Water Birth

Water has captured the imaginations of women for centuries for use in birth. Water is natural, safe and an effective means of pain relief. The popularity of laboring and birthing in water has increased dramatically around the world. Globally, more than 150,000 waterbirths occurred between 1985 and 1999. The demand for birthing pools is increasing all over the United States. Waterbirths are occurring in homes, hospitals and free-standing birthing centers all over the country. Most of the births are attended by mid-wives. However, physicians are beginning to birth more infants in water. Water has been revered historically for its life-sustaining and therapeutic benefits. Ancient rituals and spiritual traditions have developed surrounding water. Ancient petroglyphs depict water births of selected Egyptian babies destined to become priests and priestesses. Minoans on the island of Crete used sacred temples for waterbirths. Chumash Indian women on the central coast of California labored in the tide pools and shallow inlets along the beach while men of the tribe drummed and chanted. Throughout time and throughout the world, water has held spiritual, medicinal and therapeutic value. Water signifies a “rebirth” or new birth of the individual and is a symbol of new life. The Romans bathed in extensively believing baths to have outstanding therapeutic value. Native Americans believed that hot springs and sweat lodges have spiritual and healing properties.

Laboring in water gives both a hydrokinetic and hydrothermic benefit. Women laboring in pools experience weightlessness which creates equal pressure on submerged body surfaces. As the woman relaxes, she feels less pain, which results in less anxiety and probably reduces adrenalin levels that enhance the endogenous production of oxytocin. Birthing in water eliminates compression of the interior vena cava, resulting in increased blood supply to the uterus which enhances blood supply to the fetus. The same process promotes more efficient uterine contractions. This results in a shorter labor. The mild vasodilation that occurs in water decreases maternal blood pressure and increases the maternal pulse which increases oxygenation to the uterus and thus the fetus.

The theoretical benefits of labor and birth in water are many. The benefits are acceleration of cervical dilation resulting in a shorter labor, nonpharmacologic pain relief, decreased use of analgesia and anesthesia, less need for labor augmentation with the use of pitocin, less traumatic birth experience, fewer operative deliveries, reduced perineal trauma and increased maternal satisfaction with the entire birth experience. The risks include maternal and neonatal infection, thermal regulation problems, water aspiration of the newborn, fetal hypoxia and the risk of a snapped or torn umbilical cord. Fetal metabolism and temperature control are critical factors in the control of fetal breathing after birth. The regulation of the bath water temperature is of utmost importance. Contraindications to labor in water include, maternal fever, non-reassuring heart rate pattern, excessive vaginal bleeding, the use of pitocin, and women with a previous cesarean section. Other contraindications are breech or malpresentation, meconium stained amniotic fluid, history of previous shoulder dystocia and possible fetal macrosomia.

Equipment used for waterbirth include, pools, portable and permanent, Jacuzzi tubs, or special tubs installed in hospital birthing rooms. Dopplers used to monitor fetal heart tones are available in waterproof cases. Thermometers to monitor the temperature of the tub water are also used. Small disposable nets are used to remove debris from the tub if it occurs. The ability to empty and refill the tub quickly is very important because of the temperature factors. There are many available books, videos, journals and web-sites on the use of waterbirth. Waterbirth International provides rental tubs and supplies. Many hospitals and free standing birth centers are now offering waterbirths as a birth option.