Is Water Birth Right For Me?
Are you curious about water birth?
Do you want a more comfortable birth?
Is water birth safe?
Have you heard a birth story where the birthing parent got into water and the pain just melted away?
In this blog article and in my latest podcast episode, I take a deep dive and explore the world of water birth. Learn everything you need to know to help you decide if water birth or water immersion during labor is right for you. Use this information to help inform your decision-making process so you can follow your own compass in birth.
What is Water Birth?
In pregnancy, the ability to birth in water is usually dependent upon your choice of birth place.
If you’re choosing to birth in a hospital, the vast majority do not allow you to birth in the water. However, many hospitals have bathtubs that can be used to provide comfort in labor. Some allow you to bring your own inflatable birth pool.
Birth centers and home births offer the opportunity to labor and birth in water. Typically, this entails either using a large bathtub or an inflatable plastic birth pool.
Different birth places tend to have a variety of policies, procedures, and protocols for laboring and birthing in water. So, if you’re pregnant and wondering whether waterbirth is right for you… you need to talk to your doctor or midwife to learn about their protocols and resources.
Sometimes laboring in water is called water immersion. When the baby is born in the water, it’s called a water birth. The baby is simply floated right to the surface after birth and into the parents’ or caregiver’s arms.
History of Water Birth
Let’s talk about the facts, and statistics about using water in labor and birth. Many people wonder whether birthing in water is safe. There are many resources available that paint the picture of birthing in water and examine the safety of this tradition.
Firstly, let’s examine the history of water birth. It was first reported in an 1805 medical journal. However, we know that this is a long-standing cultural tradition pre-dating journals. It became more popular and accepted in our society in the 1980’s and 90’s, and further into today.
Research on Water Birth
Simply getting in the water during labor can have many evidence-based benefits. A review of seven randomized trials with 2,600 participants found that laboring in water poses no extra risks and helps relieve pain, which leads to less use of pain medication. This review also found that parents felt less anxiety, had better fetal positioning, less use of drugs to enhance labor, and more satisfied with privacy and their ability to move in labor.
Researchers have also studied a set of 11 randomized trials of water immersion during labor and birth in 2009. The Cochrane reviewers found that laboring in water reduces the use of epidurals and spinals for pain relief. They also found that it shortened the first stage of labor by about 32 minutes on average. There was no evidence of any harm to the birthing parent or baby.
Benefits of Water Birth
Waterbirth has several reported benefits according to research studies: lower pain scores, less use of pain medication, less use of Pitocin, shorter labors, higher rate of vaginal birth, less use of episiotomy, and greater satisfaction with the birth experience.
One study from Iran assigned 53 people to give birth in water and 53 people on land. There were no reported differences in newborn outcomes. There was a much higher rate of vaginal birth in the water birth group (100%). They also reported that the water birth group experienced shorter active labors (quicker cervical dilation), a shorter third stage of labor (placenta birth), less use of Pitocin, less use of pain medication, and a lower episiotomy rate.
Another study from Iran in 2013 was a bit larger, 100 participants assigned to land and 100 to water birth. Parents who birthed in water experienced a lower cesarean rate (5% vs 16%), less pain, less meconium in the amniotic fluid, and fewer low apgar scores.
Another study from China reported no differences in newborn health outcomes. But parents who birthed in water had a higher rate of an intact perineum, lower episiotomy rates, lower pain scores, and shorter labor (50 minutes shorter).
How does water birth affect the birth experience?
In 2014, there was a large review conducted that included two randomized trials and 36 observational studies that looked at 31,000 water births. The review concluded that waterbirth increases satisfaction and provides pain relief, may increase the chances of birthing with an intact perineum, and may reduce the rate of postpartum hemorrhage.
In 2016, the MANA Stats study reported that waterbirth does not appear to increase the risk of bad health outcomes for newborns. It also noted a potential increase in minor labial tears.
Laboring in Water Can Lower Cesarean Rates
Studies show that people who were assigned to a water birth group reported higher rates of normal vaginal birth. (I don’t really like the term normal when talking about vaginal birth, but they mean that these births proceeded without medications or medical procedures and ended in a vaginal birth – also called a physiologic birth) This is probably because of the benefit of simply laboring in water.
One study found that the cesarean rate for everyone who labored in water was only 4.4% (whether they birthed in water or not).
Does water birth reduce the risk of tearing in birth?
Water birth naturally decreases episiotomy rates simply because it’s much more difficult to access the perineum to cut an episiotomy. That’s one of the interesting benefits of water birth and laboring in water. It’s a lot harder for people to enter your bubble unless you want them to.
The information is mixed about the rates of tearing with water birth. Some studies have shown a slight increase in the risk of first or second degree perineal tears, and some studies have found it to be protective, and yet others didn’t find any difference.
Research shows that water birth is linked to a decrease in the rate of deeper 3rd and 4th degree tears. This is significant because these are the types of tears that can lead to potential problems for the birthing parent such as incontinence, pain, infections, and more.
The large MANA study actually showed an 11% increase in the odds of genital tract trauma in people who gave birth in water, but the greatest amount of trauma was reported in a group of people who intended to birth in water but got out to birth on land (presumably for extra support).
So, if you labor in water, you’re less likely to have an episiotomy and have a severe tear, but you may be more likely to experience minor tearing.
