Catalogue, videos and plans

The combination of evidence based, user-centred, ergonomic design, specialised materials and bespoke manufacturing result in water birth pools that are in a class of their own.

Active Birth Pools Catalogue 

Client List 1987 – 2023 

Photos, plans, 3D models and data sheets

Winner – Building Better Healthcare Awards – Building Better Healthcare Magazine

Improving Birthing Pool Design – Chartered Institute of Ergonomics and Human Factors

More Information 

This short video with almost 12,000,000 views shows how mothers move naturally to find the most beneficial positions.

The videos below were made in 2015 when we began fabricating our birthing pools in Ficore® composite.

Though slightly dated they contain a plenitude of information and clearly convey why mothers and midwives love our water birth pools.

We have published information about our water birth pools in these languages:

Visit our Blog to find out more about our range of award winning water birth pools

Please contact us if you would  like to receive a quote.

 

Images, plans, 3D models and data sheets

We’ve utilised ergonomic, evidence-based user-centred design to develop highly specialised pools for labour and birth.

It’s best to choose the largest pool that comfortably fits in your room, being sure that there’s plenty of space around the pool.
Minimum 80cm at the sides and 200cm at the front.

Please note: these are high definition rendered images – the pools look even better in real life!

CAD and 3D modelling plans are available upon request.

Active II Water Birth Pool 
Data Sheet



Place your cursor on the model below to move the image around.

Active II/360 Water Birth Pool
Data Sheet

Venus II Water Birth Pool
Data Sheet

Venus 360 Water Birth Pool
Data Sheet

Princess II Water Birth Pool
Data Sheet

Princess 360 Water Birth Pool
Data Sheet

Water Column
Data Sheet

Would you like to see how our water birth
pools will look in your delivery room?

Simply click on this link with your phone or tablet.

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Testimonials, References and Endorsements

We know that you will be absolutely delighted with our water birth pools and find doing business with us a pleasure.

But don’t take our word for it – find out what midwives, healthcare professionals and business associates have to say:

“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 – water birth pioneer, obstetrician and author

“When we introduced water birth  in 2017  at Fernandez Hospital, we choose Active Birth Pools. We have had no cause for regret. As an obstetrician, Thank you, Keith Brainin for getting us started on this journey.”

Evita Fernandez  – Founder Fernandez Hospital, Hyderabad , India

“The best pools for the Birth Olympics hands down! Makes you want to have another baby just to experience it again!
I’ve both delivered and caught babies in your pool. They’re comfortable, provide stability, are simple to clean and midwife and dad friendly. Just a dream all the way around.”

Alicia Witt Director BirthPros.com, CEO at ArizonaMidwife.com

“Let me introduce you to Keith Brainin who provided us with water birth pools for our birth centres. His pools are brilliant and the service he provides is excellent”

Dr Tracey Cooper MBE – Chief Midwife for the North East and Yorkshire at NHS England

“Not only are they gloriously spacious and inviting, they are made to the highest specifications and considerations to maximise comfort and safety.  In short, they are second to none!”

Sheena Byrom OBE – Activist, Midwife, Speaker and Author

“Beautiful pools, wonderful to see the history of their design and development. Thank you for all you have  done for mothers and midwives over the last 35 years to make birth more comfortable and peaceful.”

Amanda Edwards – midwife and active birth teacher

“I have worked intensely with Keith when we developed a birthing bed together. He knows what he wants and needs and can define if a product meets the endusers’ criteria or not. He handles a very high standard and is creative. He is very straight and a deal is a deal. He knows the market and every product there is and never sits still. What I mean by that is staying on top of new developments to keep his products at the highest possible standard, as that is the ambition always.”

Tom Smit Export manager at Score BV

“We’ve had the Venus since 2016 and 256 water births later we can highly recommend Keith and his pool. Keith has been always quick, helpful and kind in responding to any queries we’ve had and our mums and dads are very happy in using this pool! Thank you Keith!

Catherine Verrecchia – Sage-femme coordinatrice, Centre Hospitalier Annecy Genevois

“I’ve worked with Keith Brainin from Active Birth Pools for years.  The testimonials he has received from professionals and mothers are evidence of his dedication to this unique and sensitive sector and I look forward to following the success of the business, and the continuing evolution of the water birth.”

Steven Rapley – International Trade Advisor

“I’ve used Active Birth pools for over 17 years. They’re really beautiful, technically perfect and exceptionally easy to use.”

Dr Lucia Rocca-Ihenacho PhD, MSc, RM – Lecturer in Midwifery

“I have been working with Keith for years as a distributor of his line of Active Birth Pools in the US and Canada. He is an individual of great integrity and trustworthiness and believes in continuously improving his already perfect line of birthing pools. He is a true pioneer in the world of birth pools and has sharpened his pencil once again to improve upon what I thought was the perfect birth pool. With the new Active II and Venus II pools now in production, I guess you really can improve upon perfection! I’m proud to be a part of the Active Birth Pools world-wide family.”

Tim Johnson-Grass – Family Health & Birth Center

” I consistently hear from moms how much they love the pools!  The space and depth allow them to benefit fully from the buoyancy.
As a midwife, I love the fact that I can move around the tub and catch babies from any position.”

