Water Immersion and Waterbirth
Waterbirth – the evidence
Around the world, the topic of waterbirth elicits mixed opinions. For some, waterbirth is the preferred option; for others, it’s the last thing they want to do. Whatever your feelings may be, evidence has been available since 1999 that birthing in water is no riskier for your baby than birthing on land (43, 44). This low level of risk has been consistently proven (45) with recent research finding that being born into water decreases risk for babies born of healthy low-risk women (46).
However, these findings only apply to well-women with no pregnancy complications. If you (or your baby) have pre-existing conditions that may complicate your labour and birth, please speak to your health care provider about the risks and benefits of this option for you.
Waterbirth is safest when:
- both you and your baby have no medical complications
- your midwife or doctor has water immersion training;
- the model of care you have chosen supports your choice to use water in labour and birth;
- your facility is prepared for waterbirth emergencies.
If the use of a birthing pool during your labour and birth is important to you, please find out what your options are in your area.
Things to consider
Birthing pools at home
If you are planning to use water for labour or birth at home, we recommend that you engage the services of a registered homebirth midwife who is comfortable and experienced with waterbirth. Midwives who have this experience will know how to best support you during your labour. They can also advise you where you can source a pool, will have systems in place should a transfer be necessary, and are prepared should an emergency arise. You will need access to lots of warm water, so make sure your hot water system is up to it.
Birthing pools in facility
If you plan on birthing in a hospital or birth centre, it is essential to check that the facility you intend on birthing in can offer this to you.
Some things to ask are:
- Do you have birthing pools/baths?
- Is there a water birth policy?
- What are your criteria for waterbirth?
- Why wouldn’t I be able to waterbirth?
- Do you have accredited staff to facilitate this?
For many women, water immersion is a valuable tool for pain management. Water immersion has the potential to reduce your labour length and your need for additional pain relief (46-48).
Some benefits of water immersion in labour are:
- Encourages relaxation
- Increased sense of power and control
- Reduction in blood pressure
- Reduces instrumental birth
- Reduction in epidural use
- Reduces caesarean rates
- Conserves energy
- Encourages endorphin release
- Reduces adrenalin
- Promotes oxytocin, and
- Reduces need for synthetic oxytocin
The ideal time to enter the pool is still under debate. However, evidence suggests that water immersion has the most benefit for both labour progress and pain relief after 5cm dilation (46-48).
How long can I stay in the bath?
It is thought that the maximum beneficial effect of water immersion has passed by two hours, due to the physiology behind how water immersion brings relief from pain (44). Further, many facilities that support waterbirth ask that women get out of the bath, even for a short time, every two hours. Hence, when you get in the tub will depend on why you want to be in there. If it is pain relief you are looking for, then the best effect happens after 5 cm. If you’re going to birth your baby into the water, waiting until you are a bit more dilated may stack the deck in your favour.
Birthing in water
Birthing in water is safe under the circumstances previously discussed. The benefits of birthing in water include facilitating an appropriate urge to push (fetal ejection reflex) and relaxation of the pelvic floor. However, the arrival of a baby requires trust and communication between mother and midwife. Please discuss how you want to manage the birth of your placenta before you get in the bath. This way, everybody is on the same page, and there are no last-minute decisions to be made.
Some hard and fast rules need to be understood if you intend on birthing your baby into the water.
- You must keep your bottom under the water.
Once baby’s head starts to come, you must keep your bottom entirely under the water until your baby is born, or we ask you to do otherwise.
- If we ask you to move or get out, it is because there is a reason for it.
There are a few things which may make listening to your midwife an actual matter of life or death. If we ask you to move or to get out of the bath, it’s because there is a safety concern.
- We need to listen to the baby’s heartbeat.
While midwives are mindful of interrupting the birthing space as little as possible, we are also required to monitor your baby (so long as you have consented to this). The need to do this increases during the second stage. With your permission, we will request access to your tummy so we can listen to the baby.
- Babies born into water are hands-free.
Your baby’s head will ideally be born without assistance or interference, and the shoulders and body follow gently in the next contraction. When your baby is born, you will need to lift your baby out of the water and onto your chest. If you are not in a position to be able to reach your baby, your midwife can help you with this.
- Keep baby’s head above water.
Baby’s head must be kept above the waterline once they have been brought up and out of the water. They must not be submerged again after this because the baby’s breathing has already been triggered.
Baby’s first breath
When a baby is born out of the water, they usually breathe and cry within a short period. Whether there is a chance the baby will breathe while they are under the water is a common question.
Four mechanisms prevent your baby from inhaling water at the time of birth:
- The placenta puts out hormones which keep your baby’s breathing movements at a minimum. The levels of these hormones are still high in the moments after birth and suppress the baby’s breathing muscles.
- All babies are born with low oxygen levels (hypoxia). Hypoxia prevents breathing and causes swallowing rather than gasping.
- A thick protective fluid fills your baby’s lungs. It is very difficult for water from the birthing pool to move into spaces that are already full of a much denser fluid.
- The baby’s DIVE REFLEX prevents him or her from breathing. The larynx is the traffic control of the junction between the stomach and the lungs. Chemoreceptors (taste buds) detect whether it is air or fluid passing through this junction. If air is detected, it directs it toward the lung. If fluid is detected the gate to the lungs is closed, and the liquid is swallowed instead.
Why is my baby a funny colour?
Babies born into the water usually have a gentler entrance to the world. It can sometimes take them a bit longer than land born babies to take their first breath and turn pink. This delay is normal for water babies. Sometimes they just don’t realise they have been born yet, and their first breath is often less dramatic than land babes. So long as they are not showing any signs of distress, and their placenta is still pulsing, they have all the oxygen they need. They can take their time adjusting to their new environment. Should your midwife feel that your baby needs help, they may ask to disconnect your baby from you and attend to his needs out of the bath.
For further information, please click here to go to the Waterbirth International website.
Nikki-Lee Rossiter (BMid), Registered Midwife/ Dr Janelle McAlpine (PhD), Clinical Midwife.
Photo by In The Light Photography, used under license from Shutterstock.com