The Real Reason Why The Coombe Pool Has Been Closed
It’s Has Nothing to Do With Covid
Right now there’s a lot of flushed faces opening this blog. Maybe your stomach dropped a little when you saw the title. That might be you if you’re a parent reading this blog and attending the Coombe and didn’t know the pool is now closed with no date to reopen. Some of the decision makers in the Coombe might be feeling a little nauseous right now thinking…”what does she know…? is what you’re wondering? Why is she continuing to post on the global stage of Twitter about the pool closure? Why is the media now involved? Then you’ll continue reading and see that it’s ‘just’ another woman ranting about choice in childbirth and you might even stop here but I’d urge you to skip on to the last paragraph to see what might be in store for your hospital.
As someone who has been supporting parents to access evidence informed care for close to 20 years now I’ve seen how this plays out so let me share some history and why the National Maternity Strategy is gathering dust and it’s recommendations will most likely never see the light of day.
Obstetricians are the gatekeepers of maternity services in Ireland (not the HSE). Actually GPs are but that’s a post for another day. Most don’t want pools. Most don’t want waterbirths. Most won’t even read the research. Trying to get labour pools set up in Irish hospitals has been an exercise in futility for midwives and the few consultants who respect autonomy and informed decision making. Because even if you can get past the barriers that will intentionally be put in your way you might not get to keep it!
Several years ago the Rotunda added a beautiful pool but refused to ‘allow’ women to use it to labour in as they (you) can’t be trusted to get out of the pool for the birth (they were not facilitating waterbirth). I invited the esteemed Ethel Byrne, waterbirth researcher to Ireland many years ago for a waterbirth training. Several senior staff from the Rotunda attended but it was obvious from their attitude that they had no intention of facilitating waterbirth in the Rotunda - but Management needed to appear to be supportive of progress in birth options…long story short the pool was eventually removed - and the official reason given? Women weren’t using it….well no s&it sherlock…
So when the pool went in at the Coombe only due to the ongoing fighting spirit and determination of a small group of staff it was a huge achievement. When waterbirths began in Dublin I really thought Ireland was stepping into a new age of mother focused, evidence informed care…(most) midwives were excited…women were excited. But then the other shoe dropped - it’s hard not to be cynical but I’ve seen this movie before, I know how it ends (but I would love to be proven wrong). Women who were considering having a waterbirth had to fulfill certain criteria.
Pre-approval that you are healthy and well having an uncomplicated pregnancy and were well on the day.
Have a background check.
Access is only for women born under Pieces (born between February 19 and March 20)
(Ok so yes #2 & 3 are of course not part of the criteria….)
If on the day you had a midwife who was happy to facilitate your use of the pool and you checked all the boxes you were golden! If however you had a midwife not happy to facilitate your use of the pool there were no boxes to check because your paperwork mysteriously disappeared…it’s not the first time these legal documents have simply disappeared into thin air (google Neary case) or talk to AIMS Ireland.
I received this message from one parent.
“I did get to labour in the pool but wasn’t permitted to birth in it....despite healthy pregnancy and it was my second baby. And no complications throughout. Also the midwife upon checking me in claimed I wasn’t entitled to use the pool, despite having asked for it all throughout my care, completing the consent form months in advance. Said she couldn’t find it in my files. I insisted I would look myself, searched through my folder and pointed it out to her. She was disgusted. Anyway, I was allowed to labour but not birth in it. It just highlights the lack of support from within the hospital for the birthing pool. I think the pool is a wonderful resource and it upsets me that they are taking away the choice from mothers to birth who they want”
Someone at the Coombe suggested that women having waterbirths were having more 3rd degree tears and insisted that a waterbirth research project be undertaken. This is despite the fact that all of the evidence points to LESS perineal injury when women labour in water. But again the staff who wanted to continue to provide pool access had to jump through more hoops (in the name of safety…). That research has yet to be published but I’m sure it will line up with the mountains of research on perineal injury that water immersion does NOT increase tearing. In fact the evidence is very clear that epidurals increase the risk of perineal injury - so if the Coombe was so worried about your bits, then making restricting the epidural could make sense? But that would result in riots…the general public just aren’t that bothered about the many benefits of labouring in water and without an understanding of how waterbirths happen probably think it’s dangerous.
