Waterbirth : the advantages and safety concerns

Waterbirth tends to create a special atmosphere, and can be a very different experience from having your baby in the main labour suite of a hospital. The theory behind waterbirth is that the baby has been in the amniotic sac for 9 months and birthing into a similar environment
is gentler for the baby and less stressful for the mother.

The advantages

  • Immersion in warm water is an excellent form of pain relief. Some
    women feel the relief as soon as they lower themselves into the pool,
    for others it takes 10-15 minutes to get the full benefit
  • Most women find being immersed in water intensely private, giving
    feelings of security and control.
  • The depth of the water gives support and makes it easier to try different
    positions as well as providing extra buoyancy which means you do not
    have to use energy to support your own body
  • The warm water is a natural aid to relaxation, releasing tension and
    anxieties, and leaving you free to go with the flow of the contractions
  • Waterbirth is often accompanied by dimmed lights and aromatherapy
    oils, which can also aid relaxation
  • With less anxiety, the body produces less of the stress hormones adrenaline
    and noradrenaline. This in turn allows more endorphins to be produced,
    which are the body’s own painkillers, and which also promote a feeling
    of wellbeing
  • Studies have shown that the mother’s blood pressure can drop between
    10 and 15 minutes after entering the water.
  • You can still use entonox (gas and oxygen breathed in through a mask
    or mouthpiece) while you are in the pool, and some women turn to this
    during the intense contractions at the end of the first stage of labour
  • The atmosphere of a waterbirth is less rushed. The second stage of
    labour can take longer, which may be due to less pressure on the mother
    to push
  • Despite the lack of time pressure, some studies have shown that the
    first stage of a waterbirth labour is shorter than average
  • It is a low-tech way of conducting labour and leads to fewer interventions.
    However, the baby can still be monitored, using a pinard stethoscope
    or a hand-held Doppler with a waterproof cover
  • Waterbirth can be a gentler entry into the world for baby

Michael Odent says “Many women do not want to leave the pool because it is so comfortable. As a result sometimes the baby comes while the mother is still in the pool.”

And Janet Balaskas says, “Most women feel ecstatic after a physiological waterbirth. Babies tend to be calmer and often seem to smile fleetingly.

“Many mothers feel that this is the kindest, gentlest and most loving way to have a baby and that nothing could be more natural.

“For you and your partner it can be wonderful way to celebrate the birth of your child.”

Safety concerns

Since waterbirth was introduced in the 1970s it has been welcomed by
many mothers and midwives, but there is still concern that not enough
research has been done to identify possible disadvantages or even dangers
for the mother and baby. However, most birth units have developed their
own guidelines and protocols and over the years practices have been standardised
to make it safer.

  • Water temperature – this should be monitored and adjusted to the mother’s
    comfort as women vary in what temperature is beneficial for them. During
    labour the water should be between 32º C and 36º C. For delivery the
    water should be between 36º C and 37º C.
  • Water depth – this is best measured by asking the mother to kneel
    resting on her heels. The water should then cover her belly, resting
    just below the breasts.
  • Mother’s temperature – this should be monitored regularly and the
    mother should be encouraged to drink plenty to prevent over heating.
  • Baby’s heart rate – this should be monitored with a waterproof foetal
    heart monitor to ensure baby’s safety throughout labour and detect any
    signs of foetal distress. General recommendations are every 30 minutes
    during first stage labour and then after every contraction where possible
    during second stage labour.
  • Water embolism – in the early days of waterbirth, some obstetricians
    were concerned that water could enter the uterus and then the mother’s
    bloodstream through the placenta. However, the Royal College of Obstetricians
    and Gynaecologists have acknowledged that this has never happened in
    the thousands of waterbirths that have taken place.
  • Baby’s first breath – Janet Balaskas says “It is now commonly understood
    that babies born in water have inbuilt physiological reflexes that prevent
    inhalation of the water during a waterbirth. However, it is important
    to maintain the right conditions to support this reflex.” This includes
    slowly bringing baby to the surface, over 7 – 10 seconds, maintaining
    pool temperature at 37º C and minimal touching of baby’s head and face.
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