Pros, Cons, and Facts About Water Birth
Like all popular subjects, the web is awash with information on the subject of water birth. Again, like most popular subjects, a lot of this information is promotional rather than factual. That can make life tricky for someone who is looking to make an informed decision. There are pros and cons to this type of birth. Needless to say, it is essential to get all the facts when making such an important decision. It is a broad subject and it is not possible to cover all of the fine details in one article, but I've tried to cover all of the the essential considerations.
History of water birth
Water birth has been quite popular in North America, Europe, and other parts of the world for well over 25 years now. However, the history of this practise goes back over two centuries. In medical history books, the first recorded water birth was in the early 1800s in France. Fast forward almost 150 years later where you find a good amount of literature on serious research on this as an alternate method of childbirth in the former Soviet Union. Today, it is an accepted part of mainstream labour and delivery methods.
Why a water birth
Every person will have their own unique reasons for opting for a water birth. In general many consider a water birth as a way of avoiding the medicalisation of childbirth by avoiding the drug-based forms of labour pain relief. A water birth enables one to create a relaxing atmosphere during labour and having as close to a homely atmosphere as possible. In fact, the water birth option makes it far more possible for close family participation in a supporting role, allowing for a more enriching experience for the whole family (if that is what is desired).
Water birth in the developed world is now mainstream. In the UK, virtually all maternity units have this facility. It is available to all women as a free option as long as there are no medical contra-indications. In most developed countries and many large maternity hospitals in many developing countries, this option is readily available.
Water birth is also increasingly adopted by many women who opt for a home birth. If there is a large enough bath-tub with a ready and reliable availability of hot water, this can be adopted for the purpose. However, this is not ideal as conditions are likely to be cramped for more than one person and controlling the temperature of the water may prove tricky. What is normally done is to hire a purpose-built birthing pool. As long as there is a large room in the house, this can be temporarily converted into a birthing room. These pools are ideal because, apart from their ideal size (easily accommodating two or even three people), they have inbuilt thermostatic control allowing for maintenance of temperature in the ideal range of 35-38°C. This is important as we will see shortly.
It is evidently not possible to perform a robust scientific study to give objective results on a head to head comparison between a water birth and the traditional, normally hospital-based, birth. The popularity of water birth is based on the perceived relaxing effect of water thereby engendering a more positive experience of the whole process of childbirth. Labour is painful and exhausting. By any measure, it lasts a long time. A typical labour can last anything from 6 to 12 hours, often longer. Going through that many hours in constant discomfort and bouts of intermittent pain is, without doubt, quite a challenging experience. Water birth is supposed to moderate that, sometimes to a significant degree. Its availability in a woman’s own home makes the proposition even more attractive for many. This is the main benefit. However, opinions will always be that, opinions,and therefore subjective.
Reduced birth trauma?
It has been suggested (and some sources have quoted this as fact) that the prolonged stay in warm water makes the tissues more supple thereby reducing the risk of trauma to the birth canal and pelvic floor. It is supposed to reduce the likelihood of needing an episiotomy or sustaining a tear during the birth. Statistics show that it does not in fact make any difference in this regard.
There is also the claim that water birth reduces intervention in the form of instrumental delivery (ventouse or forceps) and even emergency caesarean section. Again, statistics do not support this claim. Rates of intervention are similar to conventional birth and indications for the interventions are the same.
Medication during labour
One of the pre-requisites for water birth is that sedating medications such as Diamorphine or Pethidine cannot be used during labour. Nor can epidural analgesia be employed. Depending on one’s point of view, this can be regarded as a benefit of the water birth option.
What about the baby? In a sentence; there is no direct benefit to the baby. Labour, for the baby, is the same wherever the mother might be. However, there may be indirect benefit. By foregoing opioid pain-killers, it means the mother avoids exposing the baby in the womb to these drugs. However, this benefit is not exclusive to water birth. There are many mothers who go through labour without the use of these pain-killers and that may include those who opt for an epidural. In this type of pain control, a local anaesthetic is injected into a specific space in the spine to make the whole lower part of the body numb thereby abolishing the labour pains. The drug never gets to the baby.
