Introducing waterbirth in a university hospital setting in Sweden: A qualitative study of midwives' experiences.

Introduction: Waterbirth is a popular and increasing care option in several countries but is still debated. In Sweden, there are challenges in the process of reintroducing waterbirth after decades of interruption invoked by a dissuasion. The aim of this study was to explore factors affecting midwives' provision of waterbirth at a university birthing clinic in Sweden.

Methods: A qualitative research design was used with three focus group interviews with 18 midwives at three birthing units. The data were analyzed using the principles of inductive content analysis.

Results: The midwives in the study expressed positive attitudes and potentiality about waterbirth, contributing to their desire to support physiological birth. However, obstacles were also disclosed, maiming waterbirth evolvement. Hence, two categories emerged, promoting factors and obstructing factors. The subcategories were: Provides a good experience whilst promoting physiological birth; Increased knowledge and information about waterbirth; Support from management; Updated guidelines; Ergonomic challenges; Lacking practical conditions; Lack of knowledge; Paradigm conflicts; and Limiting guidelines.

Conclusions: The study concluded that midwives recognized both promoting and obstructing factors affecting the provision of waterbirth. The predominant factor highlighted was the care-culture, with a clear distinction between a risk-focused, medicalized approach that inhibits waterbirth and a salutogenic perspective advocating for it. This dichotomy underscores the importance of providing opportunities that support women's choices to facilitate an empowering birth experience.