Childbirth is a normal physiological process. Although we've not been designed only to give birth in water, many women feel a water birth allows them to follow their natural birthing instincts so much better.
Being in water provides birthing women with privacy and autonomy, while helping them to cope with contractions.
If we think about a time where we've felt discomfort or pain, when we've been really tired, or when we felt physically fatigued, a warm bath or shower tends to help relax us, and relieve our discomforts.
Water simply makes us feel better.
It can leave us feeling energised, as if the water has washed away our stress and pain.
It makes sense that being in water for your birth would have similar benefits… and many more.
What Is A Water Birth?
Water birth is essentially as simple as it sounds. A woman labours and gives birth while in a tub filled with warm water.
Some women choose to labour in water, but not actually birth in the water. Labouring in water has the same benefits as a waterbirth, up until the second stage. Though if you laboured in water, you're likely still relaxed and benefiting from the flow of birthing hormones. The exception of this is being encouraged to get out of the water, for reasons that it could interfere with your relaxation and hormonal flow.
What Are The Benefits Of Water Birth?
While research is still growing in this area, current research and reported experiences tell us water birth has many benefits, including:
- Pain relief
- Buoyancy helps women to feel lighter
- Facilitates easier position changes
- Helps reduce stress hormones that increase pain
- Immersion in water can help reduce anxiety related hypertension
- Reduced risk of episiotomy and tearing
- Can facilitate the fetal ejection reflex rather than interfere with it
- Encourages relaxation of the pelvic floor
- Reduces inhibition and anxiety by creating a feeling of privacy allowing a mother to better listen to her natural birthing instincts and work with her body
- Encourages a gentler arrival and transition for baby
- By facilitating movement, privacy, and emotional and physical relaxation it can reduce the length of labor by encouraging the release of labour hormones
- Reduces the risk of interventions such as synthetic oxytocin (Pitocin/Syntocinon), epidural and assisted birth
How Does A Waterbirth Reduce Pain?
Birth unfolds with several hormones, physical changes and intense muscle contractions. There are many variables which impact a woman's level of discomfort, pain or intense sensations.
A scientific definition of pain is: ‘an unpleasant sensory and emotional experience associated with actual or potential tissue damage.’
In terms of labour, however, this pain is two dimensional. One aspect is the actual transmission of information to the brain, the pain stimuli, and the other aspect is how the stimuli is interpreted which can be impacted by emotional, cognitive, social and cultural variables unique to each woman.
Simply put, while labor pain is very physical, how we feel the physical pain is impacted by our environment, support people and past experiences. Waterbirth affects not only the physical aspects of labour, it also affects the emotional aspect, making it a truly holistic approach to coping with labour.
Hydrotherapy is warm water, sometimes with soothing bubbles, which helps to relax aching muscles. Heat is used to calm, quiet and sooth the body. It improves circulation which can help lessen the body's sensitivity to pain. All things that can help one cope with labour contractions.
The water provides buoyancy which makes you feel lighter and can reduce feelings of pressure. It also eases movement which can facilitate listening to your body to find the most comfortable position.
Perhaps one of the best things about water birth is it often affords mothers more autonomy and privacy, which helps with the flow of labour hormones.
Oxytocin, an important labour hormone, flows best when a woman feels safe, comfortable and loved. With the release of oxytocin, which stimulates labor contractions, the body also releases beta-endorphins which is a hormone that aids in coping with pain – it can even create feelings of euphoria. The environment of a waterbirth can help the body to use its natural pain relief.
One study found only 24% of first time mothers using hydrotherapy also used pain-relieving drugs compared to 50% of first time mothers not using water. Several studies also show statistically significant differences in self-reporting of pain during the first stage of labour (the dilation phase) – women using water report less pain.
When Should A Woman Get In The Water?
There is some evidence to support not getting into the tub until you're at least five centimetres dilated, longer if you can. In some situations, water can slow labour down, but if you're in a well established contraction pattern it isn't likely to have that effect.
You also want to get into the water when it will offer the most benefit. Getting in too early might not give you the same relief as getting in much later when the contractions are stronger.
It is, however, important to remember that each birth is unique. If strong contractions are inhibiting a woman's ability to work with the contractions and relax in order to allow labor to progress, entering the water to relax might actually aid in labour progressing.
Some maternity care providers recommend trialling the water – entering for about an hour and watching to see if contractions slow, remain steady or actually progress quickly. If contractions seem to space out too much and become less intense your midwife or doctor might recommend leaving the tub until you're in more of a strong active labor pattern.
Whenever possible, it's best to be fully submerged to at least your chest. While any bit of warm water can help in coping with contractions, being fully submerged provides more buoyancy and warmth to provide the most pain relief. Being well submerged might also help a mother to feel more secure, as if she's in a safe nest preparing for her baby's arrival.
Is There A Risk Of Infection?
Some facilities will not allow women to give birth in the water if their membranes have ruptured. This policy doesn't follow current evidence as there isn't evidence to show an increased risk of infection with or without ruptured membranes.
Research dating back to the 1960s dispels the myth that waterbirth is dangerous with regards to infection. In the American Journal of OB/GYN, Dr. Siegel posed the question, “Does bath water enter the vagina?”
In his experiment, he placed sterile cotton tampons into thirty women, asking them to bath in iodinated water for a minimum of fifteen minutes. When all of the tampons were removed, there was no iodine present. His conclusion states, “we can now stop restricting women from bathing in the later stages of pregnancy and labour.”
French obstetrician and pioneer in waterbirth, Doctor Michel Odent, reported no infections, regardless of intact or ruptured membranes (waters) during a study on waterbirth.
It's important to remember all choices have benefits and risks – including other forms of labor pain relief. However, there's no current evidence to support concerns over infection during a waterbirth when proper sterilization policies are followed in birthing facilities. Also, unlike some other forms of labor pain relief, waterbirth is not associated with lower Apgar scores or other adverse effects on newborns.
How Will My Baby Breath During A Water Birth?
When we see a birth out of the water, we often notice baby is quickly breathing and crying. However, simply exiting the womb doesn't trigger breathing. Babies are triggered to breath when they feel the change in temperature. When a birthing pool is kept at a safe temperature, a baby will continue to receive oxygen via the umbilical cord. Once brought swiftly out of the tub, the change in temperature will trigger baby to take her first breath.
You can read more about this here: How Does A Baby Breathe During A Water Birth?
What If There Are Complications?
Prior to and during labour, your maternity care provider will asses your pregnancy risk. If you're low-risk, then it's likely a water birth is a safe option for you. Just like any other labour you and baby will be monitored to watch for any unexpected complications. Generally labor and birth unfold without complication, especially when free of intervention, however they will still be sure to monitor you and baby as a precaution.
There are waterproof hand held dopplers, fetascopes, and even waterproof and portable continuous fetal monitors to check on baby's wellbeing. Your vital signs can also be taken intermittently while you're in the birthing pool.
If there are true concerns about your wellbeing or baby's it would be advised for you to get out of the tub so they can better monitor both of you. In the case of unexpected complications that need attending when you're unable to get out of the tub the water might be drained and you and baby attended to before moving.
Is A Water Birth Right For Me?
Until you're in labour it can be hard to know for sure what things will best help you cope with contractions. However, many women do plan for a water birth, and make sure to take steps to keep it a viable option should they find it helpful.
If you're wanting a water birth, your maternity care provider choice is important. Finding a midwife or doctor supportive of waterbirth and familiar with it is important. You will also need to research which facilities offer a waterbirth, and perhaps look into birth pool rental if you're planning a homebirth.