June 2025
Midwife Expert News
Crete conference • New studies and data • Pool Room Design Launch
Summer has arrived in the UK and we're delighted to share some key updates from MidwifeExpert. We’ve launched our new Waterbirth Pool Room Design and Refresh Service, supporting hospitals and birth centres in creating tranquil, functional spaces for birthing families. Whether you’re refreshing a room or starting anew, we’re here to guide you.
We’re also highlighting recent studies on waterbirth and physiological labour, underscoring the importance of evidence-based, respectful care in every setting.
Thank you for being part of the MidwifeExpert community
Dianne and the Midwife Expert Team
From Immersion to Seizure: A Novel Case of Water Intoxication Complicating a Water Birth
Sarah Al-Musawi 1,✉, Rukhsana Iqbal 1, Greeshma Rajeev 1 Cureus 2025 May 18;17(5):e84349. doi: 10.7759/cureus.84349
Water immersion birth (WIB) is increasingly used for pain relief during labour, offering high maternal satisfaction and reduced need for epidural analgesia. However, its potential complications, particularly regarding fluid and electrolyte balance, remain underexplored. We report a case of a healthy 33-year-old woman who developed a generalized tonic-clonic seizure two hours after delivering via WIB. Her antenatal course and labour progression were clinically normal; however, she experienced retention of urine and continued fluid intake during her four hours of immersion. Post-seizure investigations revealed serum sodium measured at 124 mmol/L indicated severe hyponatremia and metabolic acidosis. Neurological imaging and EEG were unremarkable. With supportive care and correction of sodium levels, her condition stabilized. This case highlights the possibility of dilutional hyponatremia associated with prolonged WIB, especially when coupled with high fluid intake and delayed urine output. Water immersion may promote vasopressin release, impair free water clearance, and precipitate acute symptomatic hyponatremia. Although WIB is generally safe, prolonged immersion and unmonitored fluid intake may increase the risk of water intoxication. Vigilant monitoring of fluid balance is essential to prevent complications. In selected cases, serum sodium monitoring should be considered, particularly with prolonged immersion or abnormal urinary output.
Comment – stresses the points of knowledge base of physiology and fluid intake of isotonics not just water. Midwifeexpert is now encouraging 2 yearly updates for health practitioners who support waterbirth.
Classical Midwifery Conference in Crete, September 2025
Multiple Presentations by Dianne Garland
Book now
An evaluation of intrapartum pain relief used by Black African and White British women -Bronte Ryan Lauren Philp-von Woyna
https://doi.org/10.12968/bjom.2024.0093 | British Journal of Midwifery, May 2025, Vol 33, No 5
Abstract Background/Aims In the UK, women and neonates from ethnic minority groups are more likely to experience poor outcomes. Ineffective pain relief for Black women may contribute to disparities in outcomes.
This study’s aim was to evaluate methods of intrapartum pain relief accessed by Black African and White British women. Methods This evaluation gathered data from Black African (n=7) and White British (n=40) women’s intrapartum records at a hospital in Birmingham. Data were analysed descriptively.
Results White British women used more pharmacological and non-pharmacological methods of pain relief and accessed water immersion. When a single method of pain relief was used, White British women were more likely to use epidural analgesia, whereas Black African women were most likely to use Entonox.
Conclusions This study highlights the need for further research to understand the differences between Black African and White British women’s use of pain relief during labour and birth. Implications for practice By summarising the provision of intrapartum pain relief across Black African and White British groups, this study aids both professional reflection and insight into why identifying women’s specific ethnic group in policy, practice and research may improve understanding of ethnic disparities.
Characteristics of Women, Intrapartum Interventions, and Maternal and Neonatal Outcomes Among Users of Intrapartum Water Immersion: The UK POOL Cohort Study Julia Sanders et al. 2025 Birth May 12.
doi: 10.1111/birt.12921. Online ahead of print.
Background: The POOL study explored intrapartum water immersion and associated maternal and neonatal outcomes at 26 UK sites 2015-2022.
Methods: Retrospective and prospective data captured in electronic maternity and neonatal UK National Health Service (NHS) information systems. Analysis-(a) proportions of women using and factors associated with water immersion during labour or birth; (b) outcomes among "low-risk" women who used water immersion during labour or birth; (c) management and outcomes of the third stage of labour following waterbirth.
