* ic11 Time to make a splasha literature review on the use of water for labour and birth to inform service provision

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The objective in writing this literature review was to take a proactive role in the development of water birth services in Ireland. To date, the only published Irish data with reference to water birth focuses on the death of an infant following a water birth in a regional maternity unit in 2006 (O'Halloran 2008, Tuteur 2008). A neonatal death under any circumstances is a catastrophic event for all the family and the professionals concerned. The devastating effect of this event was further heightened as the unit was the first in Ireland to offer water births.

This review will critique the research material available on water birth and its relationship to aiding physiological labour, alongside safety of practice. Water births came to the attention of the obstetric community following an article published in The Lancet by Michel Odent in 1983. Since then the demand, interest and practice of water birth has grown in mainland Europe, Australia, America and Britain but not in Ireland. The types of research available for review included quantitative, qualitative, randomised controlled trials, a Cochrane report review (Cluett et al 2002), Royal College of Obstetricians and Gynaecologists (RCOG) and Royal College of Midwives (RCM) guidelines, audits and prospective observational studies. Examining and critiquing the research available helps to identify best practice and inform those responsible for the provision of services (Coughlan et al 2007).

Three recurring themes were identified from the literature: the analgesic properties of water, augmentation of labour in water and the well-being of those infants born in water. Water and its analgesic properties are questioned, but the benefit as a relaxing agent is acknowledged. For those using water, the augmentation effect in labour is attributed to the relaxation of the labouring woman. There is also a reduction in the need for obstetric augmentation. It is suggested that the continuity of care of one midwife contributes to the reduced need for obstetric intervention. The research relating to the hazards of water birth for the infant offers the greatest opposition to this method of delivery. The following literature review will address in depth the three chosen themes as detailed above and so provide an evidence base for best practice.

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