The exploration of water immersion policies/guidelines and the impact upon practice of labour and birth: a mixed methods study

Background
The accessibility of water immersion (WI) for labour and/or birth is dependent on the views of the care provider/institution and the policies/clinical practice guidelines (CPGs) that underpin practice. With little quality research on the safety and efficacy of WI the policies and CPGs informing current practice lack the sound evidence base necessary to ensure they are well informed.

Aims
The aims of the study were to determine how WI policies and/or CPGs are informed, who interprets the evidence to inform policy/guideline development and to what extent the policy/guideline facilitate the option of WI for labour and birth.

Method
This study used a mixed-methods approach that included a critical analysis of Australian policies/CPGs, semi-structured interviews with policy/guideline informants and a survey of views of Australian midwives.

Results
Results reveal a limited evidence-base for use of water during labour and birth and that subjective opinion and views inform policy/CPGs and practice. Policies and CPGs pertaining to the use of water for labour and/birth are written from a risk perspective rather than providing the best available evidence to facilitate decision making for women considering this option.

Implications for research and practice
In order to overcome the current paucity of quality research available to determine the extent to which WI is used during labour and birth and more, to address concerns surrounding safety and risks surrounding the practice, there is a need for population level data to be collected. Furthermore, the need for both qualitative and quantitative research is pressing not only to determine outcomes of WI but also to determine experience, perceptions and views of both health practitioners and women within their care. The recommendations from this research can assist in the development of local, national and international policies/CPGs that are reflective of the current evidence-base and may lead
to further review and critical analysis of policies and CPGs for WI.

Conclusion
A comprehensive evidenced-based approach to policy and guideline development for WI, including the best available evidence with incorporation of qualitative data examining views and experiences, is needed to better inform policy/CPGs. Such an approach would assist birthing women and their care providers to make an informed choice about the option of WI for labour and birth.

Ethical Considerations
The research was approved by the Human Research Ethics Committee of the University of South Australia.

Conflict of Interest
The Author declares no conflict of interest.