Over past centuries, childbirth has become increasingly medicalised, with a shift to hospital births and an overuse of interventions for women at low risk of childbirth complication. In response, there has been a move towards normalising birth which has grown in strength over recent years. In this thesis, I describe a programme of research which aimed to examine whether intrapartum birthing pool use could make an important contribution to normalising childbirth for low risk women. Maternity stakeholders differ in their views of intrapartum birthing pool use, with some emphasising its potential to reduce interventions and increase spontaneous birth and others raising concerns that birthing pool use, particularly waterbirth, predisposes women and their newborn to an increased risk of adverse events and outcomes The focus of my programme of research was therefore on examining the efficacy and safety of intrapartum birthing pool use, and its potential contribution to normalising childbirth for healthy women. In the first stage of my research programme, I analysed prospectively collected data for 8,924 nulliparous and multiparous women who used a birthing pool during labour in their planned place of birth. In the second stage¸ I explored the possibility of comparing intrapartum interventions and outcomes for women who used a birthing pool and women who could have, but chose not to use a birthing pool in one obstetric unit. Having found the unit was not representative of other obstetric units, in the third stage I used a bespoke dataset comprising routinely collected maternity data collated by Hospital Episode Statistics (HES) as a comparator for the birthing pool data. This research found that, for the birthing pool sample, adverse maternal and newborn outcomes were rare, and there were no differences in interventions and outcomes between care settings for multiparae or newborn. Comparisons with HES data showed significantly more birthing pool women had a spontaneous birth. This allays concerns over safety and supports the conclusion that intrapartum birthing pool use can make an important contribution to normalising birth.
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