Birth Pool in a Box Review

Do you know what a water birth is? If not, I encourage you to check out my article - Water birth: An Informational Article, which discusses what water birth is, the history, the pros/cons, and more!  Have you heard of the Birth Pool in a Box and do you know how it comes into play during a water birth? If not, check out my introduction article on the Birth Pool in a Box, which I will be discussing in this review. If you answered yes to both of these questions, please continue reading!

The Birth Pool in a Box (BPIAB) is a popular birth pool made specifically for women to use during labour and childbirth. It has been rated #1 by Waterbirth International and is used by an estimated 8,000 mothers worldwide each year! 

After reading so much about this birth pool, I was so excited to find out that I would be trying it out during my daughter's birth.  We received the Birth Pool in a Box a few weeks before my daughter's 'guess date' (the term I prefer over 'due date'). My husband and I took the opportunity to try out the birth pool twice to make sure we (or he mostly) knew what to do and what to expect when the time came. It also gave us the opportunity to troubleshoot any issues. 

Trial #1 

Birth Pool in a Box, bottom & seat inflated, sides not inflated.

We found that during both trial set-ups it took about 15-20 minutes to set up; that included getting the area ready, spreading out the pool, and blowing it up with air.  During the 1st trial we ended up running out of hot water before the minimum line. We hadn't turned up our hot water tank and figure that this is why that happened. During this trial, we also noticed that we had sediment in our water (probably from work they had been doing on the water system in our neighbour good), and this is not good news for the water birth! Over the next week or so, we worked hard to get the water clear again and the sediment out of our water tank (not an easy task!). We also discovered that the special water hose (25') that we had ordered was too short. We had even measured before hand but didn't account for lag that we might need in the hose during set-up or draining.  Besides purchasing a special lead-free drinking water rated hose, we had to purchase a host to tap/shower adapter, a thermometer for the pool, an individual liner, a ClearFit cover (to help keep some of the heat in when the pool is not in use) and make sure that we had a air pump that would work well to fill the pool with air. When you rent a birth pool, sometimes these items (or some of these items are included) are included, other times you are responsible for purchasing them yourself.

Me in the Birth Pool in a Box (trial set-up), waiting for the water!

Trial #2

During our 2nd trial we turned up water heater and managed to fill the pool up completely to nearly the minimum line.  We topped it up with hot water that was heated on the stove. The second run was much easier. 

Given the issues that we ran into, I highly recommend that people planning a water birth take the time to do a trial run with their birth pool. This helps with planning and to make sure that any issues are dealt with before labour begins. 

The Birth Pool in a Box set up with the ClearFit Cover prior to getting in during labour.

In labour...

When I was in labour, I don't remember much about the actual Birth Pool in a Box being set-up since I was in the other room, and my labour support people and midwife we're busy setting it up while I was busy working through contractions. Although, the set-up for the 3rd time (after the first two trials) went much smoother and faster. We set it up in our living room on top of a old rug, since we anticipated that there was a chance the floor could get wet.  We also cleared an area around the pool to make sure that my support people and the midwives could have easy access to me.

Relaxing in the Birth Pool in a Box between contractions.

I entered the tub when I was at about 6cm open and I remained in the tub for approximately 3 hours (looking back, the time went by so fast). Upon exiting the Birth Pool in a Box, my midwife realized that my cervix had not really opened much more although my baby had descended and was facing occipital posterior (OP), which was likely the reason the progression was taking a bit longer than she anticipated. 

While I was in the pool, I found that using the Birth Pool in a Box for hydrotherapy was very useful for providing comfort during my contractions. I had heard from my midwife previously that they consider water 'natural's epidural' during labour. So, I figured if contractions feel like 'this' when I was in the pool, how will they feel when I was out of it?!  At one point I mentioned I was afraid to leave the pool to go to the washroom because I didn't know how bad the contractions would get! Looking back, I know that the fear was also in part due to knowing that I had to sit on the toilet, which I called the 'contraction inducer' during labour; I later learned that this may have had to do with the position my daughter was in during her descent. 

After being out of the pool for awhile, I did notice that it was more comfortable when I was in the water. Once transition started, I was eager to get back in.

