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WATER AS AN AID TO LABOR

by Vanessa Stephens Coldwater

        The use of warm water during labor is a great comfort measure; it is safe, widely available, inexpensive, and effective.  Warm water immersion in labor can diminish stress hormones (called catecholamines) which increase pain and slow labor; it also directly reduces pain by increasing the body’s production of natural pain relievers (endorphins), can ease involuntary muscular tension, and enhance relaxation during and between contractions.  It can also lower blood pressure within minutes and decrease edema (swelling), and the buoyancy can promote better circulation and increase the efficiency of uterine contractions.  In addition, use of a large tub increases mobility so that it is easier to change positions to aid the progress of labor, especially when a woman is becoming tired.  Birth into water can reduce the incidence and severity of perineal tearing; the water encourages relaxation of the pelvic floor and provides natural support to the perineum.  Waterbirth may have benefits for the baby as well, and often provides a gentler transition to life outside the womb.  Many pregnant women are drawn to water, especially during labor, and women all over the world give birth in labor tubs, tide pools or natural springs.  The advantage of tubs specifically designed for birth is that they are portable, heated, and large enough to accommodate movement and a variety of labor positions.  Rented tubs can be used in the hospital or at home, and might be just what you need for a more comfortable labor.  Some women choosing hospital birth use rented labor tubs at home, often with the services of a doula, to help them comfortably stay home longer.  This enables them to enter the hospital when labor is well established, which can often help them avoid unwanted interventions.  A bathtub or shower can also provide pain relief and relaxation, and should be available wherever you choose to give birth.

There are some practical considerations to using water as a comfort measure.  If a mother is using it for pain relief or reduction of blood pressure and edema, it is important to have enough depth to be fully immersed - her whole body should be under the surface.  Less water than this will still be helpful, but not as effective.   Be sure to use water that is close to body temperature, 96 to 99 degrees Fahrenheit.  If it is too cold she could become chilled and waste energy shivering - energy better used for labor!  For this reason, have plenty of towels and blankets handy, since many women will be in and out of the tub several times during labor.  If the water is too warm she may become overheated, flushed and dizzy; if this happens she can simply leave the tub for a while and have someone add  cold water.  In any labor it is important to keep drinking liquids, but especially while in the tub, to avoid dehydration.

 Have a non-slip surface (bath mat or similar item) nearby for when the mother gets out, and a person or two ready to assist if necessary.  A woman can use the pool whenever she wants; however, if a mother chooses to get into the water in early labor, before her contractions are strong and close together, the water may relax her enough to slow or stop the labor altogether.  That is why some care providers limit the use of the pool until labor is established and the dilation of the cervix is at least 5 centimeters.  (The tub is ideal to have at home for women who experience lots of preparatory or “false” labor, since it can sometimes help her get some rest.)  But some women have found that entering the pool helps them relax enough to really get labor going!   It can sometimes be helpful to wait until active labor so the mother has something in reserve for when labor becomes more difficult.  According to Barbara Harper of Waterbirth International, the first hour of relaxation in the pool is usually the best and can sometimes help a woman achieve complete dilation even in that short amount of time.

Last but not least, the question of safety needs to be addressed.  There are no known hazards to laboring in water, and waterbirth is completely safe as well, as long as some basic precautions are used.  First, there are several factors that prevent the baby from beginning to breathe underwater after birth.  The water temperature is close to that of the amniotic fluid in the womb, so there is no shock of a temperature change.  The baby is also receiving oxygen from the umbilical cord just as it has for the previous nine months.  In addition, the baby has an autonomic reflex, called the dive reflex, which prevents it from inhaling any substance that is in the throat and causes it instead to swallow.  (This reflex disappears after about six months.)  There is a complex chain reaction of hormones and chemicals that cause the breathing process to begin; just know that it is impossible for a newborn to breathe until up in the air. However, the baby should not be left under the water for an extended period of time (longer than half a minute).  There are several waterbirth videos that show babies under water longer than this who do just fine, since the placenta is still supplying the baby with oxygen; but it can’t be predicted when the placenta will begin to separate and stop the flow of oxygen.  The safest approach is to remove the baby unhurriedly, face down so water drains from the nose and mouth.

There are several ways to use pools during labor.  Tubs can be rented for home use, whether the birth will happen there or in the hospital; some hospitals are also receptive to allowing use of rented tubs, but this list changes all the time, so ask your care provider.  The emphasis on technology and monitoring in hospitals sometimes makes this a controversial request, but be persistent - in this setting the reintroduction of natural elements such as water can be a real lifesaver.  Abbott Northwestern has hydrotherapy pools available for labor, but will ask you to get out for the birth;  waterbirth options and a tub are available at St. Joseph’s Hospital (St. Paul), Woodwinds Health Campus (Woodbury), and Hennepin County Medical Center (Minneapolis) through their nurse-midwifery service.  Labor tubs can be rented from Waterbirth Resources, (612) 822-3263.  As this option becomes well-known and more women request it, expect more hospitals to offer water immersion for labor and birth.

Rebecca Polston offers deluxe Aqua Doula Birth Tub Rental.

rebecca@theurbanhomesteader.com          www.helpinghandsbirthservices.com

She will bring the tub, give instructions on how to set it up and in most cases she will take it down for you.She has a short supply list for you to make sure you have everything you will need to make renting her tubs the best experience possible.                              .   

Vanessa Stephens Coldwater
Family Tree Midwifery (www.familytreemidwifery.com)
Waterbirth Resources (www.waterbirthresources.com)
612 747-9096

Vanessa will bring the tub to your house and give you instructions on how to set it up and take it down. In some cases she can take it down as well.

People never sing...except in the bathroom. Birthing women also make their natural sounds next to running bath water. There is something about the power of water. People are drawn to water, spas, and sacred streams. Women in labor are drawn to water, too.

Michel Odent, MD

The water seems to act as a protective “aura” around the woman, where she feels less vulnerable and more in control of herself. As the baby is being born, the mother can choose to deliver the infant herself, as the birth attendants kneel at the tub in case they are needed. It is usually very simple for the mother, after she has the last contraction that expels the baby, to reach down, take her baby in her arms and bring baby up out of the water and to her breast. It is also very easy for dad to help catch the baby if desired.

Why Waterbirth for Baby?

Waterbirth is such a gentle way to enter the world! As the baby leaves his former home of warm amniotic fluid, he enters like warm water, where the sounds are muffled and the sights are dimmed, and he is gently lifted up to the surface just enough so that he can begin to breathe. His body continues to stay warm and supported in the water. Water-born babies, once they are gently pulled up out of the water, tend to cry less, while still having good muscle tone and respirations, than babies born outside of water. Some babies love to float in the water and stretch out with mom’s help. This is an incredible bonding moment between mom and baby.

Is Waterbirth Safe?

Yes, waterbirth is very safe, in fact worldwide statistics show that waterbirth, without the use of drugs, is the safest way to be born. The concern of most parents is will their baby inhale water and drown? Babies have what is called a dive reflex which causes them to swallow instead of inhale when water gets in their mouth or nose. They swallow and then hold their breath. Because they are still attached to the umbilical cord, they continue to receive all their needed oxygen through it, making it unnecessary to breathe up to several minutes after birth. However, most care providers gently but immediately bring the baby’s face out of the water after the birth to initiate breathing. When the baby’s face comes in contact with cool air, it is believed that this is one of the main things that stimulates him to breathe and most babies begin breathing within seconds of this.