Protocols for birthing tubs?

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Specializes in OB L&D Mother/Baby.

We recently had one of our labor bathrooms remodeled to include a birthing tub. We have a protocol for cleaning it but somehow our director has not been too particular about the actual use of the tub during labor. The only thing she has said is it cannot be used after they deliver :banghead:

If you have a tub where you work what is your protocol. Can women use it if they are ruptured... One of our OB's said she's fine with that, but like I said there is nothing written to say that. Is there a certain point at which your moms have to be out, like if they are dilated to ____ we no longer let them in? What is your protocol on fetal monitoring? Do you have special gloves for the tub if someone that needs an sve? I'm thinking they'd have to be "bigger" or longer or something to protect the healthcare workers?

I have a hard time believing many of our patients will be able to use this tub because so many of our patients are scheduled inductions. And then they are arom'd early in the day so they not only need constant monitoring but they cannot use the tub secondary to ruptured membranes.

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Specializes in Community, OB, Nursery.

I do not have any specific policies from our hospitals (we don't have any either) but in a lot of parts of the world women labor in water after ROM. Waterproof dopplers can be used to listen to baby underwater and a shoulder-length glove for reaching into the water.

I think practitioners vary in their preferences regarding delivery in the tub. Some are ok with the whole shebang, some don't want to deliver the placenta, and some don't want to deliver anything underwater.

Here's the RCOG (Great Britain) guidelines for waterbirths:

http://data.memberclicks.com/site/wi/rcog_rcm_birth_in_water.pdf

Some FAQs:

http://www.waterbirth.org/mc/page.do?sitePageId=38564&orgId=wi

www.waterbirth.org is the homepage. Hope this is some help to you. :)

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At my hospital we do not allow women in the tub after ROM so given that 90% of our patients are induced and AROMed they rarely get used. The hospital where I delivered (note they are NOT the same place) allowed anyone in and did water births as well. Perhaps the Waterbirth International website would have some evidence-based info for you.

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Specializes in Maternal - Child Health.

I worked in a birth center that had Jacuzzis in every room, and they were widely used. To be honest, it was so long ago, I don't really remember our P&P, except that patients often used them post-partum to relieve episiotomy pain and cramping.

PM me if you would like the name/website of the facility. I'm sure someone there could help you with a policy.

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Specializes in OB, House Sup, ER, Med Surg.

We use a tub - not for birth, but for labor. Moms can get in once they are in active labor. We do let them get in with rumpured membranes - either AROM or SROM. The only contraindications are non-reassuring FHR or bleeding. A nurse stays with pt and dopples FHT q 10-15 min.

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Specializes in 2 yrs as a student nurse extern in L&D..
We recently had one of our labor bathrooms remodeled to include a birthing tub. We have a protocol for cleaning it but somehow our director has not been too particular about the actual use of the tub during labor. The only thing she has said is it cannot be used after they deliver :banghead:

If you have a tub where you work what is your protocol. Can women use it if they are ruptured... One of our OB's said she's fine with that, but like I said there is nothing written to say that. Is there a certain point at which your moms have to be out, like if they are dilated to ____ we no longer let them in? What is your protocol on fetal monitoring? Do you have special gloves for the tub if someone that needs an sve? I'm thinking they'd have to be "bigger" or longer or something to protect the healthcare workers?

I have a hard time believing many of our patients will be able to use this tub because so many of our patients are scheduled inductions. And then they are arom'd early in the day so they not only need constant monitoring but they cannot use the tub secondary to ruptured membranes.

I did a clinical at a big city hospital who used birthing tubs. There were 4 rooms designated with tub hook ups. The tubs were moveable so they were not in the room unless needed. They are used only during labor and delivery, depending on the practitioner, not after delivery. They are allowed in the tub even after being ruptured. (If there are no complications or risk factors). They had a water proof cardio, and the FHTs had to be checked every 15 mins. The water temp had to be checked I think every 15 mins too. It was often, to make sure the mother was warm enough and the water was not too hot that it could burn her (since you do get used to the temp). We had gloves that went up to our shoulders. The cleaning of the tub after use is the responsibility of Maitenence. They received an inservice on how to clean them.

