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Exploratory study of the use hydrotherapy to offer choice to healthy women with a previous caesarean section in labour


1st Supervisor: Christine McCourt

2nd Supervisor: Lucia Rocca-Ihenacho

Research Centre

Maternal and Child Health research

Project description

The rates of caesarean section (CS) are rising, and alongside with it the importance of promoting Vaginal Birth After Caesarean Section (VBAC). Considering that the use of water in labour and birth facilitates the physiology of labour (Cluett and Burns, 2009), it could be hypothesized that hydrotherapy may have a beneficial effect on VBAC. However, a systematic review conducted by Branchini et al. (2016, for publication) highlighted a lack of research on this topic.

A survey conducted by the same research group (Branchini et al, 2015, for publication) showed that the offer of water as a pain relief option, in labour and at birth for VBAC mothers, varies widely between different NHS Trusts and the rationale behind the policies and guidelines adopted is often unclear.

The Birthplace in England study identified a higher use of hydrotherapy in midwifery units (MUs). This study identified that care in MUs is safe and optimal in terms of maternal and neonatal outcomes. Therefore, there is a strong case to investigate in depth the use of water in such units. In addition, there has been a recent trend to enable some women with previous CS to use water immersion in labour in MUs and obstetric units  (OUs) but to date there is no clinical evidence on the outcomes.

Aim: to explore the use of hydrotherapy in labour in MU and OU settings in the UK and potential for a future RCT to test outcomes.


  • To explore the expansion of care boundaries of AMUs and specifically the use of hydrotherapy for healthy women giving birth after a caesarean section who opt for AMU care;
  • To explore how many MUs offer care to women having a VBAC in England and how many of these offer access to hydrotherapy;
  • To map the offer of hydrotherapy to VBAC women in England in  AMU and OU settings and collect data and information from local clinical audits.
  • To investigate the views and experiences of midwives and obstetricians providing care to VBAC women who are choosing to use hydrotherapy
  • To explore the potential to conduct a randomised controlled trial to assess clinical and psychological outcomes of use of hydrotherapy in women with previous CS, in low and higher-risk birth settings.


A mixed method approach will be required. Service provision will be mapped with a national survey and data gathered from local clinical audits will be analysed in order to provide a preliminary indication of clinical outcomes. Interviews and focus groups will be conducted with midwives working in AMUs and with obstetricians and midwives in OUs offering hydrotherapy to VBAC women.

The data analysis will be used to design a feasibility trial to investigate clinical outcomes for mothers and babies.

If you would like to have an informal discussion please contact Christine.McCourt.1@city.ac.uk.