Women may choose informally to bath or shower often prior to seeking professional help in labour. This is clearly different from deep water immersion in a birthing pool. Service providers are obliged to draw up protocols that aim to provide safe and effective care when deep water is used. Such protocols cover both pools in hospitals and birthing centres, and care by midwives in the woman’s home where a pool may be hired in. The distinction is also made between the use of water for analgesic purposes during the first stage of labour and actual birth in the water. Midwives should be familiar with their local protocols for these two separate issues, and should be updated both in undertaking and assisting at pool births (RCOG/RCM 2006).

Both the NICE (National Institute for Health and Clinical Excellence), 2007 and RCOG (Royal College of Obstetricians and Gynaecologists)/RCM (Royal College of Midwives), 2006, in the light of currently available evidence, endorse labouring in water for pain relief purposes in the first stage of labour where an inclusion/exclusion criteria exists. The RCOG/RCM (2006) are prepared to state too, that ‘healthy women with uncomplicated pregnancies at term … should be able to proceed to water birth if they wish’. NICE (2007) is less sure, stating that ‘there is insufficient high quality evidence to either support or discourage giving birth in water’. Other commentators would agree that there are some outstanding issues; Cluett et al (2002) recommended that research was still needed into clinical outcomes, the economic impact and the physiological effects of water use in labour. The debates about water temperature, cervical dilatation and infection risks continue. However, the benefits of water use (as listed above) are being recognised and therefore pool use is on the increase (Garland 2006).

Firstly, any woman who has been given all the available information and wishes to use the pool is considered. Secondly, the inclusion/exclusion criteria should be applied when assessing her risk factors. Historically, low risk criteria have been proposed; however Burns & Kitzinger (2001) suspect that in particular instances other conditions may be permitted, e.g. hypertension or vaginal birth after caesarean. At this time the following are proposed as safe criteria:

Situations in which the use of water is contraindicated include: