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.
Women's Knowledge, Perception and Acceptability of Waterbirth: A Cross-Sectional Survey of Tertiary Hospitals in Abuja, North-Central Nigeria
MC Eze, HM Abdul, BO Altraide, VN Nwude, C Onyema - IPS Journal of Public Health, 2025
Women had good knowledge and perception of waterbirths high level of interest and willingness if service is offered.
Background: Waterbirth is practised, accepted and acknowledged in many countries worldwide as one of the natural options for labour and childbirth due to its evidence-based benefits. Despite its increasing popularity in many regions of the world, waterbirth is not yet widely practiced in Abuja, Nigeria. Understanding women’s perceptions, knowledge and acceptability regarding the practice is essential to inform evidence-based integration into maternity services.
Objectives: The objectives of the study were to assess the knowledge, perceptions and acceptability regarding waterbirth among antenatal women in public tertiary hospitals in Abuja, north-central Nigeria.
Methods: The study adopted a quantitative descriptive cross-sectional design. The setting was the three government-owned tertiary hospitals in Abuja. 331 women were randomly sampled from those who met inclusion criteria, and data were collected through semi-structured questionnaires. Data were analysed using SPSS version 27 and involved the use of descriptive and inferential statistics; the data were presented in frequency tables, percentages, grand means, standard deviations, and bar charts.
Results: The questionnaire return rate was 90%, with a total of 331 responses. More than half, 190 (57.4%), of the women had a high level of knowledge; 131 (39.6%) had moderate knowledge; and very few, 10 (3.0%), had a low level of knowledge about waterbirth. Perception about waterbirth was positive for the majority, 278 (83.9%); the grand mean of 2.95±0.92 was greater than the criterion mean of 2.50. More than three quarters more – 255 (77.0%) of the women indicated a high extent of acceptability for waterbirth; the grand mean of 2.79±0.89 was greater than the criterion mean of 2.50. There was a statistically significant relationship between perception and extent of acceptability of waterbirth as p<0.05 (n = 408, r = 0.58, p = 0.00).
Conclusion: Women in Abuja have good knowledge of waterbirth, positive perceptions, and a high level of acceptability, suggesting an interest and willingness to embrace services if offered. There may be need further studies to validate these findings.
Exploring Barriers and Facilitators to Waterbirth Implementation: A Qualitative Study of Maternity Care Providers in Tertiary Hospitals in Abuja, Nigeria
MC Eze, HM Abdul, BO Altraide, VN Nwude, C Onyema - IPS Journal of Public Health, 2025
Highlights potential barriers, personal factors, lack of (local) evidence, non existent waterbirth services, finances, cultural beliefs and lack of awareness.
Potential facilitators-training of personnel, guidelines and management support.
Background: Globally, waterbirth is recognized as a birthing option that offers women benefits such as pain relief, relaxation and comfort during labour and a positive childbirth experience, while reducing the need for medical interventions. Despite evidence-based benefits, its implementation remains limited in African settings, including Abuja, Nigeria, where waterbirth is yet to be introduced.
Objective: The objectives of the study were to explore the perspectives of maternity care providers regarding potential barriers and facilitators to the implementation and use of waterbirth in public tertiary hospital settings in Abuja, North-Central Nigeria.
Methods: The study adopted a descriptive qualitative approach. Purposive sampling technique was used to select the three public tertiary hospitals within Abuja. Participants consisted of 13 midwives and 10 obstetricians with varying years of experience in maternity care, purposively sampled until data saturation. A semi-structured interview guide was used for the data collection and data were manually analysed using the Braun and Clarke six steps thematic analysis.
Results: Findings were grouped into two themes: the potential barriers and potential facilitators to waterbirth implementation and use. Potential barriers were various personal factors, lack of local evidence, non-existence of services, institutional constraints, among others. Potential facilitators were availability of services, training or education of maternity care providers, adequate funding, stakeholder sensitisation, provision of waterbirth resources, including protocols/guidelines and institutional support.
Conclusion: Integrating waterbirth practices into Nigeria’ maternal healthcare is feasible and this study provides baseline understanding of maternity care provider’s views regarding potential facilitators and barriers. Adequate institutional support, sufficient funding, provision of infrastructure, including protocols/guidelines and appropriate training of providers are critical. Equally, important are inclusion of waterbirth into the national maternal health policy document, as well as public sensitisation to increase awareness and demystify implementation and use of waterbirth.
