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Water Birth

Water Birthing

This birthing process has gained a lot of appreciation in the recent few years. We at Fernandez Hospital provide you the choice of this beautiful yet safe birthing option. Water birthing is the process of giving birth in a tub of warm water under medical supervision. The unborn baby labours its way naturally from the womb’s watery environment into a similar environment of the birthing tub. It is considered gentler for the baby and less stressful for the pregnant mother.

There has been very little research undertaken on birthing in water and even less on using water in the early (latent) stage of labour relaxation, but the quality evidence so far has not shown any disadvantages. Unfortunately, not everyone is suitable for birthing in water.

Here are some of the criteria necessary for a water birth:

  • Weight under 100 kgs
  • Baby head down
  • Healthy mother able to get out of the pool quickly
  • Normal blood pressure, temperature and pulse
  • Contracting without the need for intravenous medication
  • No history of seizures

Most factors which used to preclude you from using the pool were those which required constant monitoring of the baby’s heart rate.

Note : If you choose to have a water birth, you will be cared for and supported primarily by our professional midwives. Our obstetricians are available and will be involved if you develop any complications that require intervention.

Benefits of Labouring in Water

The many benefits to labouring and giving birth in water include:

  • Less painful contractions
  • The relaxing effect of warm water helps produce endorphins – promoting the body's natural pain relief mechanism
  • Less need for analgesia (pain relief) such as pethidine or epidurals
  • Less need for drugs that accelerate labour, such as oxytocin
  • Shorter labour
  • Feelings of being in control
  • A birthing pool supports 75% of a labouring woman's weight, allowing the woman to feel buoyant and comfortable. Mobility is easier, thus conserving a woman's energy for labour
  • You are more likely to achieve a natural birth
  • A more enjoyable labour experience
  • Water helps to relax the pelvic floor muscles and soften the perineum (the skin between the vagina and the anus), thus reducing the risk of tearing
  • A more gentle birth for the baby
  • Breastfeeding can be encouraged immediately

Risks of Labouring in Water

For healthy women with an uncomplicated term pregnancy, complications are seemingly rare.

A concern for some people is that the baby will breathe while still under the water. This is highly unlikely as there are many mechanisms that prevent this from happening, one of which is the drop in temperature that normally occurs when a baby is born. The water temperature is carefully monitored throughout labour to prevent this drop.

Ensuring the baby's head is totally submerged during delivery also prevents the breathing reflex from starting until the head is clear of the water.

Is A Water Birth Suitable For You?

Generally, if you are healthy and between 37 and 42 weeks pregnant, have experienced a normal pregnancy with no serious medical conditions or complications you are suitable to use water for labour and/or birth if labour started spontaneously. You should also be in established labour with strong regular contractions.

Pain Relief

Using water in labour is an effective form of pain relief. Some women find they want to use the birthing pool for pain relief only, and give birth to their baby out of the water. Should you require any further coping strategies it may be useful to try breathing and relaxation techniques, massage or gas and air (Entonox), all of which can be used while in the pool. If you require an injection of pethidine or an epidural you will need to leave the pool. You will not be allowed to get into the birthing pool within four hours of receiving a pain-relieving injection.

A Cochrane review found that water immersion during the first stage of labour reduces the use of analgesia and reported maternal pain, without adverse effects on labour duration, operative delivery or neonatal outcome.

Reference : luett ER, Burns E; Immersion in water in labour and birth. Cochrane Database Syst Rev. 2009 Apr 15 (2):CD000111.

Water Temperature

The temperature of the water should be comfortable for you. To ensure you and your baby do not become too hot or too cold we recommend the water temperature is between 36.5°C and 37°C in the first stage of labour and 37.5°C for the birth. The midwife will check your temperature, the water and room temperature every hour.

You will also be encouraged to drink extra water throughout labour to prevent dehydration. The water is kept to a level above your uterus and below your breasts to provide adequate support but prevent overheating. It is advisable to take frequent sips of water to prevent dehydration. A sieve is used to remove any faecal matter from the pool to reduce the risk of contamination.

During the second stage the water temperature is elevated to 37.5°C so as not to stimulate the baby to breathe when the head emerges. As your baby is born, you, your partner or the midwife should bring the baby to the surface face first as soon as possible.

The Birth of Your Baby

As you near the end of your labour you will know if you wish to give birth in the pool or leave the pool for the birth of the baby. Giving birth in the pool is carried out with a hands-off approach. Your midwife will be able to give you verbal guidance when the baby is about to be delivered when the midwife, yourself or your partner gently brings the baby to the surface of the water. This is to avoid the baby breathing when underwater.

Once the baby has been born, the head must not go back into the water in order to prevent inhaling water. Babies born in water tend to have their eyes open and be very calm. Sometimes, the baby may take a short time to become pink. This is because the birth has been very gentle, and is normal.

Delivering The Placenta

If labour and delivery have continued normally, it is ideal for your body to deliver the placenta without the need for drugs. This usually takes place out of the water.

Reasons why you may need to leave the pool

  • To use the toilet
  • If there is difficulty in hearing your baby's heart rate or any irregularities in the baby's heart rate
  • You may be requested to leave the pool for a vaginal examination (although this can take place in water)
  • If your blood pressure, pulse or temperature become abnormal
  • If your labour does not progress as expected
  • In order to deliver the placenta

You can choose to leave the pool at any time during labour, except when the baby’s head is about to deliver.

How will you be cared for during labour and birth in water?

To maintain the benefits of labouring in water we will try to create a calm, unhurried and relaxed atmosphere. We will encourage you verbally when necessary and disturb you as little as possible at other times.

We will need to listen to your baby's heart rate and regularly check your temperature, pulse and blood pressure. You will be supported in labour by a midwife and your birth partner.

Two midwives are usually present at the birth of your baby.

What Should You Wear?

It is important that you feel relaxed and in control during labour so the choice of what you wear is entirely up to you. Some women like to be naked when they give birth and find clothing gets in the way. Being naked also allows skin-to-skin contact to take place straight away. Others feel more comfortable if they are wearing a long T-shirt which covers their body.

You may want to bring a dressing gown because you can become cold very quickly if you need to leave the pool for any reason, eg: to go to the toilet.

What Should You Do If You Think You Would Like Water Birth?

If you are interested in a Water Birth, please discuss this with your midwife at your antenatal appointment so your wishes can be documented.

We offer the service at Fernandez Hospital Unit 1 - Bogulkunta and Unit 5 - Banjara Hills. It is recommended we listen to your fetal heart every 15 minutes in the first stage of labour and more regularly in the second stage. If you have any concerns as to your own suitability please ask your midwife.

Sometimes, you may plan to use the birthing pool but find that they are already occupied when you arrive in labour. It is therefore important to bear in mind that you will not always be able to use the pool. At any time the midwife may ask you to leave the pool because of a problem and we would ask that you comply with her request.

Reference National Institute for Health and Clinical Excellence (2007) Intrapartum Care. Available at: www.nice.org.uk.