Rachel Stapleton – Midwife 25 years experience of water birth

“I have had the pleasure of working with Keith Brainin since 1985. His expertise in birth pools is unparalleled. He is professional to work with and the high standard of the birth pools has resulted in them withstanding the test of time and many births”

Yehudi Gordon MB BCh, MD, FRCOG, FCOG SA  Author and water birth pioneer

“Even birth pools do not always permit free movement. Some are elaborate constructions with seats, handgrips and foot-rests. Movement in them is restricted, whereas Keith’s pools allow mothers to move freely to find the most beneficial positions”

Sheila Kitzinger MBE – author and childbirth activist

“Keith is very passionate and dedicated towards improving water births. We have worked closely together on multiple projects and he is always very professional. The pools are a designed for to optimise the experience of mothers and midwifes and built to last forever.  They are truly one of a kind!”

Brian Vester – Product Manager and Partner at GM Medical

“I have been dealing with Mr Keith Brainin for more than 10 years as a distributor for Birthing Pools in UAE. He is a dedicated and trustworthy business partner with strong business ethics. He has been consitent in manufacturing and delivering quality birthing pools with great standards. His commitment to his promises has been consistent. His attitude towards his business and his partners is remarkable. Its been a great pleasure knowing Mr Keith as a business partner and as a friend.”

Binu George Varghese – Managing Director – Biomedic International

“Brilliant, like the wide rims so mums can sit on the side and swivel their legs round to get in and out, much safer. And, you can get your legs under the rim, so much more comfortable for midwives ”

Louise Bentley NHS Midwife

“Your water birth pools have revolutionised birth”

Caitlin Wilson Senior Midwife, Meadow Birth Centre, Worcester District Hospital

“GM Medical have worked with Keith for several years with great succes. Keith and his company have a portfolio of high quality products and an understanding of good partnership, which we highly appreciated over the years. Besides he is a great fun 🙂”

Jesper Anker Fremming – CEO at GM MEDICAL A/S

“Giving careful consideration to the needs of a laboring person and their attendants, Keith continues to improve the active birth pool design and provides a useful tool for enjoying a beautiful, gentle birth.”

Yasmin Rose – Founder at Rise Birth Center | Co-Author “Birthing with Heart” | Hospital Consultant UAE

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

Karen Werrbach MSN, RNC-OB, NEA-BC

“It’s my absolute pleasure to recommend Keith Brainin from Active Birth Pools. Keith and I have had a business relationship since 2015. My company, Pregnancy Birth and Beyond, became the Australian and New Zealand Distributor of Active Birth Pools at that time. His knowledge of fixed birth pools and expertise in waterbirth pools is outstanding. With over 35 years of experience within the industry, Keith has developed the highest standard fixed birth pools on the market. Active Birth Pools are second to none. I thoroughly enjoy working with Keith and know him as a valuable asset to our company.”

Jane Palmer Private midwife, lactation consultant and educator | Company Director | Author

Active Birth Pools help mothers utilise upright postures to have better births

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.

Women feel empowered in upright positions and experience a sense of control over their labour.

For birth, squatting and its variants are the positions closest to nature’s laws and are known as physiological birth positions.

These include full or semi squats, standing squats or various kneeling positions.

The use of such upright positions produce the following additional benefits in the second stage:

  • more powerful contractions resulting in an effective expulsive reflex
  •  optimal foetal oxygenation
  • minimal strain and muscular effort
  • an optimal angle of descent
  • maximum space for descent, rotation and emergence of the presenting parts through the pelvic outlet
  • optimal relaxation of the perineum

It has been demonstrated that where the use of upright positions during labour and birth is actively encouraged, the number of spontaneous physiological births increases.

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

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.

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

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.

Active Birth Pools are specially designed to provide optimum support for mothers in the range of upright positions natural to labour and birth.

The can hold onto the recessed handgrips or use the wrap around, bullnose-shape rim for support as the they move around the pool to explore and find the most beneficial upright positions.

Features such as the Labour Support Seat, Safety Seat and Lumbar Support create additional possibilities for mothers to benefit from the upright postures natural to labour and birth.

 

Freedom of Movement – a YouTube Sensation!

This short video with almost 12,000,000 views shows that mothers have room to move freely in the postures natural to labour and birth.

How they instinctively relate to our water birth pools and move naturally to find the most comfortable and beneficial positions.

Design is based on the dynamics of mothers and midwives as they interact with the pool and each other.

The form is based on function and pared down to the essence of aesthetic utility.

There is a reason for every shape, every curve and every form.

Freedom of movement combined with the relaxing effects of warm water enhance the release of oxytocin which significantly increases the likelihood for mothers to experience physiological labour and natural birth.

 

It’s easy for mothers to get into our pools

The simple act of getting into the pool is one of the most misunderstood aspects relating to the use water birth pools.

The truth is that multi-step units are dangerous and in the case of Active Birth Pools unnecessary as the photos below clearly demonstrate.

Health and Safety and Manual Handling experts strongly advise against the use of multi-step units as they present unacceptable safety risks.

They say that, “mothers in strong labour should not climb up and over the rim of the pool and down onto a submerged plinth because it is not safe or practical”.

In addition these bulky step unit take up too much space, obstruct movement around the pool and are a trip hazard.

With the help of Manual Handling  and Ergonomic Design  experts we designed a simple, safe way for mothers to get into our pools.

The distinctive extra-wide, bull-nosed shaped rim is relatively low making it perfect for mothers to sit on and gently swivel into the water.

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

All women no matter what their shape or size will find it exceptionally easy to get into our pools.

Mothers don’t even think about it – they move instinctively and naturally lower themselves into the water.

And midwives will be safeguarded from the risk associated with physically supporting mothers as they climbs up the steps .

To put this in perspective:

The average height of our pools is 75cm – about the same height as a desk or dining table.

Our 15cm high single step makes the height of the pool  60cm – the same height as an ordinary bathtub.

You don’t need a big step unit to get into your bath at home, do you?

