Water has always been a natural relaxant throughout the course of history. There is something very soothing about water and invigorating that draws us to blue oceans, outdoor hot springs, fresh lakes and even our own bathtubs. Many women feel drawn to the water when in labour and birthing their babies.
According to Water Birth Canada in Toronto “Soaking in a tub of water to ease labour sounds inviting to most women. When a woman in labour relaxes in a warm tub, free from gravity’s pull on her body, with sensory stimulation reduced, her body is less likely to secrete stress-related hormones. This allows her body to produce the pain inhibitors ‘endorphins’ that complement labour. Noradrenaline and catecholamines, the hormones that are released during stress, actually raise the blood pressure and can inhibit or slow labour.”1
The College of Midwives of Ontario recommends water birth for low risk pregnant women who are at least 37 weeks pregnant. In addition, active phase of labour should be established (i.e. good regular contractions, dilation of the cervix and descent of the presenting part).
Sky Dasey, Registered Midwife from St. Jacob’s Midwives in Ontario, says ”Midwives are clinically responsible for maintaining the safety of the birth environment at all times, whether it is a waterbirth, homebirth or hospital birth.” She goes on to say, “Since waterbirth is not a regulated skill in midwifery care, every Midwife comes with different degrees of experience.”
Obstetricians in Canada do not to deliver babies in water as this is not a part of their scope of practice. However, there may be some Obstetricians who do help out if concerns arise during a waterbirth in a hospital setting. Some hospitals permit the use of a tub or Jacuzzi bathtub on maternity wards in Canada to labour in and some may allow births as well. Whether or not a birth can occur in the tub depends on the hospital and its accompanying policy. Midwives would commonly attend those births. Sky Dasey states, “Waterbirths are typically not permitted in many hospitals so clients will rent out a waterbirth tub or use their own tubs and have the assistance of a Midwife with them.”
Amanda Burke, Certified Doula and Owner of Guiding Light Birth Services in Toronto, ON attends births with women who choose to labour in the tub. Her own first baby was born at home in water and she is planning her second delivery in water as well. Amanda believes that the soothing affect of water gives women weightlessness that in turn makes them feel in control of their bodies so that they can manage the pain much more efficiently. She cautions against getting in the water too soon, which could potentially stall labour. She does suggest listening to your body to give you the cues to move when it’s the right time.
Dianne Garland, registered midwife, lead water birth researcher in England and the author of, “Water birth: An Attitude to Care,” says the following:
” Just as labors can be slower or stop out of water so is true of water. Changes to the woman’s body are normal in labor and each of us will tolerate different lengths of first and second stage. Just as we all deal with different amounts of fatigue and stress, so each woman is individual and should be treated as such in labor. The point of this with water labor and water birth is that as each woman is an individual, so her labor should be cared for, within the normal parameters set by ourselves as autonomous practitioners. Or within the maternity units where we work. Fundamental changes to normal practice may need to be made in units where active management of labor prevails.”
Summary of benefits for labor and birth in water:
* Facilitates mobility and enables the mother to assume any position which is comfortable for labor and pushing
* Speeds up labor
* Reduces blood pressure
* Gives mother more feelings of control
* Provides significant pain relief
* Promotes relaxation
* Conserves her energy
* Reduces the need for drugs and interventions
* Protects the mother from interventions by giving her a protected private space
* Reduces perineal tearing
* Reduces cesarean section rates
* Is highly rated by mothers – typically stating they would consider giving birth in water again
* Is highly rated by midwives
* Encourages an easier birth for mother and a gentler welcome for baby
Theoretical Potential Disadvantages
* Decrease in uterine contraction strength and frequency, especially if entering the bath too soon
* Neonatal water aspiration
* Maternal hyperthermia may contribute to fetal hypoxemia
* Neonatal hypothermia
* Cord immersion in warm water may delay vasoconstriction, increasing red cell transfusion to the newborn and promoting jaundice
* Blood loss estimation and assessment not accurate
* Maternal and Neonatal infection may be increase – not supported by the evidence
* Risk of acquiring blood born infection or sustaining back injury for caregivers
Data collected 3 from The Journal of Maternal-Fetal and Neonatal Medicine indicates “Water birth is a safe indicative to delivery in air for selected women with low–risk pregnancies. Water birth appears to be associated with shorter duration of delivery, reduced maternal analgesia requirements, whereas the infection rate was not increased.”4
Across our great country more and more women appear to be utilizing water to labour in and birth their babies in. If you are considering a water birth research a few key things before deciding on what is best for you and your baby:
1) What experience does your health care provider have with water births?
2) Does your location of preference allow water births in the tub or just for labouring?
3) Will you rent or purchase your own tub?
4) What expectations do you have surrounding a water birth and how will you deal with things if they do not go as planned? Having a back up plan is complimentary as baby’s typically have their own agendas.
Most importantly listen to your body and trust your intuition!