As a practicing midwife for over 36 years (33 years as a waterbirth champion) I totally understand colleagues concerns about emergency evacuation for a birthing pool whether at home or hospital. Firstly, may I stress this is an incredibly unusual occurrence, and although I teach a skill drill and have a competency programme, which discusses / practices this issue I have never directly had to evacuate a mother. In circumstances where I have been involved and asked to assist, the clinical situations have often  been the same.

  • Room has become too hot – maybe water, room and maternal temperature not closely monitored. Water maybe too deep (at neck line) instead of between breast and bump with allows heat to evaporate through upper torso. No ventilation in room or mother not drinking sufficient.
  • Midwife not identifying blood loss has gone from normal (rosa) through to sangria (large blood clots) to cabernet (dark red) and being unable to see bottom of pool or mothers legs. However, things are not this simple which is why I teach “If in doubt get mother out”

 As this has been an ongoing concern I always teach at my study day about how to safely evacuate a mother. In conjunction with moving and handling officers I worked with a company called “ Siverlea www.silvalea.com who produce a birthing sling for manual or electric hoist evacuation.

This photo shows training with this sling and BPIAB at a birth centre

If using a portable pool at home it is possible to emergency evacuate using the sling with 3 people (midwife with student / midwife ) at head whilst partner lifts mother’s legs/feet.

To assist in lowering the pool, it is very easy to deflate the middle ring to a height which ensures a minimal lift. It also has the benefit of only a small amount of water spillage on a floor if further emergency care is required. I have heard recently of midwives suggesting that the pool should be punctured to deflate a portable pool. This I believe would cause a large amount of water (Mini pool 480 Litres and Regular pool 650Litres) onto floor, flooding a home, cause electrical concerns and health/ safety issues for emergency responders.

I will stress again that I have never had to evacuate from a home pool. The photo shown as an example, is a portable pool in a birth centre during the DVD which was filmed with Silvalea .

Skills drills can overcome both practical and environmental issues to ensure that both mother and midwives, would not be placed in any extra danger when emergency evacuating. These drills should be fundamental to any hospital/birth centre and opportunities in a suitable environment to practice this within a home like setting. A risk assessment could be undertaken for community midwives who attend home waterbirths. It would then be for the trust to balance the cost of purchasing a birthing sling against any litigation from parents if the pool is punctured with inevitable danger to the home by the midwife (and thus the trust). A Silverlea sling costs £ 150. Electric hoists cost several thousand pounds.

Emergency evacuation is a serious concern for midwives but can safely and easily be resolved through robust clinical care and skills drills.

Dianne Garland FRCM SRN RM ADM PGCEA MSc