Water Birth - An Informational Article

PLEASE READ:
I have written this article for general interest only.  I am not an expert in water births but I have included information in this article that I found through my own research.  If you are considering a water birth, please research this option thoroughly and discuss your plan to birth in water with your health care provider.  This article is not meant to be a substitute for medical advice.  You should always forward medical questions on to a qualified health care professional.  I have tried to ensure (to the best of my ability) that the information in this article is accurate.  If any incorrect information does exist, it is purely accidental.  I am not liable for any unintentional mistakes, use, or misuse of the information contained in this article.  If you do have questions about my experience with water birth, I am happy to answer those questions.

 

What is a water birth? 
A water birth is a birth in which a mother typically spends the second stage of labour, the pushing phase, immersed in water. During this phase the mother pushes with each wave (contraction) and eventually births her child into the water.

Water does not have to be used only during the second stage of labour. Women can enjoy water to help cope with the sensations of labour in the first stage, the active phase of labour. Women often enjoy using water for this purpose and then exit the water for the second stage of labour, the pushing phase.

A brief history of water birth
Women from many different parts of the world have been giving birth in the water for centuries, but it has been only recently (as late at the 1980s across the United States) that this option has become popular for North American women (Harper, 2005).

According to Barbara Harper (author of Gentle Birth Choices) (2005), the first water birth to be documented happened in 1803 in France to help a mother cope after a long forty-eight hour labour. Documents state that the warm water of the birth helped the mother's labour to progress, so fast in fact that she was unable to leave the water before her baby immersed (Embry as cited in Harper, 2005).

In the 1960s and thereafter, Igor Charcovsky, a self-taught scientist and male midwife in the Soviet Union (Russia), took particular interest in water birth and began studying it (originally by looking at how animals laboured and birthed in water and the reaction of infants in water) (Harper, 2005; Midwifery Today, 2011).  Charcovsky also studied water birthing with dolphins present and is known to be father to the Russian Method of birthing in water (Midwifery Today, 2011).

Leboyer is another popular figure that believed in the benefits of water for newborns. Although Leboyer did not focus on birthing in the water, he did believe that immersing a newborn in a warm bath following birth was helpful. I think that Leboyer's work can easily be incorporated into water birth when looking at how a baby reacts when being birthed into the water vs. on land or in air (Harper, 2005).

French Physician, Michel Odent, became on of the first to publicly discuss and allow birthing or labouring in the water. He believed that it was important for women to birth in the way their body's instincts told them too (a belief that I share), whether or not those instincts told them to labour or birth in water, or elsewhere. He left water birth open as an option. Instead of having women plan for a water birth, he encouraged them to follow their bodies cues (Harper, 2005). This is an important point that I think is still very valid today. Many women want a water birth and plan for one; in the case of a home birth, planning is a necessary step to ensure the proper supplies and set up. But, it is important to realize that the body wants what it wants in labour and you may not feel like labouring or birthing in water, even though it may have been your initial plan. It is important to go into labour with an open mind and follow your body's cues instead of forcing yourself to try and live out your dreams of a water birth.

In 1988, Waterbirth International was created by Barbara Harper when she saw a need to provide women with accurate information on using water during labour and birth. Over 20 years later, Waterbirth International continues to be a great resource for women around the world who are interested in learning about water birth (Harper, 2005). 

Where can a water birth occur?
Water births most often occur in a pool or tub of some sort. There are many different types of birth pools on the market. Some people also use children's play pools for their water births; although, it is important to note that many midwifes suggest a certain water depth for optimal safety. I have heard that some women have even given birth in the ocean (sea) or in their own bathtubs, although it seems to be less common.  If you are planning a water birth, you should discuss the type of pool you plan on using with the health care provider who will be attending your birth.

Water births seems to occur most commonly when a mother chooses to birth at home.  I have also heard of water births occurring in birth centres, and less commonly in hospitals (depending where in the world you live).  Water births are not always available in all birth settings.  For example, here in Manitoba, Canada, women can not give birth in the water in a hospital setting.