Bridging Cultures Through Waterbirth: A Conversation with the Doula Collective India
This week in London, I had the pleasure of reconnecting with Divya Deswal from the Doula Collective India; a valued colleague I first met in Delhi and again in Cochin back in 2012. Our conversation centred around the ongoing development of waterbirth worldwide and the barriers that still exist in many countries. Cultural and medical dynamics often limit women’s access to water even for labour, let alone birth, so it’s invaluable to discuss perspectives and gain insight from professionals around the world.
Following our conversation, we’re hoping to organise a series of online teaching sessions in the coming months for doulas, midwives, and medical teams in India. These sessions will focus upon the safety and benefits of waterbirth, supported by robust evidence and numerous published studies, many of which can be found in our MidwifeExpert Newsletters.
I also shared details about my new consultancy service designed to support the creation or redesign of waterbirth pool rooms; a growing global need as maternity spaces evolve.
Lastly, we touched on my forthcoming book and the welcome potential for Indian contributions, including personal stories from families as well as insights from professionals. (If you’re interested in contributing please complete the contact form at the bottom of this newsletter or email info@midwifeexpert.com.)
It was wonderful to catch up with Divya and I hope that the mutual sharing of our expertise leads to productive and positive outcomes.
Crowning Moment: When Our Patron Dropped By
Delegates at this year’s Royal College of Midwives Annual Conference in Birmingham were treated to a truly memorable moment when Her Royal Highness The Princess Royal made a surprise appearance. As Patron of the RCM, her presence was both an honour and an inspiration to all in attendance.
In her address, The Princess Royal expressed heartfelt thanks to midwives and maternity support workers for their unwavering dedication and the life-changing impact they have on women and families across the UK. Her words resonated deeply, reminding us all of the value and visibility of our profession.
We are immensely grateful that Her Royal Highness took the time to join us. Her visit brought a sense of pride and encouragement that will stay with us long after the conference ended. It was a powerful reminder of the importance of our work and the strength of our midwifery community.
Maternal and neonatal outcomes of in-water and out-of-water births in low-obstetric-risk labour: a retrospective observational study at Piacenza hospital. Journal of Biomedical Practitioners Vol.9 No.1 2025
Elisa Piccolo et al
Department of Women's Health, Childhood and Adolescence, UOC Obstetrics and Gynaecology, Piacenza Local Health Unit - Italy
Abstract
INTRODUCTION: The utilisation of birth pool immersion during labour and delivery constitutes one of the primary non-pharmacological methods for alleviating pain. Consequently, an increasing number of women are opting to employ aquatic environments as a means of managing the childbirth experience. However, the literature reports conflicting data and poor-quality evidence on maternal and neonatal outcomes. It becomes important to understand whether water birth is safe for both woman and baby. The objective of this research is to evaluate and compare neonatal outcomes, including infections, admission to the neonatal intensive care unit, and Apgar scores at one and five minutes, alongside maternal outcomes such as vagino-perineal lacerations, postpartum haemorrhage, the duration of labour and the expulsive phase, as well as infections, between water birth and non-water birth scenarios.
METHODS: A retrospective observational cohort study employing a parallel design was undertaken. A total of 698 women with low-risk obstetric pregnancies were included and stratified into two groups based on the type of delivery. Data analysis was performed using STATA 16.0 software, applying both descriptive and inferential statistical methods to assess the study variables. A logistic model was created for the study population to identify which variables may contribute to an increased likelihood of injury to the perineum.
RESULTS: The research sample comprised 698 deliveries, which were evenly distributed between the two cohorts. The groups exhibited homogeneity concerning maternal age, parity, administration of antibiotic treatment during labour, and positivity rates of vaginal-rectal swabs. A further notable discrepancy (p<0.05) was observed in the volume of postpartum blood loss; however, the difference was minimal in both cohorts. Logistic regression analysis revealed that for each 1 cm increase in infant head circumference, the risk of perineal injury increased by 1.3 times (OR = 1.27; p = 0.002).
CONCLUSIONS: The study identified no significant differences in maternal and neonatal outcomes between water and non-water births. Consequently, it appears both suitable and prudent to permit women experiencing low-risk obstetric labour the autonomy to decide whether to deliver in a water-based setting or not. However, further studies are needed. Despite the findings presented, it is crucial to emphasise that further investigation and analysis are absolutely necessary.
Reference Including
[1] Garland D, Jones K. Waterbirths: supporting practice with clinical audit. MIDIRS Midwifery Digest 2000;10(3):333-6.
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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