Multi-professional and organisational perspectives of barriers and facilitators related to birthing pool use

Introduction
Water immersion for labour and/or birth is a low-tech, non-pharmacological pain relief option. Although established as a safe alternative to pharmacological analgesics and associated with benefits such as increased rates of spontaneous vaginal birth and high maternal satisfaction, there remain significant obstacles that inhibit access to and uptake of birthing pool use.

Aims
To identify and synthesise the evidence that explores the facilitators and barriers of birthing pool use from multi-professional and organisational perspectives.

Methods
We employed a systematic integrated mixed methods approach to reviewing the evidence. Databases including MEDLINE, CINAHL, PsychINFO, EMCARE, PROQUEST and Web of Science were searched in April 2021 and March 2022. Results were crosschecked against Google Scholar and the reference lists of papers that met the inclusion criteria. Barriers and facilitators to birthing pool use were extracted from the included manuscripts and these data were then mapped into descriptive statements and further synthesised into overarching themes.

Results
The views of 9,082 multi-professionals (midwives, nurses, obstetricians, neonatologists, students, physicians, maternity support workers, doulas and childbirth educators) were collected from 37 articles (29 studies), across 12 countries. Nine papers analysed a total of 285 institutional policies or guidelines. Five themes were generated: The paradox of prescriptiveness, The experienced but elusive practitioner, Advocacy and tensions, Trust or Trepidation and It’s your choice, but only if it is a choice. The themes emphasised the challenges and barriers women and midwives face in accessing a birthing pool during labour and/or birth. While these factors were commonly found to inhibit women’s sense of control and decision-making, autonomy of choice and birthing pool access were enhanced where personal, contextual, organisational and infrastructural inhibitors were addressed. As such, we exposed how the “swing” between facilitators and barriers directly affects whether birthing pool use is viewed and supported as a genuine option.

Conclusion
The findings revealed the challenges and obstacles of navigating the often conflicting and paradoxical reality of water immersion for labour and birth. Exposing the barriers will aid in combatting negativity, overcoming obstacles and mitigating against organisational and infrastructural challenges. Our results have highlighted that where these inhibitory factors are navigated and/or addressed, change is possible, and the “swing” is in favour of birthing pool use.