embarazadaWaterbirth: Immersion in water for labour and/or your baby’s birth

When we have aches and pains, are feeling stressed, or are fatigued, there is nothing quite like a nice long soak in the bath to soothe our discomfort, aid relaxation and lift our spirits. The same may be said for immersion in water during labour and childbirth. This can include getting into your bath at home during the very early stages of labour to ease backache and/or uterine (womb) contractions; hiring a birth pool for use at home, or using one of the specially designed birth pools often found in Birth Centres and hospital maternity units.

Some women will choose to use immersion in water as their main form of pain relief in labour and to help promote relaxation and feelings of being in control. A large number of women will then choose to get out of the water to give birth on dry land. However, others find immersion in water to be so soothing, that once they’re in the water they don’t want to get out! Where this is the case, their baby is born under water and then lifted to the surface, head first, so that they are able to take their first breath in the air. This is termed a ‘waterbirth’.

 

What can I do if my local maternity unit doesn’t have a birth pool?

Newer maternity units and Birth Centres will often have more than one birth pool, so that women can be offered immersion in water for labour and/or birth. However, older maternity units may not have any waterbirth facilities or may only have one waterbirth pool. Where this is the case there is always the possibility that the pool may already be occupied when your labour starts. This means you wouldn’t be able to use the pool for your labour and/or birth.

Another potential difficulty can be the availability of midwifery staff trained in conducting waterbirths. Many maternity units and Birth Centres provide regular training sessions on waterbirth, so that women using their facilities have more opportunities to use immersion in water during labour/birth. However, there can always be occasions when there aren’t any midwifery staff on duty that are able to conduct waterbirths. If you are concerned that this might happen in your local unit, there is always the option of hiring a birth pool for use in your own home. Your midwife will be able to provide you with further information about doing this and the local pool hire or loan services that are available.

 

Making your choice

Deciding whether this is a method of pain relief and type of birth that would appeal to you can be quite tricky because professional opinion tends to differ. This means that you may encounter some midwives and doctors who favour waterbirth and actively promote it, while others believe that there are risks associated with having a baby in water and are unlikely to support it. Receiving conflicting advice from your health care professionals can make reaching an informed decision very difficult and a bit stressful too! This is why we have written this article – to let you know what the research evidence says about the benefits and disadvantages of immersion in water, and to help you make an informed decision that feels right for you and your baby.

 

What does the research say about immersion in water?

While there is limited research about immersion in water for labour and birth, the available evidence seems to suggest that being in water is helpful in a number of ways:

During the first stage of labour

During the first stage of labour when the cervix (neck of the womb) is taken up (called ‘effacement’) and dilates – immersion in water has been shown to help women relax more and cope better with their uterine contractions. Labouring in water also encourages women’s bodies to release more ‘endorphins’- these are the hormones that help women to cope with their labour contractions, which means women who use water are less likely to need pain relieving drugs. Labouring in water can also stimulate your body to release ‘Oxytocin’; this is the hormone that encourages your uterus to contract.

Water also offers physical support because the natural buoyancy of water tends to make pregnant women feel much lighter compared to labouring on dry land. Birth pools are also designed so that women can adopt a range of positions and continue to be relatively upright, and can rest themselves against the rim (top) of the bath, or sit on the pool’s inbuilt seat. Women often state that being in water is a very soothing and tranquil experience; especially where the lighting in the room is dimmed and women are able to quietly focus on their body and baby’s birth.

Immersion in water has also been found to shorten the length of labour and studies show that women are less likely to need labour care interventions. These include needing to have an ‘oxytocin’ infusion (hormone drip) to help strengthen uterine contractions and speed up labour. Studies have found that labour interventions are less likely where women have planned to give birth in a free-standing midwifery-led unit. For more information about various birth locations and the different stages of labour, see our articles ‘Choosing where to have your baby: place of birth’ and ‘The ‘Latent phase’ of labour’.

In the second stage of labour

During the second stage of labour when the woman is pushing her baby out – immersion in water has been found to help the perineum (the area of skin between the birth canal and back passage) stretch more easily, so that women are less likely to sustain birth trauma or a perineal tear. See also our articles on ‘Healing ways’ and ‘Severe perineal trauma: Third and Fourth degree tears’.