So knowing that the imagined problem of perineal injury is now NOT an issue any more what could they possible come up with next to keep women out of the pools?
Covid-19
Covid provided the perfect cover to shut the pool down for ‘health and safety’ reasons…and it does sound very plausible and totally reasonable - except it’s not. The next excuse was they were redesignating isolation areas - fair enough - it takes 6 months to do what Holles Street did in 2 weeks. Here’s what one mother shared.
I gave birth in the Coombe in May, unfortunately not in the pool.... was low risk pregnancy and so my care was entirely mid wife led throughout, didn’t see a single consultant or OB.....back in maybe January or February it was one of these midwives who suggested I opt for the pool when I had told her what relief I was getting from swimming for my pelvic pain, but it was actually an option I had been leaning towards long before that anyway....but then at a later appointment I received the disappointing news the pool was now closed, however the reason I was given was not on health and safety grounds, it was that due to Covid wards and rooms were having to be rejigged and redesignated to allow for isolation should there be Covid cases in the hospital (a red ward/green ward system) and so the pool area was being used for storage (not that thats good enough either)
Anyway eventually D-day came round for me and irony of ironies, which delivery room do I end up getting put into, only the pool room!!! It was curtained off in the corner and to be fair there did seem to be a whole pile of other stuff being stored behind the curtain too like they had said (again not saying that’s good enough either that that was their “storage” option) but knowing it was just there was almost taunting me! ...
Anyway despite all that I had two wonderful midwives who took extremely good care of me that night, listening to me and following my lead, and my little boy arrived safely during what I still considered to be a very positive birth experience for me
The ‘safety’ card is played every day to coerce parents to agree to non evidence based care as I’ve blogged about frequently - not just in the Coombe and not just in Ireland but I digress. For most women when the ‘safety’ card is played they will acquiesce believing that the Doctor/Midwife knows best and I’m in no way suggesting anyone reading this refuses medical advice. But given past events - consider asking for more information, ask for the evidence.
Or consider these questions?
Is there a special kind of Covid in the Coombe?
Are Irish women different from women in Northern Ireland who have access to waterbirth daily?
Are women attending the Lourdes hospital enjoying those beautiful pools all Pisces?
What about women attending CUMH or Limerick?
I am beyond excited that the NMH is installing pools - but can’t help but wonder if their staff will be faced with excuse after excuse as to why women shouldn’t have this option. Was it a PR exercise for our new Lord Mayor after the newspaper article the week before? Who knows - let’s wait and see. The research on labour pools shows repeatedly that the biggest barrier to accessing the pool is the staff.
So What’s Can You Do?
I’ve been in contact with several parents who are very upset that their choice to use a pool in labour has now been removed. One parent has collated all of the most recent research and recommendations into a 30+ page document to share with the Coombe along with international recommendations that water immersion remains a safe option for healthy well women. As of this morning (August 6) the Coombe is still responding to parents with inaccurate information about the RCM clinical briefing that advises units to NOT remove this choice. Here’s the document if you’d like to read it and it includes contact details of the Coombe management.
I spoke to one very frustrated parent today who has decided she will be bringing her own pool (her partner has been practicing at home) and is prepared to sign any/all waivers releasing the Coombe from any litigation. I applaud her determination but I worry that she will be faced with a lot of unnecessary stress if this happens. Due to a medical condition this mother cannot have an epidural. How will the Coombe manage this? Will the birth partner be physically prevented from plugging in the air pump? Will staff block their access to the sink? Others are considering having a pool at home to labour in before going to hospital but are nervous that their labour might progress too quickly at home (one of the benefits of labouring in water). I’m sure those parents would rather have their labour progress with a midwife next to them).
So let’s just be honest this has nothing to do with Covid but everything to do with control.
Best of luck to everyone trying to have a positive healthy birth during these very challenging times. I would love to hear from you if you make any progress with reopening the pool in the Coombe.
(August 6 - Wexford General announces new waterbirth service) So no - it has nothing to do with Covid.
If you are a midwife, obstetrician other birth professional or a parent Dianne Garland is an international expert on waterbirth and is facilitating 90 minute zoom meetings on Covid and waterbirth several times a month for €5.00. You can reach Dianne here at http://midwifeexpert.co.uk/