 

 

 

 

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Mothers, babies and midwives have a better experience of birth

If mothers are not going be reliant on analgesia for pain relief they need options to help them cope with the pain to allow a physiological labour to unfold.

Studies have shown that women who use a water birth pool need to have fewer painkillers, experience fewer interventions and give birth to stronger babies.

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

Women who enter a warm pool of water in established labour with strong contractions find that they are able to cope with the pain and have a natural birth.

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

The calming, relaxing effect of the warm water promotes the flow of oxytocin, a powerful hormone that plays a huge role in childbirth, causing the uterus to contract and triggering the ‘fetal ejection reflex’.

Michel Odent has expounded upon the beneficial physiological effect that immersion in water during labour has on hormone secretion, including observations that women entering warm water experience oxytocin surges which can advance dilation and stimulate contractions (Odent 2014).

Increasing normal births is associated with shorter (or no) hospital stays, fewer adverse incidents and admissions to neonatal unit  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.

Aside from the obvious benefits to mothers and babies, midwives experience greater job satisfaction and hospitals save money and optimise resources from the reduced use of analgesia, medical intervention and shorter hospital stays.

 

Sheila Kitzinger speaks about birthing pool design

As childbirth author and activist Sheila Kitzinger OBE 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.”

 

Long term value and economy make our pools the most sustainable on the market

Active Birth Pools deliver superior value, better results and unrivalled long term satisfaction.

They outperform all others all others in the market in terms of safety, hygiene and end user satisfaction.

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

hospital birth pools client list

Midwives at the Royal Berkshire Hospital celebrate the 25th anniversary of their water birth facility.
This early model supplied in 1992 is still going strong.

Other birthing pools have a life span of 7-10 years and are not guaranteed for life.
Over time they’ll cost far more as you’ll end up replacing them 3 – 4 times before you need to think about replacing an Active Birth Pool.

This yields significant savings  – up to £20,000 over the life of the pool!

And, you’ll also not have to experience the disruption, disturbance and additional cost that refurbishment brings.

Midwives at the `Bronte Birth Centre celebrate the opening of their water birth facility in their new Venus Pool

As our water birth pools have such a long life span you will not need to think about replacing them for 25 years or more.

Along with the cost of replacing the birthing pools you’ll need to consider the amount of waste material that will be generated by refurbishing the room and the impact its disposal will have on the environment.

Active Birth Pools are also easier to maintain (less chemicals) and more energy efficient (less hot water) which results in additional savings on labour, energy and materials.

When taken together as whole all of these factors demonstrate why Active Birth Pools are the most sustainable on the market -by far!

The use of water for labour and birth is often promoted as a means of empowering women and is consistent with the current agenda of normalising birth

When an Active Birth Pool is installed in a maternity unit it becomes the focus of attention. Mothers have been known to choose a unit with one of our pools over units that have competitors pools.

Midwives tell us that our pools are fab and a pleasure to use. They say that Active Birth Pools are the most comfortable and safest to work with.

When compared to other birthing pools mothers who use our birthing pools have a  greater possibility of experiencing physiological labour and natural birth.

Hospitals report that mothers who use our pools have easier, more straightforward births and  spend less time in hospital which translates into savings both economically and environmentally.

Click here to find out more about our range of award winning water birth pools.

 

The keyword that defines our design ethos is Active.

The keyword that defines our approach to 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.

Design is based upon the dynamics of mothers and midwives as they interact with the pool and each other.

Form is based on function and pared down to the essence of aesthetic utility.

There is a reason for every shape, every curve and every form.

Our water birth pools encourage mothers to move freely and naturally.

They instinctively interact with the pool and find comfort and support wherever they are.

Freedom of movement combined with the relaxing effects of warm water and release of oxytocin significantly increases the possibility of physiological labour and birth.

We are pioneers, innovators and trend setters.

Our water birth pools have continuously evolved over the past 35 years.

We’re able to achieve our latest designs because of the highly specialised material we use.

Ficore, a composite resin with unique properties enables us to create incredibly curvaceous pools that mothers and midwives find exceptionally comfortable, practical and easy to use.

In mid-90’s we met with a design specialist 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 birth pool design that have culminated in todays range of award winning water birth pools.

Below a copy of article that appeared in the Chartered Institute of Ergonomics and Human Factors charting the paradigm shift in birth pool design that occurred in the mid-90’s:

 

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The Water Column takes water safety to a new level

Freestanding water birth pools are becoming increasingly popular.

These installations typically present significant water safety and hygiene risks as rim mounted plumbing and fixtures provides the perfect breeding ground for micro-organisms to thrive.

For wall mounted installations the thermostatic taps, spout, handheld shower and grab rail are fixed to an IPS Panel in accordance with health department regulations.

For freestanding birthing pools a solution needed to be found.

To solve this problem we developed the Water Column – a bespoke design concept that separates the plumbing from the pool to optimise hygiene and water safety and provide crucial support for mothers and midwives.

It’s highly utilitarian, sleek ergonomic design complements the look and usability of our pools to create the ideal facility for water birth.

The wide rim, step unit and grab rail make it safe for mothers to get in and out of the pools.

The column is the perfect height for midwives to rest and lean on while attending the births.

Mothers have a choice of hand holds for support in upright and standing positions.

Adding colour to the column and step adds another dimension to the ambiance of the room.

The Water Column is available in the full range of British Standard or RAL colours.

The demountable handheld shower is essential for cleaning the pool after the birth.

It should be removed while the pool is being used to maintain optimum hygiene standards  and to not contravene relevant water safety regulations.

