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Water can be used during childbirth as a form of relaxation and pain relief and many women who choose to have an active labour will use a bath or birthing pool throughout the first stage. This is becoming available in more hospitals and birth centres but they may not (legally) be able to allow women to actually give birth in the water because they don’t have the midwives who are trained to attend this kind of birth.
However, many women are choosing to use the water as a place for the arrival of their baby as it has many benefits.
What is Water birth?
Waterbirth is when a woman in labour submerges in warm body temperature (35-37oC) water during labour and may stay here for the duration, giving birth to her baby into a pool of water where he is able to enter the world very calmly and comfortably.
You may choose to have a Waterbirth at home (read Home birth article for more details) or in a hospital who facilitates Water births.
Benefits of Water birth
- Increased relaxation and decreased pain are two important reasons to choose a water birth
- Having a reduced need for pain relief means there is less chance of complication and you are more able to be alert and aware during your labour
- Some evidence suggests waterbirths to be helpful for women who are having a Vaginal Birth after Caesarean (VBAC) or who have been induced as it reduces the intensity of labour.
- Being comfortable, having less pain and feeling more in control has positive effects on reducing the duration of labour
- Women report feeling a sense of inner peace and inherent safety
Safety of Water birth
Waterbirth is documented to be as safe for mother and baby as any other kind of birth. The usual precaution must be made to ensure you are in a low-risk category.
Is there risk of infection from a Water birth?
The practice of not allowing a labouring woman to enter the water after the membranes have ruptured is outdated and not supported by any evidence. There is no evidence of increased risk of infection to the mother during a Waterbirth than any other procedure that could be performed during a regular labour. There is also no evidence of infection rates in babies or admissions to special care units for babies born in water compared to conventional labour.
There are strict guidelines that hospitals must adhere to when cleaning any baths, pools or other equipment used for water births.
When should you enter the bath?
Some hospitals/midwives will wait until you are 5cm dilated (when you are in active labour) before allowing you to enter the water but each labour should be judged on an individual basis. A trained and experienced midwife will know the right time for the woman to enter the water and can make the decision with her.
If you enter the water too early it may actually slow the progress of labour because it can be too calming and relaxing when you need to utilise the hormones (adrenalin) produced at the beginning of labour. On the other hand these hormones may cause a woman to become a little over anxious and stressed if labour starts to progress quickly without dilation, this is when the bath can be useful to help facilitate dilation.
When you do enter the bath it is important to be fully immersed (completely covering the belly) and upright and most people notice an immediate pain reduction once in the bath.
Can my birth support person join me?
Usually yes, some people want & need their support person to come into the water with them to have them to lean on to find a comfortable position or massage them without hindrance. Being in the water may make it more difficult if they need to be getting in and out of the water to get you food or drinks so an extra support person may come in handy here. You will need to check the policies of where you are giving birth.
It is easier for a support person to be in the shower with you , perhaps holding the shower head on your back, without getting wet, enabling them to still do other things you may require.
How long is baby in the water after the birth?
Although leaving the baby under the water for several moments does not cause harm, it is also of no benefit so the baby is usually brought out of the water and into the mother’s arms within 10 seconds after birth.
How is the baby able to be underwater after being born?
There are several reasons why it is safe for the baby to remain immersed in water for a few seconds after birth.
While in the womb the baby is receiving oxygen from the placenta via the umbilical cord. The lungs practice for breathing after birth by exercising the intercostal muscles (muscles between the ribs) and the diaphragm from around 10 weeks gestation. The lungs also produce fluids which enter the mouth and are swallowed but very little amniotic fluid is inspired in the womb. So firstly these fluids are thicker than the water and prevent any water from entering the lungs even if they are taken in past the larynx (throat). Also the baby’s breathing response stops approximately 24-48 hours prior to spontaneous labour and blood flow is redirected to other organs.
Also, as a built in response to the birth process, babies are born with a lack of oxygen (known as hypoxia), which causes a swallowing reflex rather than breathing. If the baby was experiencing a lack of oxygen during labour it would be likely to gasp for air as soon as he is born, but the lack of oxygen would be noticed during fetal monitoring along the way and the mother would have to leave the water before giving birth.
There is also the consideration that the baby does not notice a change in his environment when born into water that is a similar temperature to what he was used to in utero, but babies who have been born into colder water temperatures do not breathe immediately after birth.
Newborn babies also have something called the Dive Reflex, where the larynx is able to tell the difference between amniotic fluid, water and air, enabling them to swallow rather than breathe when water comes into contact with the larynx.
So as you can see there are many safety measures built into a newborn baby to ensure he is able to safely and gently arrive into a wet environment.
How does the baby begin to breathe?
The transition from the water to air prompts a series of changes in the newborn baby to allow him to take his first breath. It is reported that babies born into water may take an extra few seconds to lose their blue coloring as their whole bodies are exposed to oxygen at once as opposed to those born into air having a slow transition with the head usually first and then the rest of the body a contraction later (usually!!).
Over about 6 hours the fluids in the lungs are absorbed into the babies circulatory system which increases his blood volume by around 20% and the lymphatic system takes the rest.
How is the baby monitored during a water birth?
The fetal heart rate is monitored using waterproof equipment including dopplers
Important Considerations
- Lifting your baby out of the water too quickly can be dangerous, firstly because there is risk of the umbilical cord being damaged or torn, but most importantly lifting his head above the water before the rest of his body is born could interfere with his Dive Reflex and cause him to breathe too early
- You will need to get in and out of the water to keep your bladder empty
- Getting in and out of the water can possibly cause your skin to dry out so if you choose to labour in the water but give birth on land consider having some vegetable oil on hand to keep your perineum soft, this will reduce the risk of tearing or needing an episiotomy
- Make sure you have plenty of fluids such as water & diluted fruit juice available to drink to prevent dehydration & keep your energy levels up
Pain Relief Options
During a Waterbirth you MAY not need many other conventional methods of pain relief as the pressure of the water on your abdomen and back help to reduce the sensation of pain. However, there are options for you, which include the following;
Natural Pain Relief
Massage – a trusty support person or birth companion can bring about great relief through strong consistent massage. You should guide them to make sure they are massaging in the right area and not too hard (as it could cause more pain) and not too soft (as it could be more of an annoyance). But be aware that once massage has begun they may not be able to stop!
Breathing slowly and deeply through each contraction, allowing yourself to be cocooned within your private space in the birthing pool enables you to focus on being relaxed through each and every contraction. Much research has been done on the Fear-tension-pain theory showing that the more relaxed a person is the less pain they will experience.
Medical Pain Relief
Gas (medical name being Entonox) is a combination of nitrous oxide and oxygen and inhaled through a nozzle or mask. For this to be effective it must be used right, beginning your deep breath at the very start of a contraction for about 4-6 seconds and exhaling as the contraction subsides, effectively breathing through it. The gas may make you feel a little strange and can cause mild numbness of the face. Some people don’t like this feeling, which disappears almost immediately after each breath.
Pethadine is also an option but the drowsiness caused may not be conducive to labouring in water.
Your midwife can advise you on the best options for pain relief.
A Tens machine or epidural cannot be used when immersed in water
For more information here are some useful links:
Maternity Coalition
Midwives in Private Practice
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