I re-entered the pool around 8cm open and remained there until the birth of my daughter. Once I was back in the water, I progressed quickly and I think I surprised my midwife that things happened as fast as they did.  I found that at this stage the water was definitely welcomed. It was a dream of mine to birth my daughter in the water (I had always imagined that this was the way I'd have babies since I was very young).

And, the experience was amazing!  I felt very much like I was in control of the situation and that I was able to move along intuitively with the way my body felt. I always thought it was amazing when women were able to 'catch' their own babies and I was excited when I found out during my prenatal visits with my midwives that they are 'hands-off' during water births - that meant I would be catching my own baby. I did end up catching my daughter and that was the most amazing moment - pulling her up on my chest and meeting her for the first time was so awesome!

During labour, because water was being added on a regular basis (I was in the pool quite a bit and therefore didn't use the ClearFit Cover all that much), it did reach the maximum line and my support people had to empty water in order to add more. In terms of draining the water, it did take some trial and error to figure out how to drain it efficiently. We found it easiest and fastest to syphon the water from the pool into our downstairs toilet. You can also get a water pump so that you don't have to use the syphon method. For the extra money, we figured it wasn't necessary for us.

What I liked about the Birth Pool in a Box:

• -I found that the handles were placed appropriately and came in handy particularly for the pushing phase of labour; I appreciated that there were some on every side of the birth pool.
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• -Because the bottom of the birth pool is also inflated with air, it was very comfortable to move around in during labour; in labour I found myself on my hands and knees most of the time so this was very important to me. Also, since the sides were also inflated and quite wide, it was very comfortable when I chose to lean against the sides during and between contractions.  
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• -The sides of the pool proved to be very strong, which allowed my support people and midwives to lean/sit on them.
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• -The size of the tub was great because it allowed me to move around and not feel confined. There was even enough room for another person, although, I didn't try that out during my labour/birth.
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• -My midwife agreed that the white at the bottom of the pool was helpful for seeing what was happening.
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• -The shape of the pool was nice since there was a bigger side and a smaller side (egg-shaped). At different points in labour, I felt like I needed either more room or a more cozy feel and it was nice that I could alternate which side I was on.
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• -The seat in the pool really came in handy once my daughter was born. It turned out that her umbilical cord was quite short so the extra boost from the seat was vital to keep her at the right height.

What we had problems with:

• -Since I am a petite person, I found that the height of the pool was too tall for me. Although the instructions state that you can adjust the height by taking air out of the center or top tube, when we did so, we thought it affected the stability (for people to lean on, etc.) and it took extra time, so we kept it as is. To make it work, we had a step stool on the outside, and my support people and midwives helped me in and out. This probably isn't 'recommended' but it is what worked for us.  Having the extra support getting in and out was vital because of this!
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• -My midwife also had some difficulty reaching me to do checks (cervical and my baby's heart rate) because of the width of the pool and because she is a very petite person as well.  I can imagine that it would have been a bit easier if I had the Birth Pool in a Box Mini.

The Verdict?

I frequently recommend the Birth Pool in a Box to anyone I know who is planning on using hydrotherapy for either labour or give birth in. This is an excellent pool that is well designed. The price of both purchasing or renting this pool is very economical and at a more affordable price point compared to the other birth pool that is available for rent in our area.  If everything goes as I hope, I plan to use the Birth Pool in a Box again with subsequent children. The experience was great and I felt that it really helped me during labour. I enjoyed this pool so much that I am considering adding a Birth Pool in a Box Professional Grade rental to my doula services in the near future so that other parents can experience the benefits of this great birth pool.

I am so grateful to Choices Childbirth Services, the exclusive distributor of the Birth Pool in a Box in Canada, who gave me the opportunity to use the Birth Pool in a Box for my daughter's birth. Without them, the experience would not have been the same!

**Disclaimer** Choices Childbirth Services provided me with a Birth Pool in a Box Eco Regular free of charge, although, I did purchase accessories from them for this birth pool.  Receiving this item did not in anyway alter the information which I discussed in this article; this review is 100% my own opinion.  I did not receive any other type of compensation for this review. If you are planning a water birth, please consult your health care provider. This review is a reflection of my experience with the product. I cannot be held liable for your chosen use of the Birth Pool in a Box.