The Water Column has a large access panel at the back that opens up to give plumbers plenty of room to install the thermostatic mixing valve, pipework and associated fittings.

We supply the Water Column only, and not the plumbing or fittings pictured in the images above.

Shown is the Rada T3 Bath/Shower Tap with Rada Spout and Grohe Demountable Handheld shower.

 

Optional Equipment – Lighting, Sound and Step

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.

Our multi-colour LED allows users to cycle through a range of colours to find the colour most that they find most appealing.

Our bluetooth sound system enables users to connect their phones and listen to the music of their choice.

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

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

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.

To find out more about how simple and safe it is for mothers to get in and out of our water birth pools please click here.

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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.

 

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Mothers and midwives love our water birth pools

Midwives tell us that our pools are by far the most comfortable and user friendly available.

They say 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 and support.

And, therefore have better births.

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.

But please don’t take our word for it….

see what mothers and midwives have to say:

“The best pools for the Birth Olympics hands down! Makes you want to have another baby just to experience it again!  I’ve both delivered and caught babies in your pool. They’re comfortable, provide stability, are simple to clean and midwife and dad friendly. Just a dream all the way around.

Alicia Witt Director BirthPros.com, CEO at ArizonaMidwife.com

“Beautiful pools, wonderful to see the history of their design and development.
Thank you for all you have  done for mothers and midwives over the last 35 years to make birth more comfortable and peaceful.”

Amanda Edwards – midwife and active birth teacher

We’ve had the Venus since 2016 and 256 water births later we can highly recommend Keith and his pool. Keith has been always quick, helpful and kind in responding to any queries we’ve had and our mums and dads are very happy in using this pool! Thank you Keith! 

Catherine Verrecchia – Sage-femme coordinatrice, Centre Hospitalier Annecy Genevois

“The pool was amazing, so inviting, warm and comfortable. I don’t know what I would have done without it. Thank you”

Gemma Woods – Manchester

“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

“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, London

“Your birth pool made my labour so much easier I’d recommend them to every women for their birth.”

Jill Ireland – Bristol

“I’ve used Active Birth pools for over 17 years. They’re really beautiful, technically perfect and exceptionally easy to use.” 

Dr Lucia Rocca-Ihenacho PhD, MSc, RM – Lecturer in Midwifery

” I consistently hear from moms how much they love the pools! The space and depth allow them to benefit fully from the buoyancy.  As a midwife, I love the fact that I can move around the tub and catch babies from any position.

Rachel Stapleton – Midwife 25 years experience of water birth

“Not only are they gloriously spacious and inviting, they are made to the highest specifications and considerations to maximise comfort and safety. In short, they are second to none!”

Sheena Byrom OBE – Activist, Midwife, Speaker and Author

“Brilliant, like the wide rims so mums can sit on the side and swivel their legs round to get in and out, much safer. And, you can get your legs under the rim, so much more comfortable for midwives ”

A. Bentley NHS Midwife

“Let me introduce you to Keith Brainin who provided us with water birth pools for our birth centres. His pools are brilliant and the service he provides is excellent”

Dr Tracey Cooper MBE – Chief Midwife for the North East and Yorkshire at NHS England

“Your water birth pools have revolutionised birth”

Caitlin Wilson Senior Midwife, Meadow Birth Centre, Worcester District Hospital

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

Karen Werrbach MSN, RNC-OB, NEA-BC

” Keith’s knowledge of fixed birth pools and expertise in waterbirth pools is outstanding. With over 35 years of experience within the industry, Keith has developed the highest standard birthing pools on the market.”

Jane Palmer Private midwife, lactation consultant and educator

 

 

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Winner – 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.

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.

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.


(The new Active II Water Birth Pool takes the original design to new levels of comfort and performance)

Note: this article taken from “Building Better Healthcare” magazine – November 2015

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We’re uniquely qualified to be of service

We’ve been dedicated to designing highly specialised pools for labour and birth 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.

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

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

We’ve supplied 1,000’s of pools over the past 35 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.

Mothers and midwives love our water birth pools.

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

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

Buyers like the fact that they’re the safest on the market, built to last for decades and guaranteed for life.

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.

Our pools are packed in sturdy wooden crates in accordance with international shipping regulations and always arrive in perfect condition.
Over the decades we have developed the ability to provide first class after sales service world-wide.
Our plumbing and lighting systems utilise components that are familiar to electricians and plumbers world-wide.
We guarantee that you will be delighted with your birthing pool and appreciate the support and service that we provide.
But don’t take our word for it, find out what clients have to say  by clicking here.

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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 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.

 Ficore® composite has many advantages:

  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 7 x longer.

Structural and engineering advantages

If you hold two equivalent size samples of commonly used material 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 which  helps mothers relax and feel more 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.

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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

DSC_5440

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

DSC_5456

Example 2) Emergency evacuation utilising the safety seat

DSC_5469

The mother is moved into position under the safety seat

DSC_5471

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

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

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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 200 kg
  • Active II Water Birth Pool: 2050 x 1810 x 970mm 220kg
  • Venus Birth Pool: 1950 x 1420 x 890mm 185 kg
  • Venus II Water Birth Pool: 2050 x 1420 x 890mm 205kg
  • 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:  Active II Water Birth Pool – front fixing bracket

Measure 1330 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 and right

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: Venus II Water Birth Pool

– front fixing bracket

Measure 1330 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 and rightt

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.

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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.

Please note: If you want to use a product that is not chloride based please contact us for approval.

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.

If you are duty flushing the taps with hot water/steam add 10cm of cold water to the pool first.

