Women denied access to showers and water immersion at some maternity hospitals due to unsubstantiated risk of COVID-19 transmission, without clear evidence to suggest any virus control value.
Anyone who has either laboured, or watched their partner labour, can tell you that sitting in a warm bath or standing under a hot shower is one of the most effective non-pharmacological methods of pain relief available. What’s more, there is an ever-growing evidence base to support this very commonly understood fact as well as the multitude of benefits that warm water provides.
Earlier this week, the Australian College of Midwives (ACM) became aware that some hospitals have commenced disallowing water immersion or showers for labouring women. This appears to be in response to a recommendation made by RANZCOG that suggests that water immersion should be suspended for all women in COVID-19 hotspots, including women who have not contracted the virus.
Having considered available evidence, ACM calls for all hospitals to continue to provide water immersion and showering for labouring women. In fact, water immersion and/or birth and showering in labour may actually provide specific benefits to the risk of transmission of COVID-19. Here are the facts:
- COVID-19 is not a waterborne virus; it is transmitted through air or from surfaces via droplets (due to coughing, sneezing, breathing). The act of immersing in warm water may actually reduce the risk of transmission.
- A watery environment dilutes any potential risk of respiratory droplet and/or faecal contamination also, while COVID-19 may be found in faeces, there is currently no evidence of faecal-oral transmission.
- Water has the effect of diluting any virus particles that may be present providing some level of protection against transmission particularly when compared with land birth.
- The physical barrier offered by the bath assists with social distancing between the woman and those who are with her including midwives and support people.
- Women who give birth in water commonly receive their baby and gently guide their baby to the surface themselves thereby reducing contact between the woman and baby, and midwives (unless, of course, there is a need to intervene).
- Birth pool cleaning protocols are already stringent and adhered to after every episode of water immersion.
The Australian College of Midwives’ Midwifery Advisor Dr Megan Cooper, whose focus of study centered around water immersion said, “The decision to deny women access to the shower is one of the worst I have seen. It certainly makes you question whether there’s an ulterior motive here. Scare mongering and removing a completely safe, natural method of pain relief will mean more women turn to pharmacological options which for many women, is completely unnecessary.”
“ACM supports recommendations that have been implemented to slow and stop the spread of COVID-19, but this new recommendation is nonsensical. We are now denying women an effective option of pain relief and the opportunity to achieve a normal, physiological birth that is a positive and satisfying experience, for no evidence-based reason.”