Some of the Pros of Water in Labour & Birth

• - Studies have shown that mothers who labour in water generally have shorter labours (Thöni, Mussner, & Ploner, 2010).
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• - Women who labour in the water are less likely to request pain relief from drugs, since warm water helps with to relieve the pains that women can experience in labour.
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• - Women who birth in water are less likely to need an episiotomy.
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• - The relaxing qualities of a warm bath can help the waves (contractions) to become more efficient, thus aid in the cervix opening (dilating) (Thöni et al., 2010).
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• - Birthworks (2011) stated that water can allow women to move easier in labour and help them to change positions, which can help the baby to descend easier.
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• - There are many benefits for the newborn including being more calm after birth, crying less after birth, plus they are more likely to want to suckle at the breast and make eye contact with their mothers (BabyCentre, 2011). Some people believe that this may be because a water birth provides the baby with a similar experience as in the womb and allow them an easier transition into the outside world (American Pregnancy Association, 2011).
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• - Birthing in the water can help women feel more independent and in control of her labour and thus can increase positive feelings of well-being.
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• - Labouring and birthing in the water can help to lower blood pressure (College of Midwives of British Columbia, n.d.).

Some of the Cons or Concerns of Water Birth

• - If proper water birth protocols are not followed, there is a risk of newborns taking a breath prior to coming out of the water. This is a concern that many parents have (my husband and I included when we first started considering water birth). However, if proper protocols are followed, the likelihood of this happening is reduced. There are several natural reactions within newborns, including innate reflexes that protect newborns from taking their first breath too early (in the water) (College of Midwives of British Columbia, n.d.).
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• - It may be more difficult to gauge maternal blood loss, which is important to determine a mother's risk for hemorrhage (College of Midwives of British Columbia, n.d.).
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• - If a mother enters warm water too early in labour, her labour can stall. Most childbirth professionals recommend waiting to enter the water until at least 5cm open (dilated). When I was pregnant, my midwife explained that entering warm water early in labour can also be useful, especially if it is favourable for the onset of labour to be delayed (e.g. your labour started in the middle of the night or just prior to going to bed - in either case you may experience a lack of energy) (College of Midwives of British Columbia, n.d.; Waterbirth International, 2010).
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• - There is typically a small cost associated with a water birth, unless you are birthing in a bathtub or if a birthing pool is supplied by your midwife, birth centre, or hospital.

The Safety of Water Birth
A study completed in Italy in 2010 looked at 2625 water births that took place between 1997 and 2009. The study found that when comparing normal vaginal deliveries in the water compared to on land (not a water birth), there was no increased risk of neonatal infection and water birth appeared to be safe for the baby (Thöni et al., 2010).

Another study completed in the UK in 2009 showed no increased risk of infection for the mother (Cluett & Burns, 2009).

A 9-year study completed in Switzerland looked at 3,617 water births and 5,901 land births and found that women who have water births experience less blood loss on average (Geissbuehler, Stein, & Eberhard, 2004). This same study also showed a lower incidence of newborn complications and need for treatment in the NICU when compared with land births.

A study completed in the Czech Republic found that women who choose water birth have a lower incidence of injury (Pellantová, Vebera, & Půcek, 2003).

According to Harper (2005), some emergencies or complications in child birth can actually be better dealt with in a water birth situation. For example, a cord wrapped around a newborn's neck can be more easily slipped over the head in the water than on land. The water can even help for things such as breech births or shoulder dystocia (Harper, 2005).

Your Choice! 
It's your birth and this is just one of the many choices that are available to you! Like all birth choices, it is important to do your research (thoroughly). I am not an expert on water birth or birth for that matter and I am only sharing some of what I have learned through my research; this article is not comprehensive.