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:

 

The benefits of using water for labour and birth are well known, here are the facts…

The benefits of using water for labour and birth are well known…

Here are the facts…

  1. Relaxing in a deep pool of warm water can be a wonderful aid in labour. It’s worth having a pool mainly for this reason.
  2. Using a birth pool helps mothers to manage pain in labour and considerably reduces the need for medical pain relief.
  3. The buoyancy of the water supports the mothers body weight allowing her to relax more easily and deeply. They can cope better with contractions and also rest more comfortably in between them.
  4. It’s easier to use upright or squatting positions and move freely from one position to another, than it is on land.
  5. Being in a birth pool gives mothers an increased feeling of privacy and security. This enhances the secretion of hormones which stimulate uterine contractions and act as natural pain killers and relaxants.
  6. Studies show that labours tend to be shorter overall when a woman enters the pool at around 5cms. dilation.
  7. Fewer women need the help of obstetric interventions.

Women who receive less medical intervention generally stay in hospital for a shorter period of time.

The combination of an intervention free birth – with a short hospital stay result in a better experience for mother and baby.

Hospital staff and resources can be employed more efficiently.

Importantly – this results in significant financial savings!

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

Click here to learn more about our water birth pools and find out how they will deliver for you.

 

 

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

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 labour to unfold.

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Water Birth Pool – Health and Safety Concerns

Many water birth pools on the market are equipped with features that at first might seem safe or even an advantage, but in reality present risks.

(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.

2018: Active Birth Pool at the award winning Meadow Birth Centre, Worcester

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.

2019: Venus Water Birth Pool, Peterhead Hospital

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.

No other birthing pool on the market comes close to giving mothers and midwives this level of comfort and support.

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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.

Hp7

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.

The benefits of labouring in water for overweight and obese mothers

Excerpt from article published by Big Birtha who provides information and support for bigger mums and mums to be.

All women are more buoyant and supported by water, it’s one of the reasons swimming and aqua aerobics are particularly good forms of exercise while pregnant.

But the benefit is likely to be greater for obese women, as fatter bodies are naturally more buoyant.

The buoyancy and support provided by water eases movement, which may make both maintaining an active labour and facilitating access for monitoring easier.

On land, it is cumbersome and difficult for a heavily pregnant woman of any size to quickly move between kneeling, reclining, sitting, leaning, crouching, turning from front to back etc.

In water, it is simple and easy to shift to whatever position is most comfortable/convenient, even midway through contractions.

Being in water also promotes positions which are more agreeable for birthing. Lying flat on your back on a bed is one of the worst positions to be in during labour.

When you are on your back you are working against gravity; actually trying to push the baby out uphill.

It’s only a slight incline, but it’s there.

To add to the problem, when lying down, your body weight is also resting on your coccyx (tailbone), forcing it into the pelvic cavity and reducing space for the baby.

In water, even if you were to float on your back, you wouldn’t be putting the same pressure on your tailbone, and you are far more likely to take an upright position, crouching or kneeling, for instance; positions which on land are uncomfortable to maintain, but not in water.

This frees up your coccyx to keep out of the way.

It is well documented that warm water reduces pain felt by labouring women, and decreases the use of other pain relief.

Given the issues with providing epidural anaesthesia to obese women, it seems sensible that using water; an effective non-pharmaceutical intervention to help with pain should be an attractive alternative?

Obese women are at increased risk of having longer labours, and of moving on to instrumental delivery and caesarean sections for ‘failure to progress’.

Yet immersion in water has been shown to significantly reduce the length of labour in ‘normal’ sized women.

It doesn’t take much of a leap of imagination to consider that water might help to address this problem, at least in some obese women?

BigBirtha.co.uk...

Active Birth Pools are specially designed for to accomodate bigger mothers enabling them to move and benefit from the positions natural to labour and birth.

Various means of entry and exit from the pool as well as emergency evacuation have been considered and designed for to safeguard  over weight mothers and the midwives who care for them.

Groundbreaking research confirms benefits of water birth

Systematic review and meta-analysis to examine intrapartum interventions, and maternal and neonatal outcomes following immersion in water during labour and waterbirth

Library of Medicine

Abstract

Objectives: Water immersion during labour using a birth pool to achieve relaxation and pain relief during the first and possibly part of the second stage of labour is an increasingly popular care option in several countries. It is used particularly by healthy women who experience a straightforward pregnancy, labour spontaneously at term gestation and plan to give birth in a midwifery led care setting. More women are also choosing to give birth in water. There is debate about the safety of intrapartum water immersion, particularly waterbirth. We synthesised the evidence that compared the effect of water immersion during labour or waterbirth on intrapartum interventions and outcomes to standard care with no water immersion. A secondary objective was to synthesise data relating to clinical care practices and birth settings that women experience who immerse in water and women who do not.

Design: Systematic review and meta-analysis.

Data sources: A search was conducted using CINAHL, Medline, Embase, BioMed Central and PsycINFO during March 2020 and was replicated in May 2021.

Eligibility criteria for selecting studies: Primary quantitative studies published in 2000 or later, examining maternal or neonatal interventions and outcomes using the birthing pool for labour and/or birth.

Data extraction and synthesis: Full-text screening was undertaken independently against inclusion/exclusion criteria in two pairs. Risk of bias assessment included review of seven domains based on the Robbins-I Risk of Bias Tool. All outcomes were summarised using an OR and 95% CI. All calculations were conducted in Comprehensive Meta-Analysis V.3, using the inverse variance method. Results of individual studies were converted to log OR and SE for synthesis. Fixed effects models were used when I2 was less than 50%, otherwise random effects models were used. The fail-safe N estimates were calculated to determine the number of studies necessary to change the estimates. Begg’s test and Egger’s regression risk assessed risk of bias across studies. Trim-and-fill analysis was used to estimate the magnitude of effect of the bias. Meta-regression was completed when at least 10 studies provided data for an outcome.

