Water birth

 

Woman holding baby in birthing poolHaving a water birth is increasingly common and popular. And with good reason it seems, because many women find that labouring in water can be immensely comforting and help to reduce the pains of labour and need for pain relief.

Are water births safe? | Where can you have a water birth? | Planning a water birth | Are water births faster? | Advantages | Disadvantages | When is a water birth a bad idea?

 

Are water births safe?

The research that has been undertaken so far suggests that babies born in water are no less healthy than babies born 'dry'.

Many women have very good experiences labouring in water, but by definition they will have received one-to-one care from a midwife throughout the birth (hospital protocols state you cannot be left unattended) and we know that this makes for a better birthing experience.

Plus, the fact they requested a water birth suggests these women may be more focused on a natural birth and, consequently, less likely to choose pain relief.

There's nothing to suggest that having a water birth means you or your baby are more at risk of infection - there are strict hospital guidelines for keeping everything extra spick and span in and around birthing pools. (That said, some hospitals' idea of cleanliness leaves something to be desired, so if things do look grubby then demand they get scrubbing or rethink your birthing plans.)

There are no hard-and-fast safety recommendations on the temperature of the water but, roughly speaking, during the first stage of labour the water should be between 35-37°C and in the second stage it should be between 37-37.5°C.

Your midwife should check the pool temperature periodically - and if you've hired a pool it should have come with a thermometer so that you (or someone somewhat less busy) can keep an eye on it.

It's important to keep the ambient room temperature comfortable for you and to make sure you keep your fluid levels up to avoid dehydration.

Throughout your labour, your midwife should regularly monitor your baby's heart rate using an underwater Doppler (fetal heart monitor). If there are any concerns about yours or your baby's health you must be prepared to leave the pool.

The biggest concern, unsurprisingly, tends to relate to actually giving birth underwater, but there's no evidence of higher perinatal mortality or admission to special care baby units for birth in water.

Babies spend nine months in a sea of amniotic fluid and have an inbuilt physiological reflex that should prevent them from taking a breath until they're out in the open air. But any baby born underwater should be brought slowly to the surface with minimal touch to their head and face, just in case this stimulates their breathing reflex.

Additionally, once the presenting part of the baby's head is visible, if it's exposed to air - for instance, if you raise yourself partially out of the water - it's advised that you stay out of the water to avoid the risk of premature gasping of water.

Where can you have a water birth?

Both the Royal College of Obsetricians and Royal College of Midwives support 'labouring in water for healthy women with uncomplicated pregnancies'. So, providing you meet the healthy and low-risk criteria, you should be able to have a water birth in hospital, at a birthing centre or in your own home.

But don't splash out on the waterproof mascara just yet: not everywhere has the right facilities and those that do rarely have enough to go round. So this is definitely something to discuss with your midwifery team and to check when you go on your hospital tour.

If your chosen hospital doesn't provide water birth facilities, it's worth asking if you can bring and use your own hired pool, but don't be surprised if this suggestion isn't met with rapturous glee. If you are allowed to do this, make sure you get confirmation in writing.

Planning a home water birth

If you're having a home birth, then it's up to you to hire or buy your own pool. You can choose between rigid pools, inflatable pools and (height of luxury and priced accordingly) heated pools in a variety of different shapes and sizes. You can even buy a 'birth pool in a box' (think of the years of subsequent summer-time fun the kids will have).

If you don't want to shell out on your own pool, there are loads of different companies offering a hire service - it's worth posting on the Childbirth Talk forum for recommendations.

As with TENS machines, the hire period normally runs from several weeks before your due date until several weeks afterwards. If you go over your due date you can normally arrange to pay by the additional day. But don't expect a refund if you don't end up using it for some reason.

Whether you're planning to buy or hire, before you do anything you need to check that your floor (house, not pelvic) is strong enough to stand the weight of what is essentially a whopping paddling pool - and that you have enough room for not just the pool but for people to move around it.

Plus, you need to have the water pressure and boiler power to fill it and keep it at a decent temperature. There's no point getting one if you won't actually be able to get in the room at the same time, or you're going to spend your entire labour worrying that your loft extension is likely to collapse.

If you are having it at home make sure your midwife is aware of this and is knowledgeable about water birth labours and deliveries.

Are water births faster?

The jury's still out: some studies suggest the first stage of labour may be shortened through labouring in water but that the second stage can take longer. Other studies suggest that labouring in water can slow down a labour, particularly if you get into the pool before you are in active labour, because your body over-relaxes.

