2013 MOREOB Patient Safety Award: Canada Winner
I have been a registered midwife for 9 years and have been a member of the Temiskaming Hospital team (maintaining active privileges as a registered midwife) for the past 4 years. As a midwife, I have seen the benefits that water immersion can give to clients in labour and during birth. I offered this option to my home birth clients but it was always my hope that I would someday be able to offer this service to my clients who chose to birth in hospital. Although there are only a few large trials that have been done in the area of water birth, there is growing evidence that water immersion in labour and birth offers comfort and pain relief and does not increase the risks to mother and baby. To my knowledge, very few Ontario hospitals offer this service on their labour units.
Specifically, as a small level 1, Northern Ontario hospital, certain pharmacological forms of pain relief, such as epidural are not always available. Moreover, many patients prefer non-pharmacological forms of pain relief which do not increase the risks to themselves or their baby.
In 2012, I decided to propose introducing the use of birthing pools on our unit to the clinical nurse manager(Mrs. Brazeau) and the Chief of obstetrics(Dr. Pace). They were open to the idea and suggested that I formally propose this at our Perinatal meeting. Although I started reviewing the research and writing the proposal in early 2013, the idea was formally presented and the process began shortly after we commenced our MORE OB program in March 2013. I believe that the tools that the MORE OB program offered greatly assisted us in the process of developing protocols and training staff to prepare to offer this service.
I am so pleased that our team was able to undertake this process and work together to ensure that the staff, care providers and the hospital’s administration could feel comfortable and confident in undertaking this endeavor. We have now been offering this service since September 2013.
At Temiskaming Hospital, our team truly embraced the concepts and principles of the MORE OB program. Patient safety has always been our priority and patient satisfaction is also very important to us. We used these as guiding principles when working through the process to introduce water immersion on our unit.
The process to introduce this option at our hospital began with a proposal to our perinatal committee. As previously mentioned, I submitted this proposal in early 2013. The committee then assigned responsibilities to hospital administration staff to adapt and complete the protocols and procedures. Many key players were involved in this process. Our clinical nurse manager, Mrs. Brazeau ensured that the nursing and physician/midwife protocols were ready and sent to the necessary committees for approval. Meanwhile, many physicians, in an effort to gain experience, attended home water births with the midwives. As midwives, we developed a teaching workshop for nurses, staff (maintenance, administration, etc...) and physicians. We all worked together to make sure that all parties were informed and had opportunities to give feedback along the way. I feel that the MORE OB program with its emphasis on communication and safety, really gave us motivation to achieve this in the best possible way.
I was thrilled that we were ready to begin training everyone by August 2013. Our team was used to the MORE OB skills drills by this point and so was eager to continue their learning through the water immersion workshop. We conducted the workshops on a variety of dates and times to enable attendance by all staff and care providers. Based on MORE OB principles, our workshops integrated staff and care providers together. We did not separate any groups during the workshops as we knew that we wanted questions and input to be shared throughout the various professions. For example we found that questions from our maintenance department (who were responsible for cleaning and maintaining the pool) were just as relevant to patient safety and needed to be heard by the nurses, midwives and physicians. More importantly, we wanted everyone to be confident and ready to work as a team when managing potential complications or emergencies related to water birth.
In September 2013 we had our first successful hospital water birth. The communication skills that we have continued to develop through the MORE OB program helped us ensure that everyone knew their role in the delivery room around the pool. As this was a new undertaking for our hospital, we have continued to adapt and improve our processes and address any issues that arise.
To date, we have had approximately one dozen water births. This accounts for approximately 16 percent of our total births and that number seems to be growing. We have a very high satisfaction rate reported by patients. We review patient comments and suggestions at our monthly perinatal meetings.
We are pleased to support other hospitals who are interested in introducing water immersion in their facilities. We have had much interest from other hospitals and we are happy to share our experiences and our protocols to assist them.
It is now a well accepted concept that water immersion can act as an effective non-pharmacological pain relief method. The fact that our small rural and remote hospital has been able to put in place a process through which water birth became an option for laboring women in our community shows that the size of the hospital is irrelevant. All it takes to put in place new initiatives that allow a facility to remain current with the latest research is open-minded administrative staff, knowledgeable medical staff, educated nursing staff and dedicated support staff. Communication, effective interprofessional relationships and a keen interest towards patient’s satisfaction were key elements that enabled our project to be initiated. At Temiskaming Hospital we are proud to have been able to successfully implement water births as a safe alternative for pain relief and we look forward to continue to share our story to assist other facilities interested in exploring this venue.