Studies have shown that immersion in water during the second stage of labour is also more likely to result in women having a more natural birth. This means that their baby enjoys a much gentler transition ‘from womb to world’. The warm water of the birth pool is believed to be similar to the amniotic fluid surrounding the baby inside the womb. Babies who are born in water tend to be calmer and often cry less than babies who are born on dry land.

For the third stage of labour

Where women have a waterbirth, the midwives caring for them will often recommend ‘expectant’ management of the ‘third stage of labour’ (delivery of the placenta). Expectant management means that once the baby has been born the uterus contracts spontaneously and expels the placenta (afterbirth) without the midwife giving a hormone injection called Syntometrine.

Women who have a waterbirth have been found to lose a smaller amount of blood at birth, compared with those who give birth on dry land. However this may not be a completely accurate assumption, because water dilutes blood, the amount of bleeding can be a little more difficult to estimate. Midwives monitor women’s health and wellbeing during labour, as well as in the period immediately following the baby’s birth; this includes checking your pulse and blood pressure.

 

Acceptability

When comparing immersion in water with other methods of pain relief in labour, it is a lot less invasive than other forms of pain relief; many of which can involve injections and/or an intravenous infusion (drip). As previously mentioned, immersion in water has also been found to maximise women’s feelings of being in control, thereby promoting a positive birth experience. For further information on the various methods of pain relief in labour, see our articles ‘Pain relief options for labour and birth’ and ‘Aromatherapy’.

 

What should I wear in the birth pool?

This is entirely up to you. Some women like to wear a baggy T-shirt or bikini top, while others prefer to feel the water against their entire body and prefer to be naked. Sometimes, women don’t know what they will want until they have actually got into the water. We would therefore recommend that you wear what feels right for you and is the most comfortable. Why not have more than one clothing option on standby?!

 

When should I get into the water?

If you are using a birth pool at home, you can basically get into the water whenever you wish to. However, if you use immersion in water right from the very early stages of labour, you may need to change the water in your pool. Some birth pools have water filtration systems, but if the one you’re using does not, then the water will need to be emptied out; the pool disinfected and refilled with fresh water every 24 hours.

If you have planned to use the birth pool in your local Birth Centre or hospital maternity unit, the midwives may recommend that you only enter the water once you are in ‘active labour’ ie you are having strong, regular, painful contractions and your cervix is at least 5 cm dilated. This is because entering the water too soon can make your labour slow right down and your contractions can become less frequent or stop altogether. Other hospital maternity units will encourage women to enter the water when they feel ready to do so. This is the case, even where there is the possibility that the woman will need to get out again should her contractions peter off. Your midwife and doctor will be able to advise you about what your local hospital maternity unit or Birth Centre recommend.

 

Dealing with birth ‘debris’

Whether you are labouring on dry land or in water, it is perfectly natural and normal to lose mucousy, blood-stained discharge (‘show’) from the birth canal. Many women worry about having their bowels open (a poo) while pushing their baby out.

There is no need to worry – should you have your bowels open a little bit, this actually shows that you are pushing in the right place! Your midwife certainly won’t be in anyway concerned and can easily remove any debris from the water without you even being aware that they are doing so. It is actually, much easier to do this in water than if lying on bed sheets!

 

Can my partner get into the water with me?

The answer is ‘yes’! If you would like your partner/birth partner to be in the pool with you, that is absolutely fine and it can be very comforting. However, it is a good idea to talk this through with your partner and midwife before labour begins.
Your midwife is unlikely to get into the water with you, although getting a little wet around the time of the actual birth is often to be expected.

 

Is having my baby in water safe?

The majority of research studies that have looked at waterbirth have not found any association between giving birth in water and harm to mother and baby. Consequently, UK National Health Service policy recommends that all pregnant women should be offered immersion in water and access to a birth pool wherever this is possible.

To ensure waterbirths are as safe as possible, maternity units have midwifery care guidelines which set criteria for those women who should be able to safely use immersion in water for their labour and birth. Hospital guidelines also state that you should not be left alone while in the water; this means that your midwife and/or your birth partner should remain with you at all times.

