For a Gentle Birth, Just Add Water
“I’m never having another LAND birth again!” That was my statement to my mother after I gave birth to my second child in 2009. It was my first waterbirth, and I loved it so much I went on to have three more waterbirths. I also became a midwife a few years later so that I could help other women and their babies experience the same kind of care in childbirth.
What is Waterbirth?
Waterbirth in the United States has gained in popularity over the past decade or two. Many women are interested in using warm water during labor for its ability to make labor easier and more comfortable. Water immersion during labor is defined as immersion in a tub with depth that allows for complete submersion of the abdomen, so the standard household tub is usually not sufficient to offer the benefits of water immersion.
There can be some confusion among consumers when it comes to the difference between waterbirth and simply laboring in water. Let’s first define and distinguish between “water labor” and “waterbirth.” Water labor is the use of warm water immersion during any stage of labor up to, but not including the actual birth of the baby, whereas waterbirth includes the second stage of labor (pushing) that results in the birth of the baby entirely underwater.
Is it Safe?
More than 28,000 waterbirths have been observed in research studies. The good news is that harmful effects of waterbirth were either non-existent or very rare, and babies born in the water had similar health compared to babies born on land.
There are some situations in which waterbirth is not recommended. Preterm babies (earlier than 37 weeks) should not be born in water. Water labor and birth are also not advised for women with:
- Abnormal bleeding
- A fever in labor
- Active herpes lesions, hepatitis B or C, or HIV
- Continuous fetal monitoring (unless the equipment is designed for use in water)
- Reduced mobility that would prevent her from leaving the tub quickly if necessary
- Epidural analgesia or anesthesia
- Administration of opioid or other sedating medications near the time of birth
- Any pregnancy condition that can complicate birth or the transition of the baby to extrauterine life
Benefits to the Mother and Baby
Warm water can help a woman relax and feel less pain during labor. Even the sight and sound of water can be calming. Women using water in labor tend to experience:
- Less fear and stress
- A shorter labor
- Greater mobility during labor
- Less pain medication
- Higher rates of intact perineum
- Significantly less chance of episiotomy (vaginal cutting)
- Less risk of significant vaginal tearing
- Less blood loss
- Higher levels of satisfaction
A waterbirth can also make a very smooth transition for the baby who has been growing and developing in a warm water environment for nine months. Rather than being born into a bright, air-filled room, the baby goes from the comfort of the womb into warm water and then is gently lifted out of the water and placed on the mother’s chest. When compared to “land-born” babies, the babies born in water have no difference in APGAR scores (an assessment of the baby’s wellbeing at birth), no difference in newborn infection rates (very rare), no difference in NICU admission rates, and no increase in mortality rates. Umbilical cord tears are rare (2.4 per 1,000 waterbirths) and are reason to proceed cautiously and gently when lifting the baby from the water. Another preventable risk is fetal tachycardia (fast heart rate) caused by high water temperature. For this reason, the water should be maintained between 97°F and 100°F. Just remember that is should be close to body temperature for the most comfort and safety.
How to Have a Waterbirth
Due to several factors, only a handful of hospitals offer waterbirth (none in the Houston area), and very few allow water labor due to continuous fetal monitoring and equipment that is not waterproof. For these reasons, women who desire waterbirth are most likely to find this option at a freestanding birth center or a homebirth with a midwife. A freestanding birth center is a licensed facility which is not affiliated with or owned by a hospital. They are typically run by midwives who have vast experience attending waterbirths. Homebirth midwives often bring an inflatable tub designed for birth to their client’s home to facilitate a smooth and comfortable waterbirth. Midwives follow practice guidelines to ensure safety and infection control. They also utilize equipment that helps them monitor and manage labor while the woman is immersed in warm water (items such as a waterproof Doppler, thermometer, and flashlight).
So, what’s the bottom line? Waterbirth is a reasonable option for low-risk women. If a woman has a strong desire for waterbirth, she should start by seeking out and scheduling consultations with midwives in her area. Good websites for Houston area women to begin their search include houstonmidwives.org or texasmidwives.com. For more information about waterbirth, check out Waterbirth International at waterbirth.org.
About the Author: Ashley Musil is a midwife and co-owner of Wellspring Midwifery Care & Birth Center in Kingwood, Texas. She is also an Evidence Based Birth® Instructor and is passionate about education and healthcare autonomy. She has attended nearly 150 births since 2011, most of which were waterbirths. For more information about her birth center and practice, please visit wellspringbirthcenter.com.