Table 3 Differences between case study sites
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) |