Birth Pool In A Box

Are you planning a water birth? There are so many different birthing pools out there, deciding on just one can be difficult! I recently gave birth to my daughter thanks to Choices Childbirth Services and the Birth Pool In A Box and I'd love to share a bit of information with you. This is a objective informational article. I will be posting my first hand subjective review of my experience birthing in the Birth Pool In A Box within the next week (P.S. The experience was amazing and I attribute at least part of that to this pool).

The Birth Pool In A Box is the only birth pool recognized as a favourite by Water Birth International, a non-profit organization that ensures that water birth is an available option for all birthing women in all settings.  The Birth Pool In A Box is also the 1st and only birth pool to be FDA approved.  It has been certified by medical device regulators in both the United States and Europe.  Plus, this pool has been rated #1 and makes water birth a possibility for an estimated 8,000 mothers and their babies worldwide each year!

Many women around the world are choosing water birth for their births because water birth:
- decreases sensations of pain in labour (my midwives called it nature's epidural)
- decreases likelihood of vaginal tearing
- increases and eases mobility
- increases feelings of relaxation
- increases the likelihood that birth will be seen as a comfortable and sensual experience
These points were taken from the Birth Pool In a Box website.

Some features and benefits of this pool include:
1. No drain plug - this can be a weak link that midwives and families state is unnecessary.  In our experience, birth pools can be easily drained using a pump or the siphon method.
2. Six handles - spaced and placed well to allow labouring mothers to labour or push in whatever position works and feels best for them!
3. A Built-in Seat in the Regular model - this is great for positioning or sitting, breastfeeding, and/or bonding with baby after the birth.
4. Opaque walls - to increase feelings of privacy.
5. Soft 2" thick floor - provides increased comfort for the mother.
6. Sturdy, thick outer wall - strong enough to allow support people or midwives to sit on.
7. Three (3) independent chambers - allows for pool height adjustments and decreases the likelihood of leaks.
8. Form-fitted Eco Liners - individual single use liners increase hygiene and thus safety.  They also allow for easier clean-up post-birth.
9. Egg shape - allows for movement whether mothers want to feel 'hugged' or like they have space.
10. White floor - increases viability for midwives, the mother, support people and family members.
11. Clear inside wall - can help increase feelings of space.
12. Plain blue rim - allows mothers to focus on their labour instead of distracting text or logos.

The Birth Pool In A Box comes in two sizes for personal use (regular and mini - great for smaller spaces), as well as a professional grade pool that it is intended for multiple uses (great for midwives and doulas).  The Personal Use Regular Size sells for $250 and the Personal Use Mini Size sells for $225.  Both come with one single use liner.  The standard ClearFit covers, accessories, and extra liners are sold separately.  Prices are available on the Birth Pool In A Box website.  To learn more about how you can rent the Birth Pool In A Box, please visit Choices Childbirth Services.

The Birth Pool In A Box is a great option for expectant mothers because it takes the needs and wants of mothers and midwifes into account, and it is reasonably priced.  For more information on the Birth Pool In A Box, please visit the Birth Pool In A Box FAQ page.

In Canada, Choices Childbirth Services is the exclusive distributor of the Birth Pool In A Box.  Choices Childbirth Services is a community-based organization that was established in 1995.  Their goal is to "improve health care to expectant women and their infants and to promote family-centered maternity care".  They provide support and educational services to pregnant women and their families, through prenatal classes, doula services, birth pool rentals, and postpartum care products.

**Disclaimer** Choices Childbirth Services sent me a regular sizes Birth Pool in a Box to allow me to conduct a first-hand review of the product and their service.  I agreed to write one informational objective review of the Birth Pool in a Box (this article) and a subjective review of my experience using the Birth Pool in a Box (upcoming).  Receiving this item did not in anyway alter the information which I discussed in this article; this review is 100% my own opinion.  I did not receive any other type of compensation for this review.

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.