Water Birth

By Michelle Southam - Student Midwife

"We recommend that all hospitals make it their policy to make full provision whenever possible for women to choose the position which they prefer for labour and birth with the option of a birthing pool where this is practicable.' Winterton, N. House of Commons Health Committee, Second Report - 1992

I have been fortunate enough to attend many women who have used water for labour and birth, and without exception they have all found water to be very relaxing and good pain relief. We are lucky enough at Warwick to have a large birth pool and also en-suite bathrooms in the labour rooms, so that the majority of women will have access to water in labour.

There have been many pieces of research on the use of water for labour and birth, but many have been small or poorly designed studies that we do not consider to be good evidence. However waterbirth is now a relatively common event, which appears to be safe if reasonable precautions are taken. Many studies suggest considerable benefits for the use of water while others suggest there are no differences between water and dry land births. No studies suggest that waterbirth is dangerous.

The suggested benefits include:-

	Reduced pain
	Increased feelings of relaxation
	Increased feelings of control
	Shorter labour - Your muscles relax in the pool, so you don't waste any energy in being tense. All your energy can be used by your womb to make contractions effective and labour quicker.
	Reduced interventions
	Reduced use of pharmacological pain relief
	Buoyancy - The water makes it easy for you to move about, so you can make yourself comfortable. The best position for you is likely to be the one that helps your baby move most easily through your pelvis.
	Reduced perineal trauma - may be less likely to tear because the water softens your tissues so that they can stretch easily around your baby's head as he is being born. Some people think that the perineum may be additionally protected because the pressure in the womb is similar to the pressure in the birthing pool, making the birth of your baby's head more gentle,
	Gentler birth for the baby
	Increased maternal satisfaction

The suggested drawbacks include:-

	Increased risk of infection
	Overheating of mum and baby
	Risk of baby inhaling water
	That forms of pain relief such as pethidine cannot be used in water

To prevent the risk of any of any problems occurring Warwick Hospital has the following Guidelines regarding waterbirth:-

	The baby's heart rate should be monitored every 15 minutes during active labour, if there is any reason why the baby should be monitored continuously such as maternal diabetes or previous ceasarean section. Warwick asks that you do not use the pool as continuous monitoring cannot take place under water
	That the water temperature is maintained between 36-37º C to prevent overheating of mom and baby during labour
	That the water temperature is 37º C when the baby is born and that the baby is totally submerged in water when it is born as temperature drop stimulates the baby to breathe
	That the baby is brought to the surface without delay so that it may begin to breathe
	That the pool is thoroughly cleaned between each use and kept as clean as possible during labour
	Warwick asks that mothers get out of the pool for the delivery of the placenta (afterbirth) as it is difficult to judge blood loss in a pool of water, and there is also the theoretical risk of water entering the mothers bloodstream.

Birthing your baby in water is just one of the many options that we offer to women, and can be very useful for women trying to avoid a medicalised birth. We hope that whatever you are looking for we can help make the birth of your child a pleasurable experience.

*Please note you cannot pre-book the birth pool for use

*Other hospitals in the area also have birth pools such as the Alexandra Hospital in Redditch

*Or if you are planning a home birth you can hire a pool to use at home

*For information on the use of water for labour and birth see MIDIRS Informed Choice Leaflet on Water Birth*

Web sites

	Waterbirth International has excellent waterbirth resources, fab birth stories and pictures, be aware this is an American site, and it is more difficult to get a water birth in many parts of the US than in the UK
	Active Birth Centre - Pool hire
	Active Birth Centre - pregnancy and birth
	Birthing Pools - Splashdown Water Birth Services Ltd.
	Birthing pools for home, Birthworks

The Research

Reviews and audits

	Beake, S. Waterbirth: A Literature Review. Practising Midwife, Vol. 3, No 2, Feb 2000. Pg 12.
	Brown, L. The Tide Has Turned: audit of waterbirth. BJM Supplement on Waterbirth. British Journal of Midwifery, Vol. 6, No. 4, April 1998.
	Nikodem, V.C. Immersion in water during pregnancy, labour and birth. (Most recent amendment, June 1997). The Cochrane Library, Oxford - 1998, issue 1.
	Garland, D. & Jones, K. Waterbirth: Updating the Evidence. British Journal of Midwifery, June 1997, Vol. 5, No.6. pp. 368 - 373.
	Campbell, K. The Water Birth Debate: A Brief Review. B.C. Midwife. Spring 1998, Vol. 4 No1, pp19 - 21

