Exploring Barriers and Facilitators to Waterbirth Implementation

Background: Globally, waterbirth is recognized as a birthing option that offers women benefits such as pain relief, relaxation and comfort during labour and a positive childbirth experience, while reducing the need for medical interventions. Despite evidence-based benefits, its implementation remains limited in African settings, including Abuja, Nigeria, where waterbirth is yet to be introduced. Objective: The objectives of the study were to explore the perspectives of maternity care providers regarding potential barriers and facilitators to the implementation and use of waterbirth in public tertiary hospital settings in Abuja, North-Central Nigeria. Methods: The study adopted a descriptive qualitative approach. Purposive sampling technique was used to select the three public tertiary hospitals within Abuja. Participants consisted of 13 midwives and 10 obstetricians with varying years of experience in maternity care, purposively sampled until data saturation. A semi-structured interview guide was used for the data collection and data were manually analysed using the Braun and Clarke six steps thematic analysis. Results: Findings were grouped into two themes: the potential barriers and potential facilitators to waterbirth implementation and use. Potential barriers were various personal factors, lack of local evidence, non-existence of services, institutional constraints, among others. Potential facilitators were availability of services, training or education of maternity care providers, adequate funding, stakeholder sensitisation, provision of waterbirth resources, including protocols/guidelines and institutional support. Conclusion: Integrating waterbirth practices into Nigeria’ maternal healthcare is feasible and this study provides baseline understanding of maternity care provider’s views regarding potential facilitators and barriers. Adequate institutional support, sufficient funding, provision of infrastructure, including protocols/guidelines and appropriate training of providers are critical. Equally, important are inclusion of waterbirth into the national maternal health policy document, as well as public sensitisation to increase awareness and demystify implementation and use of waterbirth.