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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.

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waterbirth in hospitals

Waterbirth in Hospitals

Experience of Legacy Health System, Portland Oregon

growth of waterbirth in the us

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
steps to hospital implementation of waterbirth program our journey

Steps to Hospital Implementation of Waterbirth Program—our journey

(Fortunately OHSU had implemented waterbirth in their midwife training program 9 years ago)

parties needing to buy in

Parties needing to buy-in

Health System and Hospital Administrators

Risk Management Staff

Liability Insurance Carrier

Medical and Nursing Staff

presentation given to each group

Presentation—given to each group

Literature review:

American—largely critical but based on no actual experience, written by physicians who received neonates transferred from other sites

presentation given to each group6

Presentation—given to each group

European—largely supportive and based on large experience. Typically observational reviews of large series (2000-5000) comparing to “land births”

key point

Key Point

Unable to fine a single credible case of significant maternal or fetal injury directly attributable to waterbirth.

acog position

ACOG position

Insufficient Data

Need to meet OSHA standards for infection control

benefit to community

Benefit to Community

Allows hospital to more fully address its mission

when all were convinced

When all were convinced:

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

proposal developed for irb

Proposal developed for IRB

They agreed RCT not feasible

Ultimately, they agreed more research not necessary

irb response

IRB Response

Create Registry, monitor by hospital quality department.

hospital quality department response

Hospital Quality Department Response

No need for Registry—just keep track of data to assure safety.

implementation

Implementation

Database Developed

Facilities confirmed safety of load

Medical Staff Credentialing Criteria Developed

Practice Approved

slide17
LSCH CREDENTIALING FOR Water Births

PRIVILEGE CRITERIA

  • EDUCATION: CNM TRAINING

RELATED PRIVILEGES: CNM privileges

CERTIFICATE REQUIRED: Documentation of water birth training including

proof of proctoring.

EXPERIENCE: Documentation of five (5) cases

PROCTORING: None

  • 2. QUALITY MONITORING

(for information only – not required monitoring)

INDICATIONS FOR USE OF PROCEDURE.

To manage safety and pain control of labors managed with water immersion.

  • 3. REAPPOINTMENT CRITERIA

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

outcomes

Total patients

138

Total SVD

117

In Water

81

“On Land”

36

Forceps/Vacuum

0

Total C/S

19

5 minute Apgar scores

7-10

Neonatal admissions

1

Outcomes
outcomes19

Outcomes

Pitocin augmentation 42

Percent 30%

C-section percent 14%

Percent success in tub 59%

Epidurals 38

No analgesia 90

reasons for abandoning waterbirth plans
Reasons for abandoning waterbirth plans
  • Progress too rapid
  • Progress too slow
  • PET/PIH
  • < 37 weeks gestation
  • Prolonged 2nd stage
  • Desired an epidural
  • Patient choice
  • Malpresentation
low apgar babies 2
Low Apgar babies (2)
  • 1 unexplained slow transition, went to NICU for 5 days. Birthed in bed, not in water. Cord arterial pH 7.2
  • 1 with Apgars 2, 4, and 8. Cord separation, responded well to resuscitation.
miscellaneous statistics
Miscellaneous Statistics
  • Average birth weight 8#
  • 10 women had IV pain Rx
  • Primips 73; Multips 65
  • All said they would ONLY do a

waterbirth the next time!

future

Future

Add program to additional Legacy Hospitals

Consider WBAC

Change “thin meconium” practice

Change “induced labor” contra-indication after pitocin stopped

Use as basis for low-risk patient management