United Kingdom Council Position
Statement on Waterbirths

Background

1. The Council has welcomed the recommendations from all four countries of the United Kingdom, which support the fact that women should have choice concerning the method of delivery of their babies. It also recognises the need to support the midwife who aims to assist women in making that choice.

2. The Council in its paper ‘The Scope of Professional Practice’ (June 1992), recognises that the practice of midwifery ‘requires the application of knowledge and the simultaneous exercise of judgement and skill. Practice takes place in a context of continuing change and development.

   Such change and development may result from advances in research leading to improvements in treatment and care, from alterations to the provision of health and social care services, as a result of changes in local policies and as a result of new approaches to professional practice.

   Practice must, therefore, be sensitive, relevant and responsive to the needs of individual patients and clients and have the capacity to adjust, where and when appropriate, to changing circumstances.

3. The Council has had brought to its attention a number of concerns raised by mothers and consumer groups about the potentially difficult relationships which may arise between a woman’s autonomy, a midwife’s professional judgement and accountability and a provider unit’s local policy in relation to waterbirth as a woman’s chosen method for the delivery of her baby.

4. The following Council position, based on the Council’s Midwives Rules, Midwife’s Code of Practice, Code of Professional Conduct and Scope of Professional Practice has been developed to address these concerns. This position statement will be kept under review.’

The Council’s Position Regarding Waterbirth

5. The Council recognises that waterbirth is preferred by some women as their chosen method for delivery of their babies. Waterbirth should, therefore, be viewed as an alternative method of care and management in labour and as one which must, therefore, fall within the duty of care and normal sphere of the practice of a midwife. Waterbirth is not considered to be a ‘treatment’.

6. The use of water for labour and delivery has not yet been evaluated or researched. The Department of Health has commissioned the National Perinatal Epidemiology Unit (NPEU) to undertake a survey on labour and birth in water.

   The council understands that results are expected to be available in the near future. The NPEU has stated that the ‘…study will not provide conclusive information on benefits or risks but will provide figures on the extent of use and associated problems

. It will also clarify the feasibility of, and inform the appropriate design for, our experimental study of this practice’. The midwife should therefore be aware that advice may change in the future when the results of this and other studies are available.

The Midwife’s Responsibility

7. The Council has set out its position and requirements, in the interests of the Safety of mothers and babies, in a number of documents. The following paragraphs draw together a referenced position regarding the midwife’s position and responsibility in relation to waterbirths.

7.1 Rule 40(1) (Midwives Rules, November 1993) states that ‘A practicing midwife is responsible for providing care to the mother and baby during the antenatal, intranatal and postnatal periods’. A midwife should not, therefore, refuse to continue to provide care for a mother. If the midwife has reason to believe that there is significant risk in the type of care the mother is requesting she should discuss with the mother her wishes, giving detailed information relating to her requests, options for care and any risk factors so that the mother may make a fully informed decision about her care.

7.2 The midwife should discuss the matter with her supervisor of midwives in order to seek further professional advice about the most appropriate action in the circumstances. If alternative arrangements are impossibleto make, the midwife should not withdraw care and, thereby, leave the mother unassisted for deivery.

7.3 A detailed record (Rule 42. Midwives Rules, November 1993) should be made of any such discussion. If the mother rejects the midwife’s advice, further advice and discussion with the supervisor of midwives should be sought.

   Such advice and information should be recorded and signed by both the midwife and her supervisor. The midwife must continue to give unbiased care to the best of her ability, seeking her peer support as necessary.

7.4 The midwife’s responsibility for competency in new skills is set out in the Midwife’s Code of Practice (May 1994) paragraphs 20 – 23. Key principles include:

7.4.1 ‘…you are responsible for maintaining and developing …competence.. during initial and ‘…you are responsible for maintaining and developing …competence.. during initial and subsequent midwifery education’.

7.4.2 …it is necessary for you to acquire competence in new skills…and you must ensure that you have received adequate preparation’.

7.4.3 When your practice requires the acquisition of new skills you should consult with your supervisor of midwives with regard to the requisite preparation and experience

7.5 It is the duty of the supervisor of midwives, being mindful of the woman’s right to choose, to ensure that agreed local policies are formulated with the advice of practicing midwives and supervisors of midwives, and are easily available to all within their supervisory jurisdiction.

   The local policy should ensure that the midwife has the required support in all settings. In respect of home births in particular, the availability of emergency services is essential, to enable the best possible arrangements to be made for the care of the mother and baby. The recently revised Midwife’s Code of Practice (paragraphs 13-19) provides more detailed information.

7.6 The Council’s Code of Professional Conduct (June 1992) has particular relevance in this matter. It states, in four of its clauses:

‘As a registered nurse, midwife or health visitor, you are personally accountable for your practice and, in the exercise of your professional accountability, must:

1. ensure that no action or omission on your part or within your sphere of responsibility, is detrimental to the interests, condition or safety of patients and clients;

2. maintain and improve your professional knowledge and competence;

3. acknowledge any limitations in your knowledge and competence and decline any duties or responsibilities unless able to perform them in a safe and skilled manner and

4. work in an open and co-operative manner with patients, clients and their families, foster their independence and recognise and respect their involvement in the planning and delivery of care.

Local Policy

8. The Council recognizes that employing authorities will wish to develop local policies in relation to the delivery of maternity services. In accordance with the Midwife’s Code of Practice (paragraph 22) the Council considers it essential for supervisors of midwives and other Practicing midwives to be actively involved in the development of such policies.

   The purpose should be to ensure that these policies recognise fully the role and responsibilities of the midwife and, above all else, the woman’s right to choose.