Waterbirth – Myths and Realities

Common misconceptions about water births

Wont the baby drown?

No, babies do not drown if they are born underwater. They live in a watery environment for 9-10 months until labour heralds their transition from the uterus to the air-filled world outside. The stimulus to breath at birth occurs when the baby is exposed to air, plus the dramatic change of temperature, noise and light.

During a waterbirth this occurs when the baby is lifted up out of the water. His umbilical cord, his lifeline, continues to provide oxygenated blood while he responds to the new stimuli and fills his lungs with air for the first time. Simultaneously his heart function converts to include the oxygenated blood provided by his lungs, no longer solely relying on the placenta.

Delaying clamping and cutting of the umbilical cord is very beneficial to baby’s transition to life outside the uterus. If allowed the umbilical cord may continue to pulsate for some time, providing baby with his full quota of blood volume via the placenta, maximising perfusion of his newly functioning lung tissues and supporting his transition, unhurried, into his new world.

How does water help the woman during labour?
The benefit of using water to reduce the pain of childbirth is well established and accepted, and the use of a shower or hot wet towels for pain relief is common practise in most care settings. When immersed in deep warm water the buoyancy enables a woman to move more easily than on land, allowing freedom to manouver and work with her contractions assisting the descent of the baby. Immersion reduces opposition to gravity, providing ease of movement and conservation of energy.

The comforting water environment promotes deeper relaxation allowing the woman’s hormones to respond appropriately, facilitating endorphin release and efficient progress of labour, including relaxation of the pelvic floor. This alleviates pain and optimises the progress of her labour.

Women who wish to labour and/or birth while immersed in deep warm water know it is a simple way of assisting them to cope without the use of strong drugs. A reduction in the use of pain relieving drugs not only benefits the mother who is more alert and responsive after the birth, but the baby will also benefit considerably.

Women also know that labour in water increases their chances of giving birth naturally and normally with a minimum of interference or medical intervention. A prospective observational study in Switzerland in 1999 found waterbirths had the lowest rate of analgesia use, the lowest episiotomy rate and lowest incidence of 3rd and 4th degree tears, as well as the lowest maternal blood loss. The birthing pool provides an environment which enhances a woman’s sense of privacy – a zone which is her own – permeated only by those entrusted and permitted by the labouring woman. This may be particularly important to women who have been subjected to sexual abuse in the past.

What about the baby’s wellbeing?
Immersion in water during labour reduces pressure on the woman’s abdomen, and buoyancy promotes more efficient uterine contractions and better blood circulation. This results in better blood circulation and oxygenation of the uterine muscles, and more oxygen for the baby during labour. The Swiss study also found babies born in the water had the lowest rate of neonatal infection, and the average Apgar score at 5 minutes was significantly higher after waterbirths.

Other waterbirth studies failed to detect differences in the incidence of neonatal morbidity or mortality between water and land birth and found fewer babies adopted deflexed positions during the first stage of labour when their mother’s used water immersion for pain relief.³ Water born babies are typically relaxed and alert at birth as their mothers have not required drugs during labour. One study has demonstrated that babies whose mothers had epidural anaesthesia were still showing adverse effects of the drug up to six weeks later.

What about after the birth?
Water offers a labouring woman an environment where she can behave instinctively and feel in control. When a woman feels in control during childbirth, she experiences a higher degree of emotional well-being postnatally. Many studies have confirmed that women who give birth in the water have a most satisfying birth experience.

General guidelines for labour and birth in water

It is important for the woman to be well hydrated during labour whether she is in or out of the water, and to pass urine frequently. It is not advisable to add salt or essential oils to the water. The woman should be free to leave the bath if desired, and birth plans should allow for flexibility as well as definition of the woman’s wishes for the birth.

The baby must be born either fully submerged or fully out of the water, and it is important for the woman to understand this is her choice at the time of birth. Skin to skin contact is fundamental to the birth and bonding experience as well as providing warmth and comfort to the newborn. Drying the baby’s face and head and applying a hat will also assist in keeping baby warm. Warmth and an undisturbed environment immediately following the birth are essential for the woman’s physiological functioning to safely complete the third stage of the labour.