This study has identified the discourses surrounding water birth and analyses how these discourses are utilised by the media in New Zealand to represent water birth. The philosophical approach that underpins the study is that of philosopher Michel Foucault and his theory on discourse, power and the subject. His framework is used in a discourse analysis to reveal three main discourses: the scientific medical discourse, the natural birth discourse and the dive reflex discourse. Data used for this study consisted of 30 newspaper articles containing the word 'water birth' collected over a five-year period (2000-2005) from New Zealand's eight main broadsheet newspapers. Analysis was a two-part process: Foucauldian discourse analysis and a media discourse analysis (Fairclough, 1995b).Firstly, the discourse analysis showed the subject and the power positions each discourse offered women for positioning themselves in that discourse. The literature and texts revealed Foucault's theory on power relations and resultant subjectivity within institutions and how waterbirth within institutions is disciplined, surveilled, excluded and circulated. The second part of the analysis revealed how the media chooses to deploy the three identified discourses that represent waterbirth in New Zealand. This textual analysis followed the framework of Fairclough's (1995b) media discourse analysis, showing media strategies that are used to promote the discourse deemed to be ideologically significant by the media outlet. Textual analysis identified that the scientific medical discourse contests waterbirth as an unsafe, unproven practice that puts babies' lives at risk. This discourse categorises women who choose waterbirth as unsafe, irrational, alternative, tree-hugging hippies who favour perceived benefits of waterbirth for themselves above the safety of their baby. The natural birth discourse contests that waterbirth is a safe practice that has encountered few problems since its emergence as a validated birthing practice in the late 1980s. It promotes waterbirth as having multiple benefits for both mother and baby and as a way of enhancing the physiological process of birth through non-intervention. The dive reflex discourse underpins the issue of babies drowning when born into water. This discourse details a reflex that suppresses the normal breathing mechanisms in neonates at birth. Literature debates its existence and troubles the overall trustworthiness of such a reflex to prevent a baby drowning when born into water. It is this discourse that sways people's views and positioning on the overall discourse of waterbirth.

This study has identified the discourses surrounding water birth and analyses how these discourses are utilised by the media in New Zealand to represent water birth. The philosophical approach that underpins the study is that of philosopher Michel Foucault and his theory on discourse, power and the subject. His framework is used in a discourse analysis to reveal three main discourses: the scientific medical discourse, the natural birth discourse and the dive reflex discourse. Data used for this study consisted of 30 newspaper articles containing the word 'water birth' collected over a five-year period (2000-2005) from New Zealand's eight main broadsheet newspapers. Analysis was a two-part process: Foucauldian discourse analysis and a media discourse analysis (Fairclough, 1995b).Firstly, the discourse analysis showed the subject and the power positions each discourse offered women for positioning themselves in that discourse. The literature and texts revealed Foucault's theory on power relations and resultant subjectivity within institutions and how waterbirth within institutions is disciplined, surveilled, excluded and circulated. The second part of the analysis revealed how the media chooses to deploy the three identified discourses that represent waterbirth in New Zealand. This textual analysis followed the framework of Fairclough's (1995b) media discourse analysis, showing media strategies that are used to promote the discourse deemed to be ideologically significant by the media outlet. Textual analysis identified that the scientific medical discourse contests waterbirth as an unsafe, unproven practice that puts babies' lives at risk. This discourse categorises women who choose waterbirth as unsafe, irrational, alternative, tree-hugging hippies who favour perceived benefits of waterbirth for themselves above the safety of their baby. The natural birth discourse contests that waterbirth is a safe practice that has encountered few problems since its emergence as a validated birthing practice in the late 1980s. It promotes waterbirth as having multiple benefits for both mother and baby and as a way of enhancing the physiological process of birth through non-intervention. The dive reflex discourse underpins the issue of babies drowning when born into water. This discourse details a reflex that suppresses the normal breathing mechanisms in neonates at birth. Literature debates its existence and troubles the overall trustworthiness of such a reflex to prevent a baby drowning when born into water. It is this discourse that sways people's views and positioning on the overall discourse of waterbirth.

