the immediate peak of oxytocin following immersion in warm water will induce a feedback mechanism and eventually the uterine contractions will become less effective after an hour or two.

References:

  • Azad, MB, et al. 2013. “Gut Microbiota of Healthy Canadian Infants: Profiles by Mode of Delivery and Infant Diet at 4 Months.” CMAJ 185 (5): 385–94.
  • Dogra, S, et al. 2015. “Dynamics of Infant Gut Microbiota Are Influenced by Delivery Mode and Gestational Duration and Are Associated with Subsequent Adiposity.” MBio 6 (1): e02419–14.
  • Downes, KL, et al. 2015. “Previous Prelabor or Intrapartum Cesarean Delivery and Risk of Placenta Previa.” Am J Obstet Gynecol 212 (5): 669 e1–6.
  • Gutkowska, J, J Antunes-Rodrigues and S McCann. 1997. “Atrial Natriuretic Peptide in Brain and Pituitary Gland.” Physiol Rev 77 (2): 465–515.
  • Gutkowska, J, et al. 1997. “Oxytocin Releases Atrial Natriuretic Peptide by Combining with Oxytocin Receptors in the Heart.” Proc Natl Acad Sci USA 94 (21): 11,704–09.
  • Hermansson, H, U Hoppu and E Isolauri. 2014. “Elective Caesarean Section Is Associated with Low Adiponectin Levels in Cord Blood.” Neonatology 105 (3): 172–74.
  • Levine, LD, et al. 2014. “Does Stage of Labor at Time of Cesarean Affect Risk of Subsequent Preterm Birth?” Am J Obstet Gynecol 212 (3): 360 e1–7.
  • Mukaddam-Daher, S, et al. 2002. “Regulation of Cardiac Oxytocin System and Natriuretic Peptide during Rat Gestation and Postpartum.” J Endocrinol 175 (1): 211–16.
  • Norsk, P, and M Epstein. 1985. “Effects of Water Immersion on Arginine Vasopressin Release in Humans.” J Appl Physiol 64 (1): 1–10.
  • Odent, Michel. 1977. “The Early Expression of the Rooting Reflex.” In Proceedings of the 5th International Congress of Psychosomatic Obstetrics and Gynaecology, Rome 1977. 1117–19. London: Academic Press.
  • ———. 1978. “L’expression précoce du réflexe de fouissement.” In Les cahiers du nouveau-né, vol. 1–2, edited by E Herbinet. 169–85. Paris: Stock.
  • ———. 1983. “Birth Under Water.” Lancet 2 (8365–66): 1476–77.
  • ———. 2004. The Caesarean. London: Free Association Books.
  • Prior, E, et al. 2012. “Breastfeeding after Cesarean Delivery: A Systematic Review and Meta-analysis of World Literature.” Am J Clin Nutr 95 (5): 1113–35.
  • Simon-Areces, J, et al. 2012. “UCP2 Induced by Natural Birth Regulates Neuronal Differentiation of the Hippocampus and Related Adult Behavior.” PLoS ONE 7 (8): e42911.
  • Varendi, H, RH Porter and J Winberg. 2002. “The Effect of Labor on Olfactory Exposure Learning within the First Postnatal Hour.” Behav Neurosci 116 (2): 206–11.
  • Zanardo, V, et al. 2012. “Impaired Lactation Performance Following Elective Delivery at Term: Role of Maternal Levels of Cortisol and Prolactin.” J Matern Fetal Neonatal Med 25 (9): 1595–98.

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