Water birth is not for everybody. In general, it should only be considered where the pregnancy is classified as being low-risk. As it happens, most pregnancies are classified as such (low risk). There are situations which make water birth unsuitable or downright dangerous. Such conditions include:
- Preterm labour
- Placenta praevia (where the placenta is abnormally low-lying)
- Insufficient back up facilities such as immediate access to a hospital (in case of unexpected complications)
- A medical condition complicating pregnancy such as diabetes, pre-eclampsia, heart disease etc.
- An abnormal lie of the baby where successful vaginal delivery is unlikely such as oblique or transverse lie. In fact, most experts advocate avoiding a water birth unless the situation is straight-forward with the baby leading with the head.
Where water birth does not work
Not every woman who sets out to have a water birth will achieve that. So, what could cause the woman to abandon the tub or be forced out?
- An abnormally prolonged labour. When labour doesn’t seem to be progressing as expected, a decision could be made, either by the woman herself or those assisting her, to abandon the plan and avail herself an opportunity for either the labour to be augmented or another appropriate intervention to be made to move things along.
- Maternal distress: With all good intentions in the world, sometimes the experience does not live up to expectation. The woman may find the labour pains unbearable and the soothing effect of the warm water completely inadequate. She may then decide to abandon the plan to enable her to get a more effective form of pain relief.
- Fetal distress: Like any other labour, an on-going labour in water may be complicated by an unexpected fetal distress. If there is evidence that the baby might be getting into trouble, it will be necessary to get out of the pool to allow for closer, usually continuous, electronic monitoring of the baby’s heartbeat.
As you can see, if the water birth process was taking place at home, any of the above developments will necessitate transfer to a hospital. This is why it is essential that this back-up arrangement is feasible and efficient. In the UK, regulatory bodies do not allow a midwife to assist a home birth (water or otherwise) if such arrangements are not in place.
Preparing for a water birth
If the water birth is to take place in one’s home, preparations should be in place and ready for the big day well in advance. When the labour starts, the expectant mother should take a shower to get ready for getting into the birthing pool.
In hospitals, it is advised that the rectum is empty and for this a gentle enema may be administered.
It is important to ensure the temperature of the water is right; neither too hot nor too cold. When the water is too hot, it will quickly cause exhaustion. If it is just lukewarm, it will soon feel uncomfortable, thereby depriving the woman the most important advantage of the water; the soothing effect. Purpose-built pools in hospitals and those available for hire do not have this problem since the water temperature is thermostatically controlled in a narrow ideal temperature range.
Delivering in water
Women have different views about whether the birth itself should take place in water or whether one should come out of the pool for this. This should always be individualised according to one’s circumstances and preference. When the birth takes place in water, the person assisting will deliver the baby and hand him/her over to the mother. One aspect of this stage that many ask about is whether the baby can be left submerged in water after it comes out. In fact this should not be a cause for concern. If the water is maintained in the ideal temperature, which is very close to the mother’s body temperature, there is no risk of the baby gasping or inhaling water into his/her lungs (as demonstrated in the video below). The placenta will still be supplying the baby all the oxygen he/she needs and therefore, the breathing reflex will not be activated. Once the umbilical cord is clamped, the baby‘s head should be out of the water as the baby will start breathing. Also, even if the cord is left unclamped, it is important not to keep the baby submerged for too long as the placenta may start separating from its base thereby depriving the baby his/her source of oxygen. This is rarely an issue.
There is no question that many women find water birth to be the perfect option for them, enriching the experience of the birth. If there are no identifiable potential problems and the pregnancy is regarded as low risk, water birth, in hospital or at home, could turn out to be a magical profound experience, not only for the mother but for the rest of the family too.