Results: We included 36 studies in the review, (N=157 546 participants). Thirty-one studies were conducted in an obstetric unit setting (n=70 393), four studies were conducted in midwife led settings (n=61 385) and one study was a mixed setting (OU and homebirth) (n=25 768). Midwife led settings included planned home and freestanding midwifery unit (k=1), alongside midwifery units (k=1), planned homebirth (k=1), a freestanding midwifery unit and an alongside midwifery unit (k=1) and an alongside midwifery unit (k=1). For water immersion, 25 studies involved women who planned to have/had a waterbirth (n=151 742), seven involved water immersion for labour only (1901), three studies reported on water immersion during labour and waterbirth (n=3688) and one study was unclear about the timing of water immersion (n=215).Water immersion significantly reduced use of epidural (k=7, n=10 993; OR 0.17 95% CI 0.05 to 0.56), injected opioids (k=8, n=27 391; OR 0.22 95% CI 0.13 to 0.38), episiotomy (k=15, n=36 558; OR 0.16; 95% CI 0.10 to 0.27), maternal pain (k=8, n=1200; OR 0.24 95% CI 0.12 to 0.51) and postpartum haemorrhage (k=15, n=63 891; OR 0.69 95% CI 0.51 to 0.95). There was an increase in maternal satisfaction (k=6, n=4144; OR 1.95 95% CI 1.28 to 2.96) and odds of an intact perineum (k=17, n=59 070; OR 1.48; 95% CI 1.21 to 1.79) with water immersion. Waterbirth was associated with increased odds of cord avulsion (OR 1.94 95% CI 1.30 to 2.88), although the absolute risk remained low (4.3 per 1000 vs 1.3 per 1000). There were no differences in any other identified neonatal outcomes.

Conclusions: This review endorses previous reviews showing clear benefits resulting from intrapartum water immersion for healthy women and their newborns. While most included studies were conducted in obstetric units, to enable the identification of best practice regarding water immersion, future birthing pool research should integrate factors that are known to influence intrapartum interventions and outcomes. These include maternal parity, the care model, care practices and birth setting.

Prospero registration number: CRD42019147001.

Keywords: Maternal medicine; PRIMARY CARE; Pain management.

Research review backs benefits of water births for mothers and babies  

Nursing Times

Water births provide “clear benefits” over standard care for healthy mothers and their newborns, according to UK researchers.

They found water births were associated with fewer interventions and complications during and after the birth, as well as higher levels of satisfaction for the mother.

“Water immersion is an effective method to reduce pain in labour, without increasing risk”

Study authors

Researchers compared the extent of healthcare interventions needed during and after labour to see if outcomes differed between a water birth and standard care – without a birthing pool.

They noted that a water birth involves using a birthing pool to achieve relaxation and pain relief, with the mother either exiting the pool for the birth, so the newborn can emerge into air to breathe, or remaining in the pool and bringing the newborn to the surface to start breathing.

They trawled research databases looking for relevant studies published over 20 years between 2000 and 2021, finding 36 studies involving 157,546 women. Most were carried out in obstetric units.

The study results showed that a water birth, regardless of whether women birth in or out of the pool, “has clear benefits to women” in obstetric units, where most births take place and where interventions and complications are more likely than in midwife-led units.

A waterbirth was as safe as standard care for healthy mothers and their newborns, they said in the journal BMJ Open.

Compared with standard care, a water birth significantly reduced the use of epidurals, injected opioids, episiotomy, as well as pain and heavy bleeding after the birth.

In addition, it increased mothers’ satisfaction levels and the odds of an intact perineum. There was no difference in the rate of Caesarean sections, said the study authors from Oxford Brookes University.

“Water immersion can significantly increase the likelihood of an intact perineum and reduce episiotomy, an intervention which offers no perineal or foetal benefit, can increase postnatal pain, anxiety, and impact negatively on a woman’s birth experience,” they said.

However, they observed more instances of umbilical cord breakage among water births, but the rate was still low – 4.3 per 1,000 births in water compared with 1.3 per 1,000 births with standard care.

This finding may be linked to pulling on the umbilical cord when the newborn is brought up out of the water, the researchers suggested.

Overall, they stated: “Water immersion provides benefits for the mother and newborn when used in the obstetric setting, making water immersion a low-tech intervention for improving quality and satisfaction with care.

“In addition, water immersion during labour and waterbirth alter clinical practice, resulting in less augmentation, episiotomy, and requirements for pharmacological analgesia,” they said.

They concluded: “Water immersion is an effective method to reduce pain in labour, without increasing risk.”

However, they acknowledged that information on birth settings, care practices, interventions and outcomes varied considerably among the included studies, and few were carried out in midwife-led units or in the mother’s home, which may have affected the findings of the analysis.

To strengthen the evidence base, future research should include factors that are known to influence interventions and outcomes during and after labour or birth, they added.

For example, how many children a woman has already had, where she gives birth, who looks after her, and the care she receives.

“The challenge now is to ensure this choice is open to all women wherever they live”

Clare Livingstone

Commenting on the research, Clare Livingstone, professional policy advisor at the Royal College of Midwives, said: “This is really good news for women choosing to have a water birth or thinking of having one.

“There has been previous research outlining the benefits for women and this significant study adds weight to those. It is also positive because it is more information for women when deciding how they want to give birth.”

