Laboring and Birthing in Water

Contrary to what some people have believed, giving birth in water "is not 'New Age'; it is not a cult; it is not a fad"¹. Although less than 1% of American babies have been born under water since the 1980s, several European and other countries have utilized water immersion in labor for centuries.

The majority of water births take place at home, but many hospitals across the country are beginning to recognize the benefits of laboring and birthing in water. What are the benefits of laboring and birthing in water versus in bed? What first takes the notice of pregnant women is learning that laboring in water reduces the discomfort of contractions. In some circles, laboring in water is known as the midwive's epidural because it provides the best non-narcotic pain relief. In fact, one of my own clients said that her water birth was comparable to her previous Nubain-assisted births.

Two big reasons why water immersion reduces pain are that it releases more oxytocin and endorphins as the woman's body relaxes into the water and releases pent-up stress. One study published in the British Medical Journal found that laboring in water not only reduces your pain and stress, but also your need for medical intervention. According to this study, 2/3 of the women who labored outside of the water requested an epidural, compared to only 1/2 of the women who did labor in water².

Another benefit of laboring and birthing in a bath is that it gives women more autonomy and control. They are able to change positions more easily, and are usually given more freedom to birth without intervention.

Labor is typically shortened, and dilation occurs more quickly in the water, since stress induced tension contradicts the body's efforts to progress in labor, and it is difficult to remain tense in a deep warm bath.

One of the ways a woman is given more control in the bath is that she is usually not forced to push. This along with women's tendency to use their hands as counter pressure around the baby's emerging head results in fewer tears and less bleeding following a water birth. Laboring in water also helps to maintain the woman's body fluid balance.

Laboring and birthing in water has numerous benefits for the baby as well. For instance, the increased levels of maternal oxytocin increases the baby's own endorphine level, allowing him to feel pleasure instead of pain as he exits the birth canal. Studies also report that babies born under water tend to cry less and look around more immediately following birth, as well as have better first nursing experiences.

The biggest concern about water birth that mothers tend to have is that the baby will inhale water when it comes out, and will drown. However, just as babies do not breath in the amniotic fluid in the womb, they will not breath in the bath water. Babies do not take their first breath until they feel air on their face. Until they are brought to the surface of the water, the umbilical cord will continue to supply them with all the oxygen they need.

Another concern that women often have about laboring in the water is modesty. For those who are concerned about showing a lot of skin, you could wear a sports or nursing bra into the water, and a pair of shorts until birth in imminent. Some women have worn their bikini's into the birthing pool.

So what does it look like to have a water birth? How would it happen? First, try to wait until you are at least 4 or 5 cm dilated to get into the tub. In this way you will benefit the most from the pain relief, and dilation is more likely to quicken. Using the shower before this can give you the benefit of pain relief without worrying about slowing labor down. For women who have had a long and exhausting early labor, it may be more beneficial to get into the tub before 4cm dilation in order to relax.

If your water bag has already broken at this point, some practitioners might not allow you to immerse yourself in labor due to the slight increased risk of infection. Studies have repeatedly shown, however, that if you are further along in labor, being in water should not cause you to get infected after your water has broken. Using a water tub carries a much lower risk of side effects than other pain relief methods like epidurals.

To prevent fever, a raised heart rate, and loss of energy, it is important that the water temperature remain around body temperature, or at 98.6 degrees Fahrenheit. For a woman to get the most benefit, she must sit in a deep warm bath. If the bath is big enough, your partner can sit in it with you to support your back, rub your shoulders, or just to hold you.

During labor in water, the baby's heart rate can still be monitored using a waterproof fetal monitoring system.

When it comes time to push you can continue to do so, as your body directs, in the water. If your caregiver only allows laboring in water, you can still benefit by waiting to get out of the tub until the head begins to crown, at which point the birth team would help you to get out of the tub and into the bed.

If the baby is born under water, help to bring him to the surface immediately, face down so he doesn't gulp water as he comes up. Hug him close and keep his head above water while the birth team helps dry you both off and to get out of the bath before the placenta comes.

If you wish to have a water birth, find a caregiver and environment that actively supports water birth and has experience in helping women to have them. This will both increase your chance of having a water birth, and make it safer.

In addition to having a supportive birth team, being able to have a water birth depends on a few factors. You have to have a healthy pregnancy, a healthy placenta, be at least 37 weeks pregnant at time of delivery, have the motivation to deliver without drugs, and there must be no expectation of complication.

Whether or not you end up delivering in the water, laboring in the shower or bath is a wonderful way to help your baby and yourself to have a good birth experience, especially if you plan to delay the use of pain meds or go completely natural.

References:
1. Barbara Harper. "Hydrotherapy and Water Birth in Hospitals". CBE Reporter '95
2. "Labor Pains? Go Jump in a Pool". Pregnancy Magazine. October 2005
3. Nancy Ripton. "Water Babies". Pregnancy Magazine. November 2007
4. Penny Simpkin. "Baths and Showers in Labor". DONA Birth Doula Workshop Manual 2006