POOL Study Wins Royal College of Midwives Excellence in Midwifery for Research Award 2024

The Royal College of Midwives (RCM) announced in October 2024 that the POOL study had won the award for Excellence in Midwifery for Research 2024.

Background

Since 2007 NICE have recommended that women without complications should have the option to use a birth pool during labour for pain relief. Among women who use water immersion analgesia during labour, some choose to remain in the pool for the birth of their baby.  Some people were concerned that birth in water, may increase risks for mothers and babies. Although studies to date suggested waterbirths were safe for mothers and babies, there had not been a study large enough to show this for certain.

Largest global study of waterbirths

The POOL study team conducted the largest global study of waterbirths, the primary objective of which was to answer a question commonly asked by women using water immersion analgesia: “If everything remains okay during labour should I stay in or get out for birth?”

The results

The POOL study looked at records relating to 73,229 births across 26 NHS sites between January 2025 and June 2022, among women without pregnancy complications who used water immersion during labour. The main study paper was published in BJOG with rates of outcomes such as obstetric anal sphincter injury or serious neonatal morbidity being no higher among waterbirths than in births out of the water.

Read results in main paper: https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/1471-0528.17878

What the results mean for mothers, nurses and future research

As a result of the study, midwives can now answer with complete confidence that waterbirth is a safe option for women and their babies. NICE has already indicated that the results of the POOL study will inform future recommendations on waterbirth. The team has worked with its PPI partners and multidisciplinary collaborators to develop freely available online resources that will make their findings accessible to all midwives and expectant parents.

Your Choice – Using a POOL during labour and birth leaflet

What the RCM panel said in their award for the POOL study

RCM judges said that the POOL study was “High-calibre research, performed and led by midwives working collaboratively with the multidisciplinary team. It answers a gap in the evidence, as identified by NICE in 2007. The study has provided conclusive evidence of the safety of waterbirth for women and their babies. We can see how impactful the findings will be for midwives and women.”

Resources

CTR webpage: POOL – Centre for Trials Research – Cardiff University

Main paper: Maternal and neonatal outcomes among spontaneous vaginal births occurring in or out of water following intrapartum water immersion: The POOL cohort study – Sanders – 2024 – BJOG: An International Journal of Obstetrics & Gynaecology – Wiley Online Library