She said: “Water births are becoming more widely available for women across the UK, but this isn’t the case everywhere. The challenge now is to ensure this choice is open to all women wherever they live.”

Ms Livingstone added: “What is needed now is to see more research into water births in midwife-led settings and in women’s homes. This will give us a broader picture of the impact of water births.”

Birth under water – Michel Odent

Michel Odent’s groundbreaking report “Birth Under Water” that was published in the Lancet in December 1983 is widely regarded as the seminal moment in time when the use of water for labour and birth entered our consciousness.

I’d personally like to thank Michel for being the inspiration that led me to begin to create and develop water birth pools in 1987 and for facilitating the birth of my son Theo at home in 1988.

Keith Brainin – Founder & Director Active Birth Pools

Birth under water – Michel Odent

Originally published in the Lancet: 1983

Centre Hospitalier Général de Pithiviers, PIthiviers 45300, France

The 100th birth under water in our hospital in June provided my team with an opportunity to summarise our experience of the use of water in an obstetric unit.

Since a report on birth under water in 1805,1 the subject has been rarely broached in the medical literature.

In Pithiviers, a hospital which is, in other respects, a conventional state hospital,2 a small pool has been installed close to the homely birthing room.

This pool is large enough (2m in diameter) and deep enough (about 0.7m) to make it easy for a woman in it to change her posture.

Many parturients feel and irresistible attraction to water. We don’t advise women to try the pool; we simply offer the pool as a possibility.

The water is ordinary mains tap water, at a temperature of 37 °C. The water is not sterilized, and contains no chemicals or additives on any sort.

We tend to reserve the pool for women who are experiencing especially painful contractions (lumbar pains, in particular), and where the dilation of the cervix is not progressing beyond about 5cm. 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 in the pool, especially if the lights are dimmed.

It is possible to check the fetal heartbeat regularly with a small ultrasound stethoscope or with a traditional obstetrical stethoscope. Most women choose to leave the water in the second stage.

We believe that the warm pool facilitates the first stage of labour because of the reduction of the secretion of nor-adrenaline and other catecholamines; the reduction of sensory stimulation when the ears are under water; the reduction of the effects of gravity; the alteration of nervous conduction; the direct muscular stretching action; and peripheral vascular action.

Other factors, however, are difficult to rationalise. We have found, for example, that the mere sight of water and the sound of it filling the pool are sometimes sufficient stimuli to release inhibitions so that a birth may occur before the pool is full.

We have observed that water seems to help many parturients reach a certain state of consciousness where they become indifferent to what is going on around them.

Although nearly all the women who enter the pool leave it before birth, the process of delivery can sometimes be so extraordinarily fast under water, that some parturients do not leave the pool at the second stage.

Birth under water is therefore not exceptional in our unit, although it may not be intentional. During the second stage, immersion in warm water seems to help women to lose inhibitions. Most women cry out freely during the last contractions.

When the birth happens under water, the newborn infant is brought gently to the surface and placed in the mother’s arms. This is always done within seconds but without rushing (I am present at the pool for every underwater delivery).

Our experience confirms that the newborn’s first breathing is triggered by contact with the air and the sudden difference in temperature.

There is no risk of inhalation of water. It is useful to remember that in the human species carotid chemoreceptors are thought to be insensitive at birth, and very likely play no part at the time of the first cry. 3,4,5 Only 2 newborn infants out of 100 needed suction of the upper respiratory tract and a short period of manual ventilatory support.

At the time of first contact, most mothers are in a vertical position, kneeling in the water.  They hold the baby in their arms in such a way that skin-to-skin and eye-to-eye contact are as perfect as possible.

An early demonstration of the rooting reflex is almost the rule, and a first sucking 20 min after the birth is common.

Water seems to facilitate the development of the mother-infant relationship. We cut the umbilical cord and help the mother leave the pool just before expulsion of the placenta.

We consider that there might be a risk of water embolism if the mother were to stay in the pool after this time. In 100 underwater deliveries there were 2 manual removals of placenta (our general rate is less than 1%).

All the presentations were cephalic. In breech presentations, our strategy is to use the first stage as a test before deciding on either a vaginal delivery or a caesarian section: in these cases we prefer not to interfere with drugs or with a bath.

Among the 100 women who gave birth underwater, there were 43 primipara, 37 secundiparas, 14 para 3, 2 para 4, one para 5, one para 6, and one para 7.

The youngest was 19 and the oldest was 43. The average age was 28. The lowest birth weight was 2.15kg and the highest was 4.40 kg, we did not perform any episiotomies.

All the tears (of which there were 29) were first degree. We had no infectious complications, even where the membranes were already broken.

There were no perinatal deaths. One infant was transferred to a paediatric unit one day after the birth with groaning and respiratory failure, symptoms which were diagnosed as subarachnoid haemorrhage after delivery in the posterior position at 37 weeks.

Only one infant was jaundiced and required phototherapy (15mg/dl bilirubin on the second day). One of the infants born under water died suddenly some weeks later, although it was previously considered to be perfectly healthy.

We have found no risk attached either to labour or to birth under water, and in any hospital where a pool is in daily use, a birth under water is bound to happen now and then.

Compared with the supported squatting position in the birthing room, we have found that the end of the second stage of labour can be more difficult under water, particularly for primipara, but immersion during the second half of the first stage of labour is helpful, particularly for parturients having painful and insufficient contractions.

It should be possible for any conventional hospital to have a pool situated close to the birthing room and operating theatre.

The use of warm water during labour requires further research, but we hope that other experience would confirm that immersion in warm water is an efficient, easy, and economical way to reduce the use of drugs and the rate of intervention in parturition.