Water Immersion in Labor and Birth Lowers Perception of Pain
People who labor and birth in water use less pain medication, report less pain, and have less anxiety. Most people who labored in water in the mentioned research studies required no pain medication at all.
Interestingly, something about the water must alter the perception of the labor and birth experience. Studies show that the reported pain levels during labor are roughly the same between water and non-water laboring parents. But AFTER birth, the water birth group reported less pain and a higher overall positive experience.
Water Birth Can Shorten the Pushing Stage of Labor
The evidence for shorter labor is mixed and there aren’t clear methods to study this potential benefit. Some studies report a shorter first stage of labor (3/5), one found no difference, and one reported a longer first stage. It appears that most research studies show a shorter pushing stage for parents birthing in water.
Other Interesting Research Points
Studies have shown that people who give birth in water experience less or equal to the amount of blood loss as people birthing on land. One interesting study revealed that people who gave birth on a birthing stool (on land) were twice as likely to experience a postpartum hemorrhage than those who birthed in water.
Another benefit of water birth and laboring in water is the cocooning and privacy factor. You are more likely to have a hands off labor and birth because you are in your birth pool or tub space. This gives the birthing person more privacy and autonomy. I see this as a sort of cosmic, protective, and conscious space because you have that natural perimeter around you.
There is no reported increase in the risk of infection or complications resulting from water birth for the birthing person or the baby. Nearly all studies revealed that there is little to no difference in outcomes or complications associated with water birth.
An interesting study found that birthing in water decreased the frequency of GBS colonization in newborns from 11.7% (nasal swab) to 1.5%.
Rare Events and Case Studies in Water Birth
Sometimes bacteria can grow in the water tubing and supplies in both hospitals and in communities. The midwifery practice that I work with uses a disposable hose with each water birth kit that they rent out. This means there’s no water sitting in tubing or hoses, for example, where bacteria could grow. (eww) Research shows that best practices involve filling pools only at the time of use, using equipment that is easy to disinfect, and monitoring for the presence of bacteria regularly.
There is also a possible very minute risk of umbilical cord snap, where the umbilical cord can rupture and lead to excessive bleeding. However, this is an extremely rare event in itself.
Can I labor in a hot tub?
Hot tubs or spa pools pose a unique risk of infection because they contain tubing that is very difficult to clean and they are often kept at a warm temperature for long periods of time.
Why don’t babies breathe under water? Isn’t that dangerous?
There have been cases of water aspiration, but none have appeared in any research conducted since the 1990’s. It’s possible that a baby who is compromised or struggling could have their gasp reflex triggered during water birth. However, the actual incidence of this is so small that it’s essentially undocumented in any research in the last 20 years.
In a water birth, the baby passes from the watery womb environment and into the birth pool water environment. Many people believe that this is a more gentle experience for the baby in birth, because they’re essentially born into an expanded womb-like water environment.
So why don’t babies breathe underwater in a water birth? After birth, we often nervously await that first cry and breath as a sign of assurance that all is well.
Check Out This Research:
“One of the most important triggers for breathing is the presence of gravity pushing equally on the face and stimulating the trigeminal nerve (the 5th cranial nerve) innervations around the nose and mouth. Human beings need a gravitational force of 14.7 lbs/sq inch, as well as the presence of oxygen and carbon dioxide molecules, to trigger the switch from fetal circulation to newborn circulation.” Other research shows that prostaglandin hormones shut down the baby’s breathing movements during labor to prepare for birth.
Blood from the placenta helps to expand circulation to the lungs. The blood from the placenta will continue to expand to the baby’s organs, help shift the necessary circulatory changes, and push fluid out from the baby’s lungs as they take their first breaths. This is normal physiologic newborn transition. Also, one of the first things that babies will do is swallow, spit, or cough before respirations begin.
Babies born in the water transition to newborn life very gently. They transition peacefully to quiet stable newborn breathing when they are placed skin to skin after birth.
So You Want to Have a Water Birth? Here’s What You Need to Know
If you are interested in using water during labor, here’s what you need to know.
Talk to your provider about your desire to labor or birth in water. Let them know that you’re interested and ask what their policies, procedures, and protocols are for water immersion in labor. If you’re birthing at a hospital, ask them what tools are available for laboring in water. Do they have tubs available? If so, how do you get one? Are they in all the rooms or just some of them? Be sure they know you want to labor in water.
You could also consider asking them about what conditions or situations would prohibit them from supporting laboring in water. Even if you have an IV port, you can labor in water while simply supporting your hand outside the tub. As a doula, I’ve definitely supported parents who labor in water while receiving IV medications for example. In the hospital, we just roll the pole right into the bathroom.
Policies, Procedures, and Protocols for Water Birth
Be clear on what their policies and procedures are and put it in your birth plan. The earlier you have this conversation, the better. You want to know early on if your provider supports your desire to labor in water so you can make the best choice for your family.
If you’re planning to use a birth pool, some birth centers and hospitals already have tubs for labor. Sometimes you have to rent your own inflatable pool and bring it to set up. Most birth centers will already have their own set up for this. For a home birth, you’ll either need to purchase or rent a birth pool and set it up.
I hope this information gave you more insight into the topic of water birth so you can follow your own compass and decide if laboring in water is right for you.
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