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Midwife Consent for Waterbirth Mobile App

Though warm water immersion in labor and birth has existed for a long time and in many cultures and has been studied and found to be safe, it is still considered an “alternative” practice by the field of obstetrics. For this reason patients are required to sign the Midwife Consent for Waterbirth mobile app listing the potential benefits and risks of water birth.. The app lists the criteria for waterbirth deliveries.

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Consent for Warm Water Immersion for Labor and Birth
I/We
have chosen to consider a water birth with the midwives with <Insert Name> Midwifery Services.
The following criteria must be met for the option of water birth:
Uncomplicated pregnancy of at least 37 weeks gestation
An established labor pattern with strong, regular contractions
Reassuring fetal heart rate
No heavy vaginal bleeding
Lack of significant meconium staining
Lack of maternal infection or unknown skin condition
Agreement of the midwife attending your labor and birth
* The midwives reserve the right to request any mother to leave the birth tub for any reason.
I/We understand that the potential benefits of water immersion in labor and birth include:
Relaxation and pain management in labor
Facilitation of mobility / movement in labor
A gentle transition for the newborn
Being highly rated by mothers as a more positive labor and birth experience
I/We understand that potential risks of warm water immersion may include:
Maternal or newborn infection
Fetal tachycardia (increased heart rate) secondary to water temperature being too hot or prolonge...
The slowing or cessation of contractions
Potential aspiration of fluid resulting in drowning, pneumonia or death
I/We have been informed of the alternatives to warm water immersion for labor and birth, includin...
Having been so informed, I/we have chosen warm water immersion for labor and birth with <Insert N...
Mother’s Signature
Date
Partner’s Signature
Date
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