The use of deep-water immersion during labour and birth is commonplace in many countries including Australia, yet there has been little contemporary Australian data from which to form policies regarding its use during childbirth, or which have included women’s experiences using water immersion. The literature reviewed for this study was positive with regard to the effect of water immersion during childbirth and was associated with decreased rates of perineal trauma, low episiotomy rates, low rates of analgesic use, lower operative deliveries coupled with increased maternal satisfaction of the experience of childbirth when compared with births where water immersion was not involved. The purpose of this research was to investigate the influence of deep-water immersion upon maternal and neonatal outcomes and women's experiences of giving birth in Australia. This study used a mixed method in an attempt to fulfil this purpose: the first phase was a Quasi-experimental design and the second phase was based upon a Hermeneutic Phenomenological approach. Data were collected via a Random Chart Audit, from a random sample of fifty nulliparous women who used deepwater immersion during labour and childbirth and six women were selected to participate in a semi-structured interview. Data from each phase of this study revealed positive birth outcomes and these findings were supported by the literature. The women's stories were positive and comprised elements of four lifeworld themes. • Water’s Embrace • Warped Time • Naked but Clothed • The Shape of Water. Each of these themes encapsulated different aspects of the women's experiences, which when considered together, increased the understanding of the phenomenon of deep-water immersion upon the experience of giving birth.

Att använda bad som terapi är inget nytt och finns omtalat redan under antiken. Idag är möjligheten att föda i vatten varierande globalt sett, och i Sverige erbjuds metoden endast på några få förlossningskliniker, trots en ökad efterfrågan. Evidensen visar att vattenfödslar inte påverkar förlossningen på ett negativt sätt och åsikter kring metoden grundar sig främst på attityder och inte fakta. De flesta barnmorskor har en positiv inställning till vattenfödslar trots att deras kunskap varierar. Forskning kring vattenfödsel lyfter främst kvinnors upplevelser men sällan barnmorskans. Syftet var att undersöka barnmorskors upplevelse av, och kunskap om vattenfödsel inom traditionell förlossningsvård på sjukhus. Med kvalitativ metod och induktivt förhållningssätt intervjuades åtta barnmorskor, med varierande erfarenhet, från en klinik som tillhandahöll vattenfödslar. Efter informerat samtycke genomfördes semistrukturerade intervjuer via zoom. Materialet analyserades med hjälp av innehållsanalys. Resultatet utgörs av kategorierna “Barnmorskans upplevelser av kvinnan”, “Barnmorskans inställning och handläggning”, “Utmaningar med vattenfödsel” och “Kompetens om vattenfödsel”. Det visade sig att barnmorskan upplevde vattenfödslar som stärkande för kvinnan och att vattnet hade många fördelar för den födande, där smärtlindring och avslappning särskilt lyftes fram. De menade att möjligheten att välja vattenfödsel borde styras utifrån kvinnans önskemål och inte utifrån tillgången. Vattenfödslar uppfattades som positiva och sågs som naturliga fysiologiska födslar, där kommunikationen hade en framträdande roll. Svårigheten att uppskatta blödning i vatten upplevdes som en utmaning. Utbildnings- och kunskapsläget var varierande och både den totala arbetslivserfarenheten som barnmorska och antalet handlagda vattenfödslar spelade in i hur trygga de kände sig med metoden. Klinikens tydliga PM kring vattenfödsel spelade också in i den upplevda tryggheten. Slutsatsen var att barnmorskan upplevde vattenfödsel som positivt för både kvinnan och barnmorskan själv. Kunskap erhölls främst genom praktisk erfarenhet, andra barnmorskor och tydliga riktlinjer. Vid jämförelse mellan förlossningspool och mindre badkar var poolen att föredra. / Using baths as a therapy is not a new invention and is mentioned already in Antiquity. Today, globally, the possibility of giving birth in water is varying, and in Sweden the method is offered only on a few maternity clinics, despite an increased demand. The evidence shows that waterbirth doesn’t influence childbirth in a