I thought it was a great experience for my 16y/o pt. She did it all natural with the use of the tub. :nurse:

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Specializes in L&D.

In my hospital patients are allowed to use the tub with ruptured membranes. If used in early labor, it sometimes slows things down, sometimes not. In active labor, it can be really helpful. Our policy doesn't include temperature checks, but I think it should as our moms tend to get the water very hot and come back to bed with an elevated temp and some fetal tachycardia; both resolve quickly once they are out of the tub. We monitor with a doppler q15min, just as we would for any woman not on continuous electronic monitoring.

Are there any waterproof monitors available? Our inductions can be out of bed as long as they are monitored, so we could put our inductions in the tub if we could continuously monitor them.

The patients love it. It often speeds labor (if it doesn't slow down or stop a prodromal labor) and delays (or eliminates) the use of pain medication.

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Specializes in OB L&D Mother/Baby.

Thanks for the replies. I mentioned something to the director at our meeting this week about needing to come up with a protocol and she said "oh yes I know"

I thought she had said something at one point about waterproof monitoring system but she says that she can only find a waterproof doppler so I guess we may be getting that.

Well I'm hoping to use the tub myself in october so I may be the first to actually get in the thing at the rate we're going!

Thanks again!!

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Specializes in Labor & Delivery.
We use a tub - not for birth, but for labor. Moms can get in once they are in active labor. We do let them get in with rumpured membranes - either AROM or SROM. The only contraindications are non-reassuring FHR or bleeding. A nurse stays with pt and dopples FHT q 10-15 min.

This is how we do it too, except that a support person can stay with the pt, it doesn't have to be the nurse constantly. The support person can climb in the tub too if they like. We have awesome water-proof tele monitoring, so if the monitor is picking up everything (continually a challenge for me with corded and cordless! sigh!) I can even monitor UCs and FHR on the strip. Neato, huh? :)

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Specializes in Multi-Specialty, L&D, Mother/Baby.
This is how we do it too, except that a support person can stay with the pt, it doesn't have to be the nurse constantly. The support person can climb in the tub too if they like. We have awesome water-proof tele monitoring, so if the monitor is picking up everything (continually a challenge for me with corded and cordless! sigh!) I can even monitor UCs and FHR on the strip. Neato, huh? :)

We have this two...it's really nice! Works GREAT for primips when they're at that stage when they hit active labor, but they don't want an epidural yet. Multips...most of us are pretty nervous about putting a multip in the tub. We have had two bad incidents with our tubs, a breech precip (it was a primip who was really high up, they thought was vertex, she ruptured in the tub, and was a breech precip...thankfully it ended up a good outcome!), and another precip with a shoulder dystocia, the baby came out with zero apgars, we had to code the baby and ended up on a vent. It ended up being ok also. Needless to say, everybody always thinks twice before putting somebody in the tub.

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Specializes in Community, OB, Nursery.

NurseBlueEyes,

There are some OBs that actually use breech as an indication for water birth. And quite a few midwives.

Also, the case with the shoulder dystocia, do you think the baby's apgars would have been any better had he been born 'on land'? Not second guessing you, just asking.

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Specializes in Midwifery.
We have this two...it's really nice! Works GREAT for primips when they're at that stage when they hit active labor, but they don't want an epidural yet. Multips...most of us are pretty nervous about putting a multip in the tub. We have had two bad incidents with our tubs, a breech precip (it was a primip who was really high up, they thought was vertex, she ruptured in the tub, and was a breech precip...thankfully it ended up a good outcome!), and another precip with a shoulder dystocia, the baby came out with zero apgars, we had to code the baby and ended up on a vent. It ended up being ok also. Needless to say, everybody always thinks twice before putting somebody in the tub.

Which is silly really cos they were both recognisable obstetric variances that would have occurred despite the tub! And great for the primip who birthed a breech! I'd say that was a positive outcome due to the tub because she would have been sectioned if they'd known it before - good for her!:yeah::yeah::yeah:

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