THE MOTIVATION OF WORKING MIDWIFES TO USE THE WATERBIRTH METHOD AS AN ELEMENT OF THE PRACTICAL APPLICATION OF THE OBSTETRICAL MODEL OF CARE

Abstract

The continuous care provided by a midwife or team of midwives during pregnancy, birth and the early postpartum period defines the obstetric model of care. The obstetric model of care is based on the understanding that these processes are physiological and occur naturally. The World Health Organization (WHO) emphasizes the importance of positive birth and places the woman at the center of maternity care, regardless of her social status, ethnicity or location. This means that every woman has the right to respect, support and information to make informed decisions about her birth.

Birth occurs in three stages: the cervical dilation period; the expulsion period and the placental period. The cervical dilation period during the first stage of labor begins with the onset of labor and ends with the complete effacement of the cervix. An important determinant of the progress of labor are uterine contractions. When conducting the first stage of labor, five characteristic features of uterine contractions are monitored: duration, /duration/, periodicity /interval/, rhythm, strength and productivity.

The mechanism for the occurrence of labor pain is still not fully understood. Its nature varies depending on the stage of labor. For pain relief during labor, two methods are mainly used - pharmacological and non-pharmacological, which can complement each other to achieve an optimal effect. One of the most used non-pharmacological methods of pain relief during labor is the immersion of the body of the woman in labor in warm water, including childbirth in water /water birth/.

Objective: to study the opinion of working midwives on the practical application of the water birth method.

The subject is the attitudes and motivation of midwives to implement the method in the obstetric model. As well as the attitudes and preferences of women with low-risk pregnancies to benefit from it.

The subject is the ability of midwives to prepare, inform and implement the non-pharmacological method of pain relief in the birth process.

Methodology: In May 2024, an online survey was conducted, randomly, through the Google Forms platform. A documentary method was used; observation. The study included 100 pregnant and postpartum women, as well as 27 midwives working in maternity wards of Burgas University Hospital, Deva Maria University Hospital, Burgasmed, on the territory of the city of Burgas. A significant part of pregnant and postpartum women indicated that water birth provides an opportunity for pregnant women who wish to give birth normally, vaginally, in low-risk pregnancies. 91% of respondents indicated confidence in the midwife's competence. The surveyed pregnant women indicated the water birth method as necessary 40.9% and recommended - 68.2%, therefore the water birth method is suitable and can be included in the plan for discussing normal birth. According to 89.7% of pregnant and postpartum women, water birth is a practice that should be implemented in public hospitals. A significant percentage of 94.1% of the same group of respondents are of the opinion that part of the cost of this method of birth should be covered by the health insurance.

Conclusion: Based on the study, the need for prior monitoring and consultation during pregnancy for the smooth implementation of this non-pharmacological method of pain relief, with the participation of a midwife, was identified.