Factors influencing the use of birth pools in the United Kingdom: Perspectives of women, midwives and medical staff

Objective
To identify factors influencing the use of birth pools.

Design
Online discussion groups and semi-structured interviews, analysed thematically.

Setting
United Kingdom.

Participants
85 women and 21 midwives took part in online discussion groups; 14 medical staff participated in interviews.

Findings
Factors influencing the use of birth pools were grouped into three overarching categories: resources, unit culture and guidelines, and staff endorsement. Resources encompassed pool availability, efficiency of pool use and availability of waterproof cardiotocograph equipment. Unit culture and guidelines related to eligibility criteria for pool use, medicalisation of birth and differences between midwifery-led and obstetric-led care. Staff endorsement encompassed attitudes towards pool use.

Key conclusions
Accessibility of birth pools was often limited by eligibility criteria. While midwifery-led units were generally supportive of pool use, obstetric-led units were described as an over-medicalised environment in which pool use was restricted and relied on maternal request.

Implications for practice
Midwives can improve women's access to birth pools by providing information antenatally and proactively offering this as an option in labour. Maternity units should work to implement evidence-based guidelines on pool use, increase pool availability (even where there appears to be low demand), and enhance awareness amongst medical staff of the benefits of water immersion.