Struggling to Get Into the Pool Room? A Critical Discourse Analysis of Labor Ward Midwives' Experiences of Water Birth

RESEARCH AIM: The aim of this article is to share the findings from an ongoing action research study aimed at identifying inequalities in the availability of water birth on one hospital labor ward. Efforts to encourage labor ward midwives to take action and influence the delivery of normal birth care in the maternity concerned are addressed in the larger study. METHODS: Unit midwives who regularly worked on labor wards were invited to take part in focus groups and face-to-face interviews over an 8-month period. Critical discourse analysis was used to identify actual midwifery practices, the social ordering of the water birth discourse, obstacles to water birth, dominant group interests, and solutions to the identified obstacles (Fairclough, 2001). RESULTS: The author conducted a total of five unstructured interviews (35-60 minutes) with labor ward matrons, a consultant midwife, labor ward manager and clinical practice facilitator, and three focus groups (40-60 minutes; 11 midwives) with clinical midwives. Institutional practices focused on the delivery of standardized midwifery care for low-risk women and, therefore, did not promote or encourage water birth practice. The small number of requests and the low water birth rate were used as evidence by some midwives that childbearing women no longer wanted this type of care. The key obstacles to water birth in this setting were coordinators' priorities, midwives' negative attitudes, high workloads, and lack of institutional support for this type of care. CONCLUSIONS: Findings suggest that hospital water birth practice is dependent not only on the availability of equipment and midwifery knowledge, but also on the philosophy of care adopted by the organization (Stark & Miller, 2009). Interventions to improve the practice and availability of water birth are more likely to succeed if supported by midwifery managers, championed by coordinators, and led by labor ward practitioners.