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REFERENCES

1. Embry M. Observation sur un accouchement terminé dans le bain. Ann Soc Méd Prat Montpellier 1805; 5: 13.

2. Gillett J. Chilbirth in Pithiviers, France. Lancet 1979; ii: 894-96.

3. Girard F, Lacaisse A, Dejours P. Lestimulus O 2 ventilatoire à la période néonatale chez l’homme. J Physiol (Paris) 1960; 52: 108-09.

4.  Purves MJ. The effects of hypoxia in the newborn lamb before and after denervation of the carotid chemoreceptors. J Physiol 1966; 185: 60-77.

5.  Purves MJ. Chemoreceptors and their reflexes with special reference to the fetus and newborn. J Devl Physiol 1981;  3: 21-57.

 

Ventilation for the birthing environment

Engineering experts Phil Nedin and Dr. Anna Coppel from Arup’s advanced Technology and Research team look at the science of ventilating a birthing room.

Water Birth Pools expel a high volume of moisture that must be considered when designing the ventilation system for a water birth room.

Ventilation for birthing pool facilities

 

Sheila Kitzinger – Birth in Water: Just a Fad?

Originally published December 11, 2014

World-renowned social anthropologist and birth activist Sheila Kitzinger (1929-2015) was a strong advocate for birth in water, known as waterbirth.

A voice for the ability for every woman to choose, Sheila believed that waterbirth should be an option in mainstream maternity care.

May0042569. Daily Telegraph. Childbirth Guru Sheila Kitzinger for DT Weekend. Picture shows Sheila Kitzinger MBE, she is an author and social anthropologist specialising in pregnancy, childbirth and the parenting of babies and young children. Picture taken in her bedroom, she does most of her writing in her four poster bed. Location Standlake, Oxfordshire. Picture date 27/09/2012

In this piece for Birth Institute, Sheila outlined some of the myths surrounding the birth method, and provides evidence that, in fact, waterbirth is a safe, effective and empowering birthing option.

Learn how to support women through labor and delivery in water. Become a midwife!

Waterbirth is often discussed as if it were a novelty – and a dangerous one at that. It has been assumed to be something that “dropouts” and “weirdoes” choose, or that it is just a recent, passing phenomenon.

In truth, birthing in water is a safe and widespread practice among hospitals in the UK and Western Europe – including Switzerland, Italy, Spain, Portugal, Malta, Denmark, Norway and Finland.

Furthermore, most practices aren’t as new as we think (the Ostend Aquanatal Centre in Belgium has been going strong since the late 80s), and waterbirth practices are here to stay.

Birth in water is safe and effective

Swiss study reveals that when using a pool women require less analgesia, have a lower incidence of perineal trauma, and reduced blood loss at delivery.

NICE (National Institute for Health and Care Excellence) concludes that waterbirth ‘provides the safest form of pain relief’.

There is evidence that being in water improves uterine contractility and speeds dilatation.  So, awoman giving birth in water is less exposed to interventions, including artificial augmentation of uterine activity, and is more likely to feel happy about her birth experience afterwards.

Yet that may not only be due to the water.  Labouring women who give birth in water have more one-to-one care from a midwife they have come to know.

This, combined with a relaxed environment in which the pool is used, contributes to the positive results. More first time mothers have spontaneous births in a freestanding midwifery center or at home than those in hospital.

In the UK, the NHS (National Health Service) states that women should be able to use a pool if they wish, and recommends one be available for every thousand women.

This option has become part of mainstream maternity care, and approximately 75% of all hospitals in the UK have installed birthing tubs.

Many community midwives are eager to raise the homebirth rate, and portable pools, designed to be used by just one woman (to avoid cross-infection), are selling well.

Complicated waterbirthing pools are not necessary.

Chairs, stools and other contraptions restrict movement, and when a woman is immobilized she is more likely to need obstetric intervention.

Francoise Freedman of Birthlight in Cambridge suggests using a pool at home to explore yoga movements during pregnancy.

These include hip-openers, kneeling stretches, and those to prevent and ease back pain, and others for ribcage expansion and pelvic floor toning.

The warm water acting as a cushion also makes a comfortable space to practice perineal massage.

Waterbirth is here to stay

Midwives keen on home birth and waterbirth were once seen as dissidents and mavericks.

This has changed now – so much that in the UK, it is common to encourage women to choose to labour, and perhaps give birth, in water and in their own home.  Pregnant women and midwives are being empowered now.

Every midwife-run and staffed birth center for low risk women offers pools, and midwives are beginning to develop the skills to use them. There is a feast of research from which midwives can learn more.

Ethel Burns, Waterbirth Practitioner, Research Midwife and Midwifery Teacher, and I have drawn up recommendations for practice in a paper available from Oxford Brookes University (read it here).

Sheila Kitzinger (1929-2015) was a social anthropologist of birth and an advocate of home births.  She believed that women have the right to decide the place of birth and kind of care they prefer, and to make an informed choice, based on research and their own values.

Women suffering post-traumatic stress after birth would ring her for help, seeking the confidence to deal with it.  For years she worked with mothers and babies in prison and asylum centers.  She lectured all over the world and her books are published in 23 languages.

Exploring movements in Water

Sheila was a keen proponent of water birth.

Her wonderful article gives us examples of the type and range of movements natural to labour and birth that mothers explore in water.

 

The pool in the photos is an original Oval Portable Water Birth Pool circa 1987  – to my knowledge the first specially designed portable water birth pool ever produced.

Please click here for a copy of Exploring movements in water:

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