negative way, and opinions about the method mainly are based on attitudes rather than facts. Most midwives have a positive approach to waterbirths although their knowledge is varied. Research on waterbirth mainly focuses on women’s experiences, but rarely on midwives. The aim was to examine midwives’ experience of, and knowledge about waterbirth in traditional obstetric care in hospitals. With a qualitative method and inductive approach, eight midwives with varying experience, from a clinic that provides waterbirths, were interviewed. After informed consent, semi-structured interviews were conducted via zoom. The material was analyzed by using content analysis. The result consists of the categories “The midwife’s experiences of the woman”, “The midwife’s attitude and handling”, “Challenges with waterbirth” and “Competence about waterbirth”. It showed that the midwife experienced waterbirths as strengthening for the woman and that the water had many benefits for the woman, where pain relief and relaxation were especially highlighted. They believed that the possibility of choosing waterbirth should be governed by the woman’s wishes and not based on availability. Waterbirths were seen as positive, natural physiological births, where the communication had an important role. The difficulty of estimating bleeding in water was perceived as a challenge. The state of education and knowledge was varying, but the security in the method was based both in the experience as a midwife and in the number of experienced waterbirths. The clinic’s policies and guidelines about waterbirth also played a part in the perceived security. The conclusion was that the midwife experienced waterbirths as positive for the woman and the midwife herself. Knowledge was obtained mainly through practical experience, other midwives and clear guidelines. When comparing the birthpool and a smaller bathtub, was the pool to be preferred.

The topic of this diploma thesis is a design of bathtub for delivery to water. The goal is to improve shape, ergonomic and safety parameters compared to current representatives. The resulting design is a new product that is suitable for the professional medical environment while reflecting the psychological aspects of childbirth.

SAMMANFATTNING Bakgrund: Globalt sett drabbas cirka 70-80 procent av alla kvinnor av någon typ av bristning i underlivet när de föder sitt första barn och dessa skador kan orsaka både smärta och lidande. Det är av stor vikt att barnmorskor och obstetriker känner till det kvinnliga könsorganets anatomi så att både diagnostisering och handläggning av bristningar blir korrekt. Forskning kring hur dessa skador skall kunna undvikas är ständigt pågående. En av de många frågor som ställs är huruvida förekomsten av dessa skador minskar när barnmorskan utför perinealskydd och hur detta används när kvinnan föder i vatten. Vattenfödsel är ett omdiskuterat ämne och forskare har olika uppfattning om dess för- och nackdelar. Syfte: Syftet med detta arbete var att beskriva utfallet och handläggningen av perinealbristningar vid vattenfödslar. Metod: En kvantitativ ansats har använts och information ifrån 123 kvinnors förlossningsjournaler har sammanställts. Alla kvinnorna födde sina barn i vatten på BB Sophia eller Södra BB från mars 2014 till mars 2015. Bristningsgrad har beskrivits i tabeller och diagram i förhållande till variablerna paritet, barnets vikt, utdrivningsskedets längd, barnets huvudomfång, tid för bad, BMI, ålder och suturering. Resultat: Betydligt fler av förstföderskorna drabbades av perinealbristning än vad omföderskorna gjorde. Av de kvinnor som fick en grad 3 eller grad 4 bristning hade alla längre utdrivningsskeden och var förstföderskor. Nio procent av kvinnorna i studien fick en grad 3 bristning vilket ses som en hög siffra. Av de totalt 101 kvinnorna som fick någon typ av perinealbristning lämnades tio stycken osuturerade och nästan hälften av barnmorskorna som besvarat enkäten använde sig av perinealskydd vid vattenfödslar. Slutsats: Att vara förstföderska ökar risken för perinealbristningar oavsett om kvinnan föder i vatten eller inte. Utdrivningsskedets längd kan ha betydelse samt även om barnmorskan använder perinealskydd eller inte. Vad som i övrigt påverkar utfallet av bristningar vid vattenfödsel är inte säkerställt. Mer forskning i ämnet behövs.

