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CHHHS Midwifery learning packages: Water immersion in labour and underwater birth

Guide for Cairns & Hinterland Hospital & Health Service Midwifery learning packages and resources

Water immersion in labour and underwater birth

Water immersion in labour and underwater birth

The Water Immersion for Labour and Birth workshop is available through Queensland Health’s Clinical Skills Development Service - see links below. The face to face workshop builds on the content from the online package.

estiMATE e-learning tool

estiMATE - an e-learning tool for estimating blood loss during waterbirth

estiMATE is now available as an open access module on All4Birth. It takes a maximum of 2 hours to go through, including quizzes. Successful completion releases a certificate which makes it useful to evidence CPD for midwives and learning for students. 

estiMATE is a unique e-tool comprising a professionally-created series of videos filmed in real time, using live models and a range of blood volumes using expired human blood. This presents an authentic simulation. The videos were filmed in a standard-sized, white, plumbed-in birth pool that is typically used in hospital and midwifery unit birth settings. Around the world, more women are giving birth in water every year.  Water immersion facilitates physiological labour and birth with no known risk to healthy mothers and babies.  This e-tool offers essential learning to secure safe, skilled practice.


estiMATE was created and developed over the course of two MSc midwifery students’ dissertation projects, a small-scale study that confirmed proof of concept and a national evaluation.The course has been enhanced to optimise knowledge and understanding, together with accuracy in visual blood loss estimations during waterbirth.  It is based on the best available evidence and provides guidance and tips to inform clinical practice during waterbirth that is equally applicable to physiological birth on land.


The estiMATE course has three chapters, which you can navigate your way through at your own pace. 

Chapter 1 revisits physiological birth and clinical care features that can impact on the physiology, particularly in relation to third stage management.  It also provides a brief research overview of water immersion, including factors that influence its uptake, its benefits and lingering concerns.  The second part of this chapter requires you to observe videos of a random sequence of blood volumes in a birth pool and to log your estimation for each.  You need to achieve 50% accuracy for this baseline assessment before progressing to Chapter 2.

Chapter 2 takes you down a layer, with practical tips to enhance your learning and includes information about the relevance of maternal weight in relation to blood loss, and the shock index.

Chapter 3 involves scenario problem-solving and a final sequence of blood volumes to estimate.  You need to estimate all of these correctly for successful course completion and a certificate.


Burns E, McDonald M, Rodd Z, Shepherd E, Smith L, Blamey C (2023) estiMATE – An e-learning tool for estimating blood loss during waterbirth. Available at: (date accessed).

Clinical Skills Assessment Tool - Underwater birth

Professional development plans


For further information relating to learning packages and midwifery education within CHHHS, contact:

Rita Ball

Midwifery Educator | Women's Health Unit | Nursing and Midwifery Education & Research Unit | Cairns & Hinterland Hospital and Health Service

Email | Tel. 07 4226 6470

P: +61 7 4226 6679 | E:
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