Water Birth – Is it for you?



Preparing For Your Water Birth

It can’t be denied that when in labor water can become your best friend.  It is common to be in and out of the shower or tub and sometimes, not even wanting to get out of the water.  This speaks volumes about the benefits of water in the birthing tool kit.   This is especially true in the instance of water birth.  Birth in the water?  Why would I want to birth in the water?  Is that safe?  How does one go about having a water birth?


What’s So Great About Water Birth?


According to Water Birth International the benefits of a water birth are:


  • Water facilitates mobility and enables the mother to assume any position that is comfortable for labor and birth

  • Speeds up labor

  • Reduces blood pressure

  • Gives mother feelings of control

  • Provides significant pain relief

  • Promotes relaxation

  • Conserves mother’s energy

  • Reduces the need for drugs and interventions

  • Gives mother a private protected space

  • Reduces perineal trauma and eliminates episiotomies

  • Reduces cesarean section rates

  • Is highly rated by mothers – typically stating they would consider giving birth in water again; some even stating they would never give birth any other way!

  • Is highly rated by experienced providers



Movement is so important in labor and laboring in water can help you to move freely into any position you feel is comfortable.  That gives us another benefit.  You move into what position is comfortable for you, not what is convenient for the care provider.  Water birth can give you a sense of control. With regards to speeding up labor, Michele Odent a pioneer of water birth in the 1980’s in France, found that women whose labors were not progressing beyond 5 cm, quickly dilated once immersed.  He attributes this to the reduction in catecholamines, which have been associated to slowed or stalled labor, due to pain relief from water immersion.  Michele Odent felt that when these levels go down it allows a release of oxytocin and cervical dilation.  The reason for reduced pain in labor with water immersion may be because the warm water causes peripheral vasodilation and improved blood flow which provides pain relief. Penny Simkin (1989) attributed the pain relief to “ cutaneous nerve endings causing vasodilation in the skin, relaxation of tiny muscles in the hair follicles and generally a reversal of the sympathetic nervous system response flight or fight response.”  As a massage therapist, I’ve seen this to be true in my work with nurturing massage.  


So many benefits to water birth.  There needs to be more research to give water birth more credit.  Many of these are observed findings by countless physicians and midwives.  Though there is no formal bodies of scientific research there is a plethora of observational evidence in the safety and benefits of water birth.  According to Evidence Based Birth’s website over 20,000 water births have been documented in some manner.  So if you are having or have had a water birth consider sending your experience into Water Birth International’s Registry.  They have been building a database since 2004.  Well now that we’ve talked about benefits let’s look at safety.


Is Water Birth Really Safe?


One of the first concern you  may have about water birth is, what if the baby breathes in.  Well, let’s get a little technical on how amazing our bodies are.  When the baby is in utero, the baby makes a breathing movement intermittently, about 40% of the time.  The baby does not breath as such in utero.  It’s more of practicing since baby’s lungs are filled with fluid that keeps the lungs protected and open to get ready for the real breathing work.  This fluid’s presence will keep any other fluids from entering due to its viscosity.  Also, there is low blood supply to the lungs and this causes high pressure in the lungs making it difficult for any other fluid to enter.  When the time nears for labor to begin, prostaglandin E2 levels released from the placenta increase which slows or ceases fetal breathing movements.  As the baby is being born, the levels of prostaglandin E2 remain high and this keeps the lungs from functioning which is the first inhibitory response.  Another mechanism in place to help the baby is baby’s are born with low oxygen levels, which causes an absence of breathing, and thus the baby’s first reflex is to first swallow not breath.  There are other physiologic mechanisms in place that would keep the baby safe during a water birth.  There is a more thorough paper on this that I highly recommend parents to read regarding the safety of water birth at Evidence Based Birth.


When Is It Not Advisable?


The following are a few contraindications to birthing in the water:


  • Amnionitis

  • Maternal fever greater than 100° F or suspected maternal infection

  • Active genital herpes

  • Fetal distress

  • Rupture of membranes greater than 24 hours

  • Thick meconium-stained amniotic fluid

  • Excessive vaginal bleeding



Setting Up For Your Water Birth


So you have decided a water birth is definitely for you.  So how do you do this?  Well the first thing is look at your space that your birthing in.  If you are in a birthing center, the setup is already designed just right.  If you are birthing in home, you want to have a birth pool set up within a hose distant of a faucet.  Be sure that your faucet is compatible with the adapters for the hose.  You want to make sure there is enough space all around the pool for the support team to access you or your partner.  Once you’ve found the right space, you’ll need to choose the right birth pool.  Considerations are the size of your space or if your partner is going to be getting in the water with you will you both fit.  Most pools are spacious enough for two.  There are many sources to buy or rent a pool.  Yourwaterbirth.com has many supplies for water birth and homebirth and you may find that your midwife or doula has an account and recommended supply list.  Ask them and if they do they will be able to give you a 10% discount.  If you would rather not purchase a pool many midwives or doulas offer birth pools for rent along with the needed supplies to go along with the pool.


It takes about 20 minutes to inflate your pool and it is a good idea to inflate it before the big day to make sure there are no tears causing leak in the pool.  Something you don’t want to find out while you’re laboring.  It’s also good to practice different positions in the pool ahead of time before it is filled with water to see all the possibilities.  The next important thing is to make sure that the pool’s temperature stays between 92-100 ° F (32-38° C) but not exceed 101° F (38° C).  We don’t want your core temperature to increase because that can adversely affect the baby.  You can find a thermometer that floats in the pool to keep track of  your pool’s temperature.  It’s important to keep the water comfortable and keep it warm.  With that said, being in the warm water, make sure you stay hydrated and use a cool cloth on your forehead or neck.  


How deep should you fill your tub? You should fill the tub at least 20 “ of water depth to give benefits of buoyancy and to insure the baby is born into the water and not exposed to the air too early so as not to stimulate inhalation.  You don’t want it so deep so that the care provider is not able to see what is going on either.  It takes about an hour to fill the pool up and when things start moving along you can fill it about half way, so that if it cools a bit you have more space to fill it up with more warm water.  Keep it covered in between when you get in and out to lengthen your pools warmth.  Someone should stay with you at all times.  You can get in and out whenever you feel you need it.  It has been observed that it may be best to wait for immersion once your 4-5 cm dilated and have a well-established pattern.  Really though whatever helps you be comfortable and helps you manage the contractions do it.  You want to alternate between water and land to maintain the effects of the water.  Dr. Michele Odent’s research found that when entering the water early in labor (before 5cm dilated),  a surge of oxytocin happens and this increases uterine contractions and helps cervical dilation and effacement move along.  This effect, however, decrease if immersed 90-120 minutes.  So if you do get into the pool in early labor, take breaks so that labor can consistently progress.


Birthing In The Water

Finally you’re ready to push and as baby is born, your care provider will make sure to gently but quickly bring baby to the surface.  You finally feel the warm and slippery little person that has been a part of you for the last 9 months.  Eyes so bright looking right at you.  What an unforgettable moment.  If you are comfortable in the water and all is well, you can birth the placenta in the water.  Just have a lightweight bowl on standby to place the placenta in.  You’ve done it!  With any birth choices, do your research.  Watch water birth experiences.  There are plenty on YouTube.  Or ask your childbirth educator or doula their suggestions for water birth videos and resources as well.   I hope this article has been helpful.  Happy birthing!


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