Water birth

Woman giving birth in a water bath

A water birth is a safe way to have your baby and is increasingly common and popular. As the name suggests, it involves giving birth (or labouring) in water – usually in a specially designed pool. The comforting sensation of warm water can help you relax during labour and even reduce labour pains and the need for pain relief.

What is a water birth?

Put simply, a water birth is when you labour and/or give birth in water. It generally happens in a specially designed birthing pool, available in some hospitals and birthing facilities as well as for home hire. Water births are becoming more popular as they're simple and non-intrusive and can help you to relax and more around more during labour, reducing the pain from contractions. While they don't work for everyone, the act of floating in warm water is soothing to many women and simply the act of slipping into the bath and having their own private space can help them deal with labour.

Advantages of water births

  • The water helps you to relax and produce endorphins, the body’s natural painkillers, which keeps you calm and reduces the pain of contractions.
  • The birthing pool provides an enclosed, private space which helps you to feel in control of your labour.
  • It can reduce the need for additional medication, including epidurals and opiates.
  • The buoyancy of the water makes it easier to move into different positions and find the most comfortable one for you.
  • You may tire less quickly as your body is partially supported by the water, so it doesn’t have to work as hard.
  • You can use gas and air in the pool as you would on dry land. Lying in a deep, warm bath feeling slightly woozy sounds good any day of the week, frankly.
  • The set-up is more holistic than a hospital bed, and the spa-like surroundings make everything feel a bit less clinical.
  • A water birth can help to lower blood pressure.
  • In some cases they may make for a shorter first stage of labour.
  • There's been some research to suggest that you're also less likely to require a forceps, a ventouse delivery or an episiotomy, or to tear badly.
  • You’ll have someone with you at all times to ensure your safety in the water.
  • Supporters of water births believe that the transition to the outside world may be more peaceful for babies born in water, as the warm water is similar to the amniotic fluids in the womb.

Disadvantages of water births

  • Not all hospitals and maternity units have the facilities for water births, and it’s possible there may not be a midwife with experience of them on duty when you go into labour.
  • In some cases it may slow down labour
  • You won’t be able to use a TENS machine, as electricity and water don’t mix well.
  • 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.
  • The water could get a bit messy with bowel movements, mucus or blood which may bother you.
  • 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.
  • While you can deliver the placenta the pool, the midwife may ask you to get out of it if there’s heavy blood loss.
  • There’s no difference in perineal trauma or maternal infection in water births, as found in a Cochrane review in 2009.
  • It can be demoralising if you’ve planned for a water birth and don’t find it helpful once you’re in the water – they’re not right for everyone and you won’t know until the time comes.
Pregnant woman labouring in water birth with head on towel

What giving birth and labouring in water is like

The safe, enclosed space of a birthing pool helps many women to relax and go with the flow of their labour. You’ll find it easier to manoeuvre yourself into as many positions as you need to to find where you’re most comfortable. Getting into a vertical position, to let gravity help with the birth, may be less difficult than on dry land. As with a ‘dry’ birth, you may well soil yourself while pushing – midwives are completely used to this and will scoop the offending poo out of the water with a small net kept for that exact purpose, and you may well not even notice it happening.

Be under no illusion that it takes away the pain – it doesn't – but if you are the kind of person who relaxes by taking a bath then it may help you.

When your baby is born, your midwife will gently bring her to the surface, where she’ll take her first breath. She won’t float as there will be no air in her lungs yet, and will only start breathing once the air hits her skin. She’ll still be receiving oxygen via the umbilical cord and you don’t need to worry about her inhaling water or drowning. 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 and it’s exposed to the air, such as you’re half in and half out of the water, it’s advised that you stay completely out of the water to prevent the baby from breathing in water.

You can stay in the pool with your baby while you hold him and can start to initiate breastfeeding if you want to. Depending on the policy of where you’re giving birth, you may need to leave the water to deliver the placenta.

Positions you can use in a birthing pool

To a certain extent the only limit is your imagination, but this may help you to get the idea of the kind of positions a water birth offers:

  • Kneeling while leaning forward onto the sides of the pool.
  • Squatting while holding onto the sides for support.
  • Using a waterproof pillow to support your head while you lie on your back or tummy, with your hands holding onto the sides of the pool.
  • If your partner gets into the pool with you, leaning back into them as they support you from behind or putting your arms around their neck.
  • You can use a folded towel (from the hospital or otherwise) to provide a cushion for your knees, bottom or chin, whatever position you’re in.
Man helping woman to labour in a birthing pool

What to wear during a water birth

It’s really up to you what you’d like to wear in the water, if you choose to wear anything at all. Many women find that modestly flies out the window during labour and birth. And that’s fine – you certainly won’t be the first to get into the water starkers.

You can wear a t-shirt or nightie if you’d like, or some feel that their breasts need supporting so choose to wear a bikini top or bra. A hospital gown is also an option.

Bear in mind that this might not be the best situation to whack out your Sunday best, as there may be poo – yours or the baby’s – blood and mucus in the water with you. If your top half is covered it may delay skin-to-skin contact as removing wet clothes can be slower than taking off dry ones, and if you need to exit the pool, a dripping wet t-shirt can mean you get colder faster than you would otherwise.

What will my midwife do during a water birth?

