Review finding | Codes | Studies contributing to the findings |
---|---|---|
Education, training, mentorship, and experience leads to knowledge, competence, and confidence in facilitating water immersion | Limited opportunities for education both during training and as midwives | |
Training and experience improved competence and competence | ||
Additional training is not needed | ||
Mentorship is key | ||
Midwifery-led spaces promote greater confidence | ||
Water immersion is a midwifery option in demand that facilitates physical and psychological benefits and normal physiological birth | Facilitates normal birth | |
Reduces intervention and adverse events | ||
Promotes comfort, protection, relaxation, and a more positive birth experience | ||
Decreased use of analgesia | ||
Promotes empowerment and control | ||
Demand | ||
Midwifery option | ||
Policies and guidelines can be facilitative and prompt implementation of water immersion | Ensure safety for the woman and midwife | |
Alleviate practitioner concerns and promotes confidence | ||
Improved accessibility and availability | ||
Prompt information provision | ||
Participation in development | ||
The importance of medical and organisational support | Easier process | |
As long as guidelines/policies followed, and information provided | [15] | |
Organisational support and leadership are essential | [1] | |
Midwifery champions | Midwives promote and support water immersion | |
Champions are needed | ||
Midwives offer water immersion as an option | ||
Policies and guidelines are often risk averse and do not reflect women's experiences | Focus on risk and safety | |
Precludes high risk, only low risk | ||
Inconsistencies in guidance and contraindications with little underpinning evidence | ||
Authoritative, prescriptive, restrictive, did not include women's views | ||
Not reflective of contemporaneous evidence | ||
Normalise intervention | [23] | |
Resistance stems from fear, lack of experience and support and the view that labour and birth are inherently risky | Obstetricians lack training and experience | |
No support from obstetricians and/or seniors | ||
Legal and insurance barriers | ||
Midwives’ resistance or lack of experience | ||
Infrastructure, cost, and concerns inhibit implementation and accessibility | Resources, few or no pools or the room blocked | |
Maternal collapse and evacuation | ||
Culture | ||
Staffing | ||
Midwives discomfort | ||
Paperwork | [23] | |
Cost | ||
Safety of the baby e.g., drowning | ||
Personal concerns | [32] | |
Waterproof CTG | ||
Women must actively seek and request water immersion | Policies not woman-centred | |
No information antenatally | ||
Women must ask | ||
Midwives influence women’s access | ||
If women don’t ask, there must be no demand | ||
Not a primary option compared to other options | ||
The illusive experienced practitioner | Option removed because experienced/accredited practitioner not available | |
Accreditation or extra training required | ||
'adequately' and 'appropriately' 'experienced', 'qualified', 'registered', responsible', 'competent', 'educated' practitioner |