It’s time for…..(drum roll please!)….ask the Midwife with Liz Withnall, CNM!
Q: I have heard that some women give birth in water. What are the advantages of doing this? Are there any risks to myself or my baby?
The use of warm water for relaxation and pain relief during labor is not a new idea. In the 1960’s, water birth became popular in Russia, and in the 1970’s and 1980’s thousands of water births occurred in Europe. Currently, birthing in water is a popular option in hospitals and birth centers across the U.S. Many benefits of immersion in water during labor and birth have been documented by research.
These benefits include reduction in the perception of pain; reduction in the need for pain medications; increased relaxation; shorter labor; decreased incidence of lacerations during birth; and increased satisfaction with birth experience. Women who experience water birth very often comment on what a positive experience it is, and how they would like to birth that way again with the next baby.
In order to experience the full benefits of water birth, full immersion is necessary, which means the mom is in a deep tub, with her belly covered with water, all the way up to the breasts. Being fully immersed promotes the hormonal responses of the body which aid in the relaxation of the woman and shortening of the labor. The recommended temperature of the water is between 98 F and 101F, in order to avoid chilling or overheating the baby. Most often, women will enter the pool during active labor and may stay in until the birth, or they may decide to get in and out of the tub. Sometimes getting out for a short period of time and then getting back in will cause a rapid increase in dilation. When the time comes to push the baby out, women will assume whatever position feels comfortable to them. Her partner can be behind her in the tub, supporting her, or at the edge of the tub, giving encouragement. Both mom and partner are encouraged to help guide the baby out and to the surface if they choose, with the assistance of the midwife. The placenta can be delivered in the tub, but often the woman will get out, which aids in assessing blood loss.
In our practice the baby is guided to the surface of the water promptly after delivery so that he/she can take that first breath. Often people ask what keeps the baby from breathing as soon as he/she is out of the birth canal. There are several factors involved that prevent baby from taking a breath while under water. One is a hormone called Prostaglandin E2 which comes from the placenta. When these levels are high, the baby’s muscles for breathing are inhibited, and prevent a breath from being taken. Also, the baby already has fluid in the lungs from being inside the amniotic sac for nine months; this fluid prevents other fluid, such as water, from entering the lungs. Additionally, babies are born with a reflex that causes the glottis to close if a substance such as water tries to enter, and effectively seals off the passage to the lungs. When the baby is brought up to the air, the nerves in the face respond and trigger the reflex to breathe. At that point, the circulation to the lungs begins. Remember, baby is getting oxygen through the umbilical cord up until that point.
Risks of water birth are rare. One potential complication is the umbilical cord tearing off the placenta at time of delivery. This would be more likely to happen if the cord were unusually short. In cases where the baby is stressed at birth, the reflex to not take a breath at delivery could be overridden, and there is potential for the baby to take a breath. This situation can be avoided by monitoring the baby’s heartbeat and having the mother get out of the tub for delivery if there are any concerns about fetal wellbeing. Additionally, if there is meconium in the amniotic fluid (the baby has had a BM in the water bag) the birth cannot take place in the tub.
Women who are having a normal, healthy pregnancy are ideal candidates for birthing in water. Those with risk factors such as prior cesarean delivery, high blood pressure, small for gestational age baby, preterm or post term (42 weeks or more) or other medical conditions requiring continuous monitoring of the baby’s heartbeat are not candidates for waterbirth due to safety concerns.
If you are interested in having a water birth, or have more questions, please talk to any of your midwife providers at Women’s Specialists of New Mexico! Water birth is an option for those of you delivering at Lovelace Women’s Hospital, who meet the screening criteria and agree to be part of an ongoing study. Remember, as with any birth experience, you might not end up delivering in the water for a variety of reasons which could include such a rapid labor that there is not time to get the tub filled; you could change your mind and jump out of the tub; you might decide you need an epidural; or concerns about fetal well being or infection could cause your provider to recommend you deliver out of the tub. Water birth is an excellent option for some women in labor, keeping in mind that labor is always an unknown and mysterious experience… which is what we love about it!
To make an appointment with Liz Withnall, CNM, call 843-6168.