Your midwife’s primary role is exactly the same as with a ‘dry’ birth: to ensure the safety of you and your baby and to make you as comfortable as possible. They will ensure that the water temperature is right – the NHS recommends that it should be comfortable, but not above 37.5 degrees – and will assist you with getting in and out of the pool. He or she will also monitor your baby with a handheld Doppler machine, which will be made waterproof using a cover.

Pain management and relief during a water birth

You can use gas and air exactly as you normally would while you’re in the birthing pool, but for another other means of pain relief you’ll need to get out of the water. TENS machines are a no-no for obvious reasons (electricity + water = bad) and you’re also not allowed pethidine, or any other injectables that might make you drowsy. You’ll need to get out of the pool if you decide on an epidural.

Are water births less painful?

Water births may seem less painful because of the environment. If you’re more relaxed, which is an effect of labouring in water, you’ll be able to deal with the contractions better which may make them seem less painful.

Where can I 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.

Hospital water birth

If you’re keen as mustard on a water birth, you’ll need to make sure that the place you choose to give birth in has the right facilities. Discuss this with your midwife and bring it up when you tour the hospital.

It feels a lot more private labouring in a pool – like ‘this is my space and you're not allowed in it’, which made me feel a lot better during the contractions that felt as though they were controlling me.

Even if the place you choose does have the right equipment, it’s possible that it won’t be available when the time comes, or that a midwife trained in water births won’t be on duty. You may want to give the hospital a ring when you’re on your way to say that you’d like to use the pool, so they’re aware that you’re coming.

If your ideal hospital or birthing centre doesn’t provide water birth facilities, it’s worth asking if you can bring your own hired pool. If they agree, ensure you get it in writing.

Home water birth

If you want a home water birth, then it's up to you to hire or buy your own pool. You can choose between rigid, inflatable or even heated pools in a smorgasbord of shapes and sizes.

If you don't want to shell out for your own pool, lots of companies offer a hire service – it's worth posting on the Childbirth Talk forum for recommendations.

It didn’t make a difference for me. I floated in the water in between contractions and pushed in there for around an hour but got really hot and bothered, so decided to get out.

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.

Either way, you’ll need to check that your floor (house not pelvic) is strong enough to withstand the weight of the filled pool, which is surprisingly heavy, and that you have enough room for people to move around it once it’s set up.

You also need to have the water pressure and boiler power to fill it and keep it at a decent temperature. You don’t want to spend labour shivering in chilly water while worrying that the loft extension is going to collapse.

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

Woman and baby wrapped in a towel after a water birth

Times when a water birth is inadvisable

Things can change quickly in labour, and even if a water birth starts out fabulously you need to be prepared to revert to dry land if necessary. This can happen when:

  • Your labour is progressing too slowly
  • There is a problem with your baby’s heartbeat
  • You start bleeding during labour
  • Your blood pressure, pulse or temperature is raised
  • If you feel faint or drowsy

You should leave the pool to go to the toilet, and you may also need to get out to be examined by a midwife. You may find that even if the water is helpful at the start of your labour you want to finish the big event on dry land.

Before labour

You won’t be allowed to have a water birth if:

  • Your baby is breech
  • You have been experiencing excessive bleeding or have a maternal infection or a medical problem such as diabetes or heart disease
  • You are very overweight or have mobility issues which would make it difficult to get you out of the pool if needed
  • You have herpes, as it transfers easily in water
  • You're carrying twins, triplets or more
  • Your baby is two weeks or more premature
  • There is a lot of meconium in your amniotic fluid (your midwife will keep an eye out for this and advise accordingly)
  • You have toxaemia or pre-eclampsia
  • Your labour is being induced
  • You have had a previous caesarian section

Are water births safe?

Research 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 are consequently less likely to choose pain relief. You should also make sure to drink plenty of fluids to avoid dehydration.

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. If the pool looks grubbier than you would like, don’t be afraid to double-check that it’s clean.

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 feel like you want to be in water.

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

Useful items to have

You will generally need the same items you would normally pack in a birthing bag, but you may also find it useful to have:

  • Clothes to wear in the pool – if you’re planning to wear pyjamas or a nightie, make sure you bring a spare or two so you have dry options
  • A small plastic stool to help you climb in and out of the water, or to sit on
  • An inflatable pillow to use as a head rest
  • Extra towels to dry yourself and your baby off with – the hospital will have their own, but fluffy towels could be a nice touch of home
  • A dressing gown or bath robe to slip on when you get out

If your birth partner will be getting in the pool with you, they will need to bring their own bathing suit. It would also be advisable to resist the temptation to bring a lilo or rubber ring with you, however high the comedy value might be.

Water birth experiences

“My baby took a few contractions to get out so there was an extraordinary few minutes where the head was out, but not the body. Her eyes were open and she was just starting up at me through the water, then she came out completely and swam straight up to me. I will never forget that moment and I get butterflies thinking about it now seven years later.”

“I would not have stayed so calm without the water, it really helped me stay on top of the contractions.”

“I was so desperately eager to get into the pool that I started ripping my clothes off straight after the paramedics let me off the ambulance gurney. When I turned round to get into the pool, there were at least five people behind me – paramedics, midwives, I don't know who else. I couldn't have cared less. It could have been the news crew from ITN, cameras and all, and I would still have barged nude straight past them to get to that pool.”

“In hindsight, I think I got into the pool too early. 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.”