Conclusion: This large UK study of water immersion during labour and birth provides important information for policymakers, maternity health professionals, and for women and families considering the option of intrapartum water immersion. Care providers need to ensure equal access to intrapartum water immersion across demographic groups and provide women with evidence-based rates of obstetric interventions that take into account their risk status and birth choices.
In case you missed this last year – at least they say its a “reasonable choice”
Redefining Waterbirth Spaces: The Rationale Behind MidwifeExpert’s New Design and Refresh Service
At MidwifeExpert, we believe that the environment in which birth takes place is more than just a backdrop—it’s a vital part of the experience for families and a daily reality for staff. That’s why we’re proud to officially launch our new Waterbirth Pool Room Design and Refresh Service, created to help maternity units around the world elevate their birthing spaces with confidence, clarity and care.
This service is the result of decades of hands-on experience and global insight. As Dianne Garland, founder of MidwifeExpert, explains:
“During my travels around the world, I’ve seen the very best and unfortunately, the worstof pool room design. It’s clear to me that both mothers and staff deserve the best environments possible: spaces that are safe, efficient and emotionally supportive.”
Drawing on this international perspective, our consultancy offers tailored design solutions and recommendations that blend clinical excellence with calming aesthetics. From optimised equipment selection and placement to lighting and layout, every detail is considered to support physiological labour and enhance staff workflow.
We also understand the financial pressures many units face. That’s why our service is designed to maximise the efficiency of available budgets, ensuring that even modest investments can lead to meaningful improvements in safety, satisfaction, and reputation.
Whether you’re refreshing an existing room or starting from scratch, MidwifeExpert is here to help you create a space that reflects your commitment to excellence in maternity care.
Water birth: a systematic review and meta-analysis of maternal and neonatal outcomes
Am.J.Obs & Gyn.March 2024 Jordan A. McKinney, MD, MBAa∙ Gustavo Vilchez, MDb ∙ Alicia Jowers, APRN, CNMa ∙ Andrew M. Kaunitz, MDa ∙ Kendall E. Lewis, MDa ∙ Luis Sanchez-Ramos, MDd
Objective
This systematic review and meta-analysis aimed to conduct a thorough and contemporary assessment of maternal and neonatal outcomes associated with water birth in comparison with land-based birth.
Results
Of the 20,642 articles identified, 52 were included in the meta-analyses. Based on data from observational studies, water birth was not associated with increased probability of maternal infection compared with land birth . Patients undergoing water birth had decreased odds of postpartum hemorrhage. Neonates delivered while submerged in water had increased odds of cord avulsion and decreased odds of low Apgar scores , neonatal infection , neonatal aspiration requiring resuscitation , and neonatal intensive care unit admission .
Conclusion
When compared with land birth, water birth does not appear to increase the risk of most maternal and neonatal complications. Like any other delivery method, water birth has its unique considerations and potential risks, which health care providers and expectant parents should evaluate thoroughly. However, with proper precautions in place, water birth can be a reasonable choice for mothers and newborns, in facilities equipped to conduct water births safely.
Brio Innovative Journal of Novel Research (BIJNR)
Jul - Dec 2024 Issue:2 Volume: 1
“Revolutionizing Childbirth: The Role of Nurses in Supporting Water Births and Natural Labor” Avaniben Vinodbhai Patel1, Dr. Payal Sharma2 1PhD Research Scholar, 2Research Supervisor Index Nursing College, Malwanchal University, Indore M.P Abstract: Childbirth is one of the most significant experiences in a woman's life. Over the years, birthing practices have evolved from traditional home births to highly medicalized hospital deliveries. However, with growing interest in holistic and patient-centered care, many women are choosing alternative birthing methods such as water birth and natural labor. Water births, where labor and delivery occur in a tub of warm water, and natural labor, which minimizes medical interventions, are increasingly being embraced for their potential benefits, including pain relief, shorter labor duration, and improved maternal satisfaction. Nurses and midwives play a crucial role in supporting these birthing practices. Their responsibilities include patient education, monitoring maternal and fetal well-being, providing emotional and physical support, ensuring safety, and managing emergencies when necessary. While water births and natural labor have been associated with numerous benefits, they also pose certain challenges, including infection risks, lack of standardized protocols, and limited accessibility. This review article provides an in-depth exploration of water birth and natural labor, emphasizing the nurse’s role in facilitating safe and effective alternative birthing practices. The discussion highlights global trends, research-based evidence, challenges, and future directions for integrating these methods into mainstream maternal care.
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