Fragestellung/Hintergrund: In den letzten Jahren hat die Wassergeburt eine weite Verbreitung gefunden. Die Geburt eines Kindes ist als 'life-event' (Kentenich) im Leben werdender Eltern zunehmend ins Bewusstsein gerückt. So soll nach den Forderungen der Eltern in möglichst häuslicher Umgebung mit Freiraum für eigene Gestaltung das Spektrum medizinisch-technischer Möglichkeiten im Bedarfsfall verfügbar sein. Um Zufriedenheit mit dem Geburtserlebnis zu erreichen, müssen die an eine Geburtsklinik gestellten Erwartungen erfüllt werden. So ist es unser Anliegen, eine Geburtshilfe anzubieten, welche auch als psychosomatisch verstandene Geburtshilfe die Zufriedenheit der Eltern zum Ziel hat. Methode: Die vorliegende Untersuchung ist eine Fall-Kontrollstudie, in der die Geburtsmodi Wassergeburt und Bettgeburt auf drei Aspekte hin untersucht wurden: Daten des Fetal Outcome, mütterliche geburtshilfliche Parameter sowie Daten zum Geburtserlebnis, der Geburtsvorbereitung, der Assoziation zum Thema Wassergeburt und soziodemographische Variablen. Anhand des letzten Aspektes wurde untersucht, ob ein Zusammenhang besteht zwischen dem Geburtsmodus und der Zufriedenheit mit dem Geburtserlebnis. Weiterhin wurde die mikrobiologische Kontamination des Badewassers untersucht. Ergebnisse: Die Kollektive unterschieden sich nicht hinsichtlich Parität, Schwangerschaftswoche und mütterlichem Alter. Bezüglich der mütterlichen geburtshilflichen Parameter und des Fetal Outcome ergaben sich keine signifikanten Unterschiede. Der Entschluss zur Wassergeburt wird von den meisten Frauen (59%) spontan im Kreißsaal getroffen. Das Geburtserlebnis wird von den Frauen der Fallgruppe signifikant besser beurteilt. Es traten keine Neugeboreneninfektionen auf, die durch Keime des Badewassers verursacht wurden. Schlussfolgerung: Die Wassergeburt ist unter Berücksichtigung von Ausschlusskriterien ein sicherer Geburtsmodus für Mutter und Neugeborenes. Die Möglichkeit für die Gebärende, sich spontan für diesen Geburtsmodus zu entscheiden, geht mit einer positiven Bewertung des Geburtserlebnisses einher. Somit ist die Wassergeburt ein sinnvolles Angebot an die Gebärende vor dem Hintergrund der an die Geburtshilfe gestellten Erwartungen. / Objectives: In recent years water birth has obtained much acceptance. Childbirth has more and more taken on the quality of a life event (Kentenich) in the consciousness of expectant parents. While parents want it to take place in a personal and homely atmosphere they whish at the same time to have the security of medical facilities. Parents will be satisfied with the experience of childbirth if their expectations towards obstetrics are fulfilled. Methodology: This study is based on a case-control trial in which water birth and conventional birth in bed have been compared in respect of the following data: fetal outcome, maternal obstetrical parameters, birth event, pre-birth preparation, association regarding the subject of water birth and sociodemographical variables. It has been examined whether there is a correlation between the mode of birth and the satisfaction with the birth event. Furthermore microbiological contamination of bath water after water birth was examined. Results: The two collectives are equal concerning parity, gestational age and maternal age. They have shown no significant differences concerning maternal obstetrical parameters and fetal outcome. The majority of women (59%) make decision for water birth spontaneously in the delivery room. Women in case group have shown a significantly greater satisfaction with birth event. There were no infections in neonates by germs from bath water. Conclusion: With the exclusion of risk-groups water birth is a safe mode of delivery. The possibility for the birth attendants to opt for a mode of birth spontaneously correlates with a positive assessment of birth event. In our opinion water birth is a commendable alternative fulfilling expectations of parents towards modern obstetrics.