Where a woman has a high-risk pregnancy, labouring and/or giving birth in water will not be advised. This is because she and her baby will need to be monitored more closely. The midwife and doctor will always explain their concerns and the reasons why having a waterbirth is not recommended. This can be a huge disappointment, especially where women have set their heart on having a waterbirth. It is important to remember that the midwives’ and doctors’ priority will always be yours and your baby’s health and wellbeing.

Similarly, if you become unwell and/or your baby becomes distressed, the maternity staff will need to ensure that you can be manually lifted or assisted out of the birth pool quickly and safely. It is for this reason that maternity units and Birth Centres require their staff to attend regular training sessions on manually lifting and assisting women out of the birth pool in emergency situations. This is why waterbirth guidelines recommend that women with a raised BMI (Body Mass Index) do not give birth in water.

Should you feel strongly that waterbirth is the right option for you and your baby, but your midwife and doctor have advised against it, talking to a local supervisor of midwives can be helpful. See also our article ‘Support for parents: how supervisors of midwives can help’.

Common concerns associated with having a waterbirth

Will my baby breathe in the water?

Parents often worry that their baby will inhale the water while being born. However, healthy babies only take their first breath once they have been brought to the surface of the water head first – this is always done as soon as possible. When your baby’s face comes into contact with the air, this encourages them to take their first intake of breath. This is why once your baby’s head has been born you will be instructed to stay in the water until their body has been delivered. If you take yourself out of the water after the baby’s head is born, then re-immerse yourself in the water, your baby may try to take a breath as they have already been in contact with the air.

Babies are also protected by the ‘Dive Reflex’ – this is a reflex that prompts them to close their airway so that they don’t breathe in any of the pool water.

Delivering the placenta (afterbirth)

Once your baby has been born you may be advised to step out of the pool to deliver the placenta safely. This enables your midwife to accurately observe the amount of bleeding present and to ensure the placenta and membranes (the sac that held your baby) are complete (are delivered intact). If you have torn and need sutures (stitches), you will be asked to wait for an hour until this is done to allow the skin to dry out and any swelling to reduce slightly.

Will my baby get an infection?

Parents may worry that their baby will pick up an infection from the water in the pool. However, hospitals and Birth Centres maintain very strict standards of hygiene and waterbirth facilities are always thoroughly cleaned between each use. This includes robust cleaning of the surfaces of the pool, as well as all items and equipment that come into contact with the water. For example, underwater fetal heart rate monitoring equipment. See also our article, ‘Monitoring your baby’s heart rate in labour’.

Will my baby develop a raised temperature?

Babies are actually one degree warmer while inside their mother’s uterus. A woman’s normal body temperature is 37Oc; this means that her baby will be in an environment that is even warmer at 38Oc! For this reason, it is important that the birth pool water is not too hot and that mother and baby do not overheat. Should this happen, the baby’s temperature increases and their heart beats faster in order to try and ‘cool down’ their body.

National guidelines for immersion in water during labour and/or for childbirth recommend that the water in a birth pool is maintained at a comfortable temperature – ie a temperature that is no more than 37oC. This temperature is actually much cooler than the temperature of a bath that you’d normally run at home.

What happens if I or my baby suddenly become unwell?

Should an unexpected concern arise, the staff looking after you are trained to work quickly and effectively to safeguard you and your baby’s health and wellbeing. This might mean advising you to leave the water, letting the water out (draining it away), or in the event of an emergency situation, manually lifting/assisting you out of the pool and onto dry land. Your midwife will advise you to leave the water should the following situations arise:

• Your baby becomes distressed and there are concerns about their heartbeat

• You develop high blood pressure

• You start to bleed during labour

• You feel faint or become unwell

• Labour isn’t progressing as it should be and your midwife advises you to start mobilising to help speed up contractions

• Your baby has their bowels open while still in the uterus – this is called meconium-stained liquor

 

And finally…

The evidence around immersion in water for labour and birth remains limited. There is currently more research about the benefits of using immersion in water during the first stage of labour, compared with its use during the second and third stages of labour. Your midwife and doctor will be able to provide you with additional information about the facilities that are available within your locality and can answer any queries you may have. It is important that you have appropriate and reliable information about immersion in water for labour and birth, so that you can make an informed decision that feels right for you and your baby.

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