Surveys

	Garcia, J. Labour and birth in water in England and Wales: a report of a survey. National Perinatal Epidemiology Unit, Radcliffe Infirmary, Oxford.
	Alderdice, F., Renfrew, M., Marchant, S., Ashurst, H., Hughes, P., Berridge, G., Garcia, J. The national waterbirth study. Research and the Midwife Conference Proceedings, Manchester. Research and the Midwife 1996, pp 18-22.
	Alderdice, F., Renfrew, M., Marchant, S., Ashurst, H., Hughes, P., Berridge, G., Garcia, J. Labour and birth in water in England and Wales: a report of a survey. BJM Supplement on Water Births. British Journal of Midwifery, July 1995, Vol.3, No. 7. pp. 375-382.

Perinatal mortality and morbidity

	Gilbert, R., Tookey, P. Perinatal mortality and morbidity among babies delivered in water: surveillance study and postal survey (1999) BMJ, Vol 319, 211 pp 483-487.
	Floyd, L. Research Update: Perinatal mortality and morbidity among babies delivered in water. The Practising Midwife, March 2000. Vol. 3 No. 3. pg. 43.
	Charles, C. Fetal hyperthermia risk from warm water immersion (1998) British Journal of Midwifery, Vol 6, no 3. pp 152-156

Clinical overviews

	Hartley, J. The use of water during labour and birth. RCM Midwives Journal, December 1998, Vol. 1. No. 12. pp 344-345.
	Harris, K.T. Hydrotherapy: An Alternative Method for Relieving Labor Pain. Mother Baby Journal. Vol. 4, No 5. September 1999.
	Odent, M. Birth under water. The Lancet. December 24/31, 1983. pp 1476-1477
	Harper, B. Why Waterbirth. Excerpt from Gentle Birth Choices. Revised Jan. 1999.

Hormones / when to enter the pool

	Odent, M. Use of water during labour – updated recommendations. MIDIRS, Midwifery Digest, March 1998, vol 8, no1. pp. 68-69.
	Odent, M. Can water immersion stop labor? Journal of Nurse-Midwifery, Vol 42, No 5. September/October 1997. pp 414-416.
	Eriksson, M., Mattsson, L-A., Ladfors, L. Early or late bath during the first stage of labour: a randomised study of 200 women. Midwifery, Vol 13, no 3, Sept 1997, pp 146-148.
	Boulvain, M., and Wesel, S. Neurobiochemistry of immersion in warm water during labor: the secretion of endorphins, cortisol and prolactin. Fedor-Freybergh, P., Vogal, V. (Editors), Prenatal and perinatal psychology and Medicine. New York. Parthenon, 1988. pp 431-438

Asphyxia and infection (hospital studies)

	Kingsley, A., Hutter. S., Green, N., Speirs, G. Waterbirths: regional audit of infection control practises. Journal of Hospital Infection (1999), Vol 41, pp 155-157.
	Forde, C., Creighton, S., Batty, A., Hawdon, J., Summers-Ma, S., Ridgway, G. Labour and delivery in the birthing pool. British Journal of Midwifery, March 1999. Vol .7 No 3. pp165-171.
	Royal College of Paediatrics and Child Health, Royal College of Obstetricians and Gynaecologists. Resuscitation of Babies at Birth. BMJ Publishing Group, 1997, London.

Dive reflex

	Johnson, P. Birth under water – to breathe or not to breathe. British Journal of Obstetrics and Gynaecology, vol 103, no 3, March 1996. pp 202-208
	Letter: Birth under water – to breathe or not to breathe. MIDIRS Midwifery Digest (Jun 1997) 7:2. pg 201.
	Eldering, G.,Selke, K. Water Birth - a possible mode of delivery? Water Birth Unplugged, Books for Midwives Press 1996.

Position statements

	United Kingdom Central Council for Nursing, Midwifery and Health Visiting. Position Statement on Waterbirths. Annexe 1 to Registrar’s Letter 16/1994. 6 October 1994.
	The Royal College of Midwives. The use of water during birth. Position Paper No.1, June 1994.
	The National Childbirth Trust. NCT says labour and birth in water good for mothers. NCT Press Release 31 March 1995.