With this in mind, your best bet may be to try to hold off during early labour and only use the pool once your contractions are well established, at least three to four every 10 minutes. Although some studies have suggested that at least 5cm dilated is the optimum time to get into the pool, you can get in earlier than that if you need pain relief.

If the contractions slow down you can always get out again and walk around until they pick up again.

What are the advantages of water births?

  • Can provide excellent pain relief and reduce need for additional medication, including epidurals and opiates
  • If you need to, you still have the option of using gas and air - lying in a nice, deep warm bath, feeling slightly woozy works for us
  • Helps you relax, which, in turn helps you feel more in control of your labour
  • Increased buoyancy makes it easier for you to move into and adopt different positions, as the water helps to support your body
  • Because you're being partially supported you may find you get less tired as your body doesn't have to work as hard
  • The whole holistic set-up can help reduce stress - it makes your surroundings a bit less clinical and a bit more spa-like - less stress means you're better able to produce your own endorphins (your body's natural painkillers)
  • They can help lower blood pressure
  • In some cases they may make for a shorter first stage of labour
  • There's been some research that suggests you're also less likely to require a forceps or ventouse delivery, an episiotomy or tear badly. But, a Cochrane review in 2004 found there was no significant difference in duration of labour, operative delivery and perineal trauma.

What are the disadvantages of a water birth?

  • Not every hospital and maternity unit has the facilities and, even if they do, there might not be a midwife with experience of water births on duty when you go into labour
  • Electricity and water don't mix, so that's the TENS machine out the window
  • You can't use a pool if you have had pethidine or an epidural, although you can have either after leaving the pool
  • In some cases it may slow down labour
  • You need to have a specially trained midwife to attend to you if you plan to give birth in the pool - if one isn't available you'll probably be asked to get out of the pool before delivering your baby (if you're given this advice when you ask about using the pool, ask to speak to the midwive's supervisor)
  • They're probably not for the overly squeamish as things can get a bit messy
  • If an emergency occurs it can take time to get out of the pool and into a situation where you can be better attended to
  • You can deliver the placenta (the third stage of labour) in the pool, but the midwife will ask you to leave the pool if there are any concerns about heavy blood loss
  • They're not right for everyone and it can be a bit demoralising if you get in to the pool, expecting nirvana, and not much happens or you loathe it 

When is is inadvisable to have a water birth?

  • If your baby is breech
  • If you have been experiencing excessive bleeding or have a maternal infection or a medical problem such as diabetes or heart disease
  • If you have herpes, as it transfers easily in water
  • If you're carrying twins, triplets or more
  • If your baby is two weeks or more premature
  • If there is severe meconium (your midwife will keep an eye out for this and advise accordingly)
  • If you have toxaemia or pre-eclampsia
  • If your labour is being induced
  • If you have had a previous caesarian section

What Mumsnetters say about water births

  • My daughter was born underwater: I was on my knees when her head came out, then the rest of her a few minutes later. I then turned over to a sitting position before I picked her up from the bottom of the pool. As her head broke the water she took her first breath, it was the most amazing thing I've ever seen. carol3
  • I laboured in water for my first daughter's birth and I found it so relaxing and calm and am sure it helped the pain for me. However, after pushing for two and a bit hours I had to be hauled out as she had shoulder dystocia. Have to say that was frightening, but expertly dealt with by fab midwives. lockets
  • I was soooooo in love with the idea of a water birth - hopped in all keen, hopped out after 10mins, hated it, SO uncomfortable. PhDlifeNeedsaNewLife
  • I pooed in the water. Not much, but I distinctly remember pooing. The relief of the water honestly made it worth it. Even though it was a home birth and my partner had to clear it up. Motherinferior
  • I got in at around 8cm dilated. so was well into established labour, so I cannot say if it made what was very painful any better, but it had other benefits that would make me want to do it again, such as supporting my body and allowing me to move about so easily. Also it was a little private space and I felt safe and enclosed. rubles
  • In hindsight, I think I got into the pool too early, as within an hour my labour, which had been progressing normally, had slowed down to a snail's pace. I had to get out and ended up having oxytocin to speed things up, then an epidural and then a forceps delivery. Willow
  • I had a home water birth with my second child. I wasn’t sure whether I actually wanted to give birth in the pool beforehand but once I was in the pool, I didn't want to get out and my baby was born in the pool about one and a half hours after getting in. It was a really good experience helped by having two lovely midwives who were experienced in home and water births. Janus

Last updated: 10-Jan-2013 at 3:05 PM