POOLing our resources

By Julia Sanders on 23 November 2018 Midwives Magazine Waterbirth

How much do we know about the safety of waterbirth and the factors that affect rates of waterbirth use? Julia Sanders and the POOL study seek to find out, with your help. 

The use of birth pools for pain relief in labour is now very common and it’s estimated that up to 60,000 (9%) babies are born into water annually in the UK (Redshaw and Henderson, 2015). But how much is really known about the safety of waterbirth and the outcomes? The POOL study, being run by Cardiff University, aims to address this question through enhanced routine data collection and by online discussions with women and professionals.

The POOL study

The NICE (2007) recommendation that women without obstetric complications have access to water immersion analgesia has been in place since 2007. Despite the increasing numbers of women giving birth in water, to date there have not been studies large enough to show whether women who give birth in water experience a different rate of adverse outcomes, compared to women who leave a pool prior to birth. The POOL study plans to fill this gap in evidence by comparing the rates of adverse maternal and neonatal outcomes among women who have an uncomplicated labour and who leave a pool prior to birth, compared to women who experience a waterbirth.

The POOL study will collect data on births to women in around 30 UK maternity units that use the maternity information system EuroKing®. To set pool use and waterbirth in the context of NHS care, the study will describe the proportion of women that use a pool for labour or birth and also the characteristics of, and outcomes for, women with identified risk factors that use a pool during labour. The study will also examine the rates, indications and outcomes of women requiring obstetric care during or following pool use.

To answer all the research questions, approximately 600,000 individual computerised maternity records held in the EuroKing® systems, covering the period January 2015 to November 2020, will be extracted. As all maternity units also provide individual level data to the National Neonatal Research Database, working in partnership with them will enable matching between maternity and neonatal unit data.

Online discussion groups

One of the POOL study aims is to explore factors associated with high and low rates of pool use in individual maternity units. Professionals and parents often have strong opinions on waterbirth. Some health professionals are great advocates of waterbirth, and promote the potential benefits to women, while others remain concerned that women may be taking additional, unnecessary risks by giving birth in water. It is this diversity of opinion, and how this translates into access to pools and waterbirth in different maternity units, that the study will investigate through online discussion groups, which are open now. There are different groups for women, midwives, obstetricians and neonatologists.

The discussion groups are planned to remain open until the end of 2018 but individual groups will be closed once sufficient participants have provided responses. Please sign up to a group and share your experiences of providing access to birth pools and waterbirth in your area – we would love to hear your views. 

Julia Sanders is chief investigator of the POOL study


More info

To sign up to a discussion group, go to pool.sewtudb.cf.ac.uk.

For further information about the POOL study, contact [email protected] or email Julia directly at [email protected]

The POOL study is funded by the National Institute for Health Research HTA 16/149/01. The views expressed are those of the author and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.


Redshaw M, Henderson J. (2015) Safely delivered: a national survey of women’s experience of maternity care 2014. NPEU: Oxford.

NICE. (2007) Intrapartum care: Care of healthy women and their babies during childbirth. NICE: London.