Like every choice, their are pros and cons, and risks and benefits. It is important that you weigh your options and only choose to birth in ways that you feel comfortable. Finally, it is important that you discuss your options with a trained birth professional (e.g. a midwife or an obstetrician) and if you are hoping for a water birth (or labouring in the water), to share your vision with your health care provider. Safety protocols and guidelines should be considered if you are thinking about having a water birth. Most health care professionals are probably familiar with them if they routinely do water births but I recommend taking a look at the water birth protocol and guideline documents provided by Waterbirth International.

I hope this article has provided you with a bit more information about water birth as an option for your birth. If water birth interests you, please research the option in more detail and discuss it with your health care provider. I wish you all the best in your journey to a water birth!

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Please stay tuned for two other articles that I will be writing in relation to water births: an information objective article about the product birth pool in a box, and my subjective review on the birth pool in a box based on my water birth experience with my daughter.  I wrote this article to help educate my readers about what a water birth is, prior to sharing my objective and subjective review articles.

I have also posted this article on my new Pregnancy, Childbirth, and Postpartum Website: Simply Beautiful Beginnings.  If you are interested in any of these topics, please consider following me through Twitter or Facebook or subscribing via RSS feed or email. 

Books about water birth:

• - Water Birth: A Midwife's Perspective by Susanna Napierala
• - Choosing Waterbirth: Reclaiming the Sacred Power of Birth by Lakshmi Bertram, Sandra Amrita McLanahan and Michel Odent
• - WATER LABOUR, WATER BIRTH: A guide to the use of water during childbirth by Annie Sprague
• - All About Water Birthing (eBook) by Monica Smith
• - The Waterbirth Book: Everything You Need to Know from the World's Renowned Natural Childbirth Pioneer by Janet Balaskas
• - Revisiting Waterbirth: An Attitude to Care by Dianne Garland
• - Gentle Birth Choices by Barbara Harper (although this book is not specifically about water birth, it has a large section about water birth that I found extremely detailed and helpful)
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References

1. 1. American Pregnancy Association (2011). Water birth. Retrieved from http://www.americanpregnancy.org/labornbirth/waterbirth.html.
2. 2. BabyCentre (2011). Water birth. Retrieved from http://www.babycentre.co.uk/pregnancy/labourandbirth/waterbirth/.
3. 3. Birthworks (2011). Why choose a waterbirth? Retrieved from http://www.birthworks.co.uk/about_water_birth.php.
4. 4. Cluett ER, Burns E. Immersion in water in labour and birth. Cochrane Database of Systematic Reviews 2009, Issue 2. Art. No.: CD000111. DOI: 10.1002/14651858.CD000111.pub3
5. 5. College of Midwives of British Columbia (n.d.). Guideline for the use of water in labour and birth. Retrieved from www.auroramidwifery.ca/documents/BCmidwiveswaterbirthdoc.pdf.
6. 6. Geissbuehler, V., Stein, S., & Eberhard, J. (2004). Waterbirths compared with landbirths: an observational study of nine years [abstract]. Journal of Perinatal Medicine, 32(4), 308-314.
7. 7. Harper, B. (2005). Gentle birth choices. Healing Arts Press: Rochester, Vermont.
8. 8. Midwifery Today. (2011). Biographies. Retrieved from http://midwiferytoday.com/bio/.
9. 9. Pellantová, S., Vebera, Z., & Půcek, P. (2003). Water delivery - a 5-year retrospective study [abstract]. Ceská gynekologie, 68(3), 175-179.
10. 10. Thöni A, Mussner K, and Ploner F. (2010). Water birthing: Retrospective review of 2625 water births [abstract]. Contamination of birth pool water and risk of microbial cross-infection. Minerva ginecologica, 62(3), 203-211.
11. 11. Waterbirth International (2010). Waterbirth FAQ. Retrieved from http://www.waterbirth.org/mc/page.do?sitePageId=38564&orgId=wi.