Waterbirth in Hospitals. Experience of Legacy Health System, Portland Oregon. Hospitals with Maternity Care. 3,984. WB Protocols 1991. 2. WB Protocols Sept 2004. 280. Water Labor Only Sept 2004. 460 . Growth of Waterbirth in the US.
Experience of Legacy Health System, Portland Oregon
(Fortunately OHSU had implemented waterbirth in their midwife training program 9 years ago)
Health System and Hospital Administrators
Risk Management Staff
Liability Insurance Carrier
Medical and Nursing Staff
American—largely critical but based on no actual experience, written by physicians who received neonates transferred from other sites
European—largely supportive and based on large experience. Typically observational reviews of large series (2000-5000) comparing to “land births”
Unable to fine a single credible case of significant maternal or fetal injury directly attributable to waterbirth.
Need to meet OSHA standards for infection control
Allows hospital to more fully address its mission
American Academy of Pediatrics issued its statement—that this practice may be dangerous and should not be done in hospitals except in an IRB-approved RCT setting
They agreed RCT not feasible
Ultimately, they agreed more research not necessary
Create Registry, monitor by hospital quality department.
No need for Registry—just keep track of data to assure safety.
Facilities confirmed safety of load
Medical Staff Credentialing Criteria Developed
RELATED PRIVILEGES: CNM privileges
CERTIFICATE REQUIRED: Documentation of water birth training including
proof of proctoring.
EXPERIENCE: Documentation of five (5) cases
(for information only – not required monitoring)
INDICATIONS FOR USE OF PROCEDURE.
To manage safety and pain control of labors managed with water immersion.
ONGOING MINIMUM PERFORMANCE REQUIREMENTS REQUIRED TO REAPPOINT: None
Reviewed and revised with info from IRB: 2/14/06 – IRB Cmte reviewed request for water births to be a research study. Reviewers felt that this is not a research study, that activity should be monitored by Quality and that individuals should be credentialed to perform water birthing.
LPH, MH & MP reviewed: N/A - Only available at LSCH
Credentials approved: 4/17/06 MEC approved: 4/18/06 Board approved: 4/20/06
Pitocin augmentation 42
C-section percent 14%
Percent success in tub 59%
No analgesia 90
waterbirth the next time!
Add program to additional Legacy Hospitals
Change “thin meconium” practice
Change “induced labor” contra-indication after pitocin stopped
Use as basis for low-risk patient management