One of the first births I witnessed was a water birth. The woman I was caring for couldn’t wait to get into the pool when she arrived at the hospital, so as soon as the pool was full of water (they take a while to fill up – there’s a lot of water going in there) we helped her to get into the pool. As soon as she got into the pool, her face visibly relaxed and it seemed like the edge of her contractions blurred as she swayed in the water; it was as though the water empowered her to move her body in different patterns.
Labouring in water isn’t a new concept – women have used showers and baths for pain relief for a long time – there are accounts of water births in ancient egypt, but the first referenced birth I’ve found is from 1803 where a woman in France having a particularly long and difficult labour finally found relief and birthed in a tub of water (Church, 1989). From then, it took until the 1980s and 1990s to become a widespread practice, which is attributed to Michael Odent and his installation of a birthing pool in Pithiviers hospital (Beech, 2000).
Some of the main reasons women may choose to labour in water:
Pain relief – “increases mobility, soothes contraction pain” (Johnson & Taylor, 2010)
Well-being and control – the pool can offer a feeling of protection for some women (some refer to it as a “sacred space”), and women are able to more easily be the first person to touch their own baby as during a water birth, midwives are more likely to be “hands off” (they won’t touch the woman’s perineum or the baby’s head)
Low intervention – in the most simplistic sense, people won’t poke and prod you if you have a moat around you!
High levels of satisfaction – in a study by Richmond 2003, 81% of woman would birth in water again, and in a study by Torkamani et al. (2010), 72.3% of women who had a water birth would choose to again
Decrease of postpartum blood loss – studies show thhere is a significant decrease in blood loss following waterbirth (Dahlen et al, 2003)
Some of the main reasons women may not to labour in water:
Dislike of water – if you don’t like baths and you’re not fond of swimming, it makes sense that a water birth isn’t going to be high on your list of priorities..!
Monitoring/interventions – if your labour has been induced or you have developed pre-eclampsia, raised blood pressure or have a chronic health condition which requires monitoring in labour, it’s advised that you don’t have a water birth – refer to your midwife or hospital trust for more information
So, how exactly does water help reduce pain in labour?
“Blood flow redistribution promotes muscle relaxation and decreases catecholamine release and, by increasing endorphins, decreases anxiety and promotes [women’s] satisfaction” (Santano et al, 2013)
In other words, the water relaxes women which causes endorphins (our happy hormones which give us feelings of pleasure or euphoria), and lessens catecholamines (the stress hormones) which makes women feel less anxious. Hurrah!
There appears to be a great debate about the risks of perineal trauma in waterbirth – some sources say that water birth reduces the risk of tears, some research says that in increases the risk of tears, some says it reduces the rates of episiotomies, some that it increases the risk of 1st and 2nd degree tears, and some that it lowers the rates of 3rd and 4th degree tears… The RCM (Royal College of Midwives) state that:
“Immersion in water during labour or birth was not associated with a reduction in perineal trauma in a Cochrane review which included 12 trials and data on 3243 women” (RCM, 2012)
In that review immersion in water was found to make no difference to perineal trauma (no more, no less). In Dekker’s article on water birth for Evidence Based Birth (Dekker 2014), she states that 4/5 studies of water births, women were more likely to have an intact perineum (I found Dekker’s section on perineal trauma in that article very interesting. If you’re impatient like me, use ctrl+f to find the section titled “episiotomy” and work your way from there – it’s about a third of the way through the article).
Some more research is required methinks!
Using water pools:
- Women should be aware of the availability of a pool if they are planning a waterbirth in a hospital
- Current guidelines for water temperature are that the water should not be above 37.5 or too cold, and so the temperature of the pool needs to be checked hourly
- The depth of the water should be to the breasts when sitting or kneeling – it must cover the baby
- Observations and care – the woman’s temperature should be taken hourly,
- Entonox can be used while the woman is in the pool
- It’s vital that the woman maintains good hydration
- The woman will need to leave the pool for any vaginal examinations or to pass urine
- It is recommended that women get out of the pool and walk around for 30 minutes after being in the pool for two hours – this reactivates the hormonal process and causes an increase in oxytocin (Harper, 2006)
- The midwife will use a mirror to assess progress, and possibly a torch
- When baby is born, baby should be born completely under the waater and then brought carefully to the surface (in case of a short umbilical cord), and should rest with his or her head above the water (this is to ensure a good temperature due to evaporation and potential heat loss)
- During the actual birth there is a ‘hands off’ approach to stop from stimulating the baby (stimulation may cause the baby to begin to breathe)
- I’ve not witnessed third stage of labour in a birthing pool, however, literature promotes this (Nutter et al, 2014; Johnson & Taylor, 2010)
- Suturing must take place outside of the pool
I’d love to hear from you guys – would you like to have a water birth, have you had a water birth, have you read any recent articles about perineal trauma that you would recommend? Let me know!
Extra for experts
Benefits of water birth – Waterbirth Intenational
Midwives and water births – Midwife Diaries
Want to promote normality? Try adding water! – Sara Wickham
Evidence on the safety of water birth – Evidence Based Birth
Does water slow down labour? – Talk Birth
(In the interest of getting this post up, these references aren’t finished – promise I’ll finish them soon!)
Water birth safety and suggestions for new guidelines. Keith Brainin, Adam Tobias. MIDIRS June 2015, vol. 25, no. 2. 165-170.
Church, L.K. 1989. Water birth: One birthing centre’s observations. Journal of Nurse Midwifery. 34 (4). pp.13-16.
Skills for Midwifery Practice. Johnson & Taylor, 2010.
Gentle Birth, Gentle Mothering. Sarah Buckley
Waterbirth: an intergrative analysis of peer-reviewed literature. Nutter et al. 2014
Effect of shower bath on pain relief of parturients in active labor stage. Licia Santos Santana; Rubneide Barreto Silva Gallo; Cristine Homsi Jorge Ferreira; Silvana Maria Quintana; Alessandra Cristina Marcolin