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Table 3 Differences between case study sites

From: Factors influencing water immersion during labour: qualitative case studies of six maternity units in the United Kingdom

Categories and themes Barriers Facilitators
Criteria for pool use
 Criteria for using the pool Women must meet specific criteria to use a pool. Lots of exclusion criteria. (Site C) Few contraindications to pool use mentioned in guidelines; risk factors assessed on an individual basis (Site A)
Guidelines specifically mention women with risk factors who can use a pool (Site B)
 Staff training requirements Midwives required to be trained to support women in water for labour/ birth; otherwise they have to approach their manager before undertaking this (Site C) No specific training required (other than emergency evacuation training); midwives required to have the necessary competences and skills (Sites A & B)
 Criteria for entering the pool Women should be in established labour (4–5 cm) (Sites B & C) No fixed cervical dilation required; pool can be used for prolonged latent phase (Site A)
Use of equipment and resources
 Allocation of pool rooms Women usually automatically allocated a non-pool room (Site B, Obstetric unit)
Pool room used for non-water births so is rarely empty (Site C, Obstetric unit)
Women not using the pool would not be moved out of the pool room during labour (Site C, Obstetric unit)
Low risk women asked at triage if they would like to use a pool (Site A, Obstetric unit)
Some midwives will ask women to switch rooms to free up the pool room (Site A, Obstetric unit)
 Filling pool Pool is usually filled after women arrive (Sites B & C, Midwifery unit) Pool is automatically run when women are on their way (Site A, Midwifery unit)
 Pool room environment Pool rooms less popular than other rooms (Sites B & C, Obstetric unit) Considered ‘nicer’ than general birth rooms; one pool room located near midwives’ station (Site A, Obstetric unit)
 Emergency procedures Emergency evacuation not well-practised; some midwives not confident in emergency procedures (Site C, Obstetric unit) Midwives confident in ability to cope with emergencies in the pool (Sites A & B, Obstetric unit)
 Home birth pool use Cost can be a barrier to pool hire (Sites A & B)
Women have to source their own pool (Sites A & B)
Pools, liners and water pumps provided for women wanting to use a pool at home (Site C)
Support for natural birth
 Support for natural birth Obstetric consultants sometimes block women from accessing the midwifery unit (Site C) Obstetric consultants are supportive of the midwifery unit and facilitate women going there (Sites A & B)
Support for natural birth at all levels of management (Site A)
Women’s awareness of and attitudes towards pool use
 Tours of the unit No tours of the midwifery or obstetric unit; virtual tour available online (Site B) Women are invited to have a tour of the midwifery unit (Sites A & C)
 Antenatal classes Antenatal classes are over-subscribed, so not all women have the chance to attend (Sites A & B) Antenatal classes are available for all women and pool use is discussed at length (Site C)
 Sociodemographic differences Large Asian population who are perceived as less likely to want to use the pool (Site C) Women in the area are well-informed and aware of their options (Sites A & B)