Advice on Birthing Tubs

USA987, MSN, RN, NP · Oct 1, 2004

We moved into our new facility just recently. We do about 2500 deliveries/yr. We have a very large portable tub that can only be used in a limited number of rooms. We have only had a few patients that want to try it and we have run into all sorts of problems like:

-we are at capacity and the pt. that wants to use it is not in one of the capable rooms

-engineering is suppose to hook it up and I don't think they have all been inserviced

-our policy regarding it's use is not specific enough and therefore most of us don't even want to try to use it.

-debate over who will sanatize the tub after it's use

-our rooms are designed as such that the tub only fits right at the entrance to the room...basically blocking access to the rest of the room. The tub is so big and heavy when it is full that you can't move it...it must be drained in order to move. Draining it takes approx. 14 minutes. That's kind of alarming in an emergency situation.

Those are just some of the problems we have encountered. We are looking at smaller, more "portable" tubs...until then we are encouraging patients to labor in the shower using a shower chair.

Kudos to you for trying to research it ahead of time!

kmrmom42 · Oct 3, 2004

Here is my $.02 worth....be careful of the built-ins, make sure they are deep enough so that the water will cover the abdomen when the mother is in the tub, if it doesn't it won't get used much. As for the portables, the Aquadoula tub http://www.aquadoula.com/ is nice, not too hard to set up or clean but just be sure that you can fill it from the room or else you will have the problems the USA987 mentioned in her post.

PegRNBSN · Oct 4, 2004

The tub we have in mind is made of fiberglass and very lightweight no assembly. We had a horrible experience with a trial tub that resembled a kiddie pool. A mess, too hard to set up and take down. The concern we have with built ins are difficulties in being able to give support to the woman in the tub due to space constraints.

shay · Oct 4, 2004

Just a caveat, we tried the portable birthing tub jazz at my facility, and it was an absolute mess. Of course, the model of tub could have been the problem. It was big, cumbersome, and we had to run water hoses from under the sink, across the labor room to the tub to fill it. We used it maybe twice in the few months it was there, and got rid of it promptly.

My personal advice is to spend the $$ on a model that's not only patient friendly, but nurse friendly as well...i.e., easy to use and clean. Don't skimp (this is assuming you're in charge of selecting the model) to save $$, it will cost you more in the long run in staff headaches and complaints and eventual replacement.

JMHO.

SmilingBluEyes · Oct 4, 2004

I am with Shay. they are really NOT worth it most of the time, at least where I worked. Most of the moms ended up w/epidurals, and there we had it, a HUGE mess to clean up, not to mention the thing being totally in the way, unused, during delivery. I can't recommend them highly. I wish our facility would get some jacuzzi's for our moms. At least they would be easier to drain and clean afterward.

shay · Oct 4, 2004

No kidding, Blue Eyes.

Having worked with labor patients in both built in tubs and portable tubs, I can tell you, providing nursing care and labor support to a pt. in a built in tub is MUCH MUCH MUCH easier.

Plus, let me just say something a little nasty....when you spend so much time and effort to fill up the stupid portable tub, get the patient in, yadda yadda yadda, and then they go and get an epidural 20 minutes later, it's REALLY frustrating. I can tell you from first hand experience, a built in tub WITH JETS will cut your epidural rate. A portable tub with no jets isn't worth the money, IMO.

Yeah, being submerged in warm water is great and all, but when I was in labor and used the tub (when I was laboring at home prior to going to the hosp.), it was the jacuzzi jets that helped me. The warm water immersion was nice, but when your hips feel like they're going to explode, that water blasting on your body is a blessing.

The last hospital where I worked had built-in tubs with jets and a 40% epidural rate.

Gompers, BSN, RN · Oct 4, 2004

I have seen the portable ones in our own L&D rooms and don't think I'd ever set foot in one - they seem dangerous to me in the case of an emergency. I'd feel much more comfortable in the jacuzzi-type tubs myself. I like that they often have "quick drain" features that empty the tub in record time, and the fact that some of them even have doors that open so you can walk in and out, rather than stepping in. In the case of an emergency (and as a NICU nurse I'm always picturing the worst case scenario) the tub can be drained and someone can get you out of there without having to lift you out of the tub.

PegRNBSN · Oct 4, 2004

Thanks for all the input. The tub we looked at drains to a level that you can open the door in 90 seconds.

Nurse_Educator · Oct 4, 2004

Hi,

I have a quick question regarding your reply:

How does your institution clean the tub with jets? Do you have a policy you follow regarding soaking after use and how the actual inside lines / jets are cleaned?

We currently have built in tubs without jets. The reason for not getting jets, as I understand it was infection control related issues with cleaning the lines / jets.

We do have patients use them, but many times they still opt out of the tub and back in bed for their epidural!

Marilyn

QUOTE=shay]No kidding, Blue Eyes.

Having worked with labor patients in both built in tubs and portable tubs, I can tell you, providing nursing care and labor support to a pt. in a built in tub is MUCH MUCH MUCH easier.

Plus, let me just say something a little nasty....when you spend so much time and effort to fill up the stupid portable tub, get the patient in, yadda yadda yadda, and then they go and get an epidural 20 minutes later, it's REALLY frustrating. I can tell you from first hand experience, a built in tub WITH JETS will cut your epidural rate. A portable tub with no jets isn't worth the money, IMO.

Yeah, being submerged in warm water is great and all, but when I was in labor and used the tub (when I was laboring at home prior to going to the hosp.), it was the jacuzzi jets that helped me. The warm water immersion was nice, but when your hips feel like they're going to explode, that water blasting on your body is a blessing.

The last hospital where I worked had built-in tubs with jets and a 40% epidural rate.

shay · Oct 4, 2004

Hi,
I have a quick question regarding your reply:
How does your institution clean the tub with jets? Do you have a policy you follow regarding soaking after use and how the actual inside lines / jets are cleaned?
We currently have built in tubs without jets. The reason for not getting jets, as I understand it was infection control related issues with cleaning the lines / jets.
We do have patients use them, but many times they still opt out of the tub and back in bed for their epidural!
Marilyn

Env. svcs. puts anti-micro/bio cleaner, the same kind of stuff they use to clean up really bloody messes etc., in the tub, fills it, runs it with the jets on, drains it, then repeats the procedure, then repeats the procedure once more with plain hot water to rinse. From what I understand, this procedure purges water through the jets and cleans them. There have never been problems with JCAHO wrt how the tubs are cleaned, as far as I know.

Now, an infec. control nurse/guru I am not, however, I think that as long as you use an antimicrobial cleaner and purge it through the jets, it kills all the little buggies, yes? When I clean my jacuzzi bathtub at home, I use plain clorox mixed in a tub full of hot water and a similar procedure. Of course, I'm not letting any strangers into my tub nakey and dripping bodily fluids , but I think my tub is pretty darned clean.

I do understand the IC concerns, though.