In this article, Brenda Manning MIPP (Midwife in Private Practice), addresses numerous questions surrounding waterbirths, such as:

Choosing a tub Water The Birthing Room What to Eat & Drink When to Get Into the Tub Birth positions How long should the baby stay under water? How does the baby breathe? Brenda also discusses the benefits of water for labour and/or birth, some of which being greater comfort and mobility, helping the mother to conserve her energy, promoting deeper relaxation and the minimisation of pain by water.

First prepare your mind

(This encompasses the issue of informed consent).

Examine your own motivations, incentives and expectations for wanting a waterbirth. Ask yourself what made you decide to have a waterbirth and why is it something you are doing for yourself or are you doing it because someone else expects you to? Remain flexible and let go of your expectations that you must birth your baby in any certain way. Examine how you might feel if your baby is not born in water. Get in touch with your own fears. Most importantly, develop and trust your own intuition.

Choosing a tub

The tub should be big enough to sit in comfortably and deep enough for the water to come up to armpit level, so as to get an adequate degree of buoyancy. For actual birthing the water needs only to come to below the woman’s breasts. This is so the baby can go to the breast as soon as  s/he is born & if the water is too deep there is a danger of a short umbilical cord snapping as the mother tries to get the baby’s head clear of the water.

Make sure that your tap adaptor fits the outlet you will be using. Clean the tub with a non-abrasive cleaner, then use 10% solution of bleach and rinse thoroughly.

Consider purchasing 2 hoses, of different colours, one for filling and one for emptying the water. Remember that the water rises by 3 to 4 cms for each person who enters the tub and allow for this as you are filling it. Fill the tub to 30cms from the top, and then add more water as necessary to avoid spilling over. Do a test run by timing how long it takes to fill the tub so that you already know this when your labour starts. Depending on how quickly you are progressing and how rapidly the tub fills, you may want to start filling the tub when labour begins.

Water

The water should be clean: if it is pure enough to drink, it is pure enough to give birth in. You don’t need additives but a cup of salt per tub will prevent your skin becoming wrinkly & waterlogged. Don’t add any essential oils if you are planning to birth in the tub unless you dilute them in 10mls of milk first.

The water temperature ought to be within 35C – 38C, depending on your preference. Adjust the temperature to your comfort. If the water is too cold, you will lose body heat trying to keep warm, you will become tense and if you are  shivering it is thought that cold women don’ t birth their placentas as well.

If the water is too hot you will feel drowsy, overheated, become dehydrated and as it dilates all your blood vessels. Your blood pressure will drop which can make you feel faint and you will have a greater tendency to bleed after the birth. If you just want localised heat, say on your back; use wet, hot nappies or hot packs whilst kneeling in the water. Use a cold washer if needed on your face, have a fan blow on you (turn it off for the birth) and suck ice.

The Birthing Room

The floor should be strong enough to support the weight of the tub when full. The room should be large enough allow access from all sides. Heat the room to personal comfort ,  have heated towels and blankets for mother and baby ready.

What to Eat & Drink

Drink to thirst. Ask your partner to remind you to drink at least 300mls of water every couple of hours to avoid dehydration, which can result in fatigue and a poorly functioning uterus. Eating and drinking during labour has been shown to reduce the total length of labour by as much as 90 minutes. Eat light, easily digested food.

When to Get Into the Tub

Wait until you have a strong desire to be in the water. It is best to wait until your contractions are strongly established. Some recommend waiting until you are at least 5cms dilated, since you want to save the pain relieving effect for the time you need it most, and for transition. If labour slows down when you are outside the water, try getting into the tub as this might stimulate labour. If your progress slows down whilst you are in the tub, get out, empty your bladder and move around to stimulate labour. Often it is the CHANGE of environment that gets labour moving again.

What about debris?

Use a sieve to remove any old clots, mucous, faeces or vomit from the water as soon as possible. But don’t spend lots of energy worrying about this. Remember that the solution to pollution is dilution!

Birth positions

Experiment with a variety of different positions while in the tub. Try kneeling, squatting, leaning, sitting or lying outstretched (face up or down. Use a snorkel if you like your face to be immersed). Some women prefer their partner to be in the tub with them to hold onto and act as an anchor, others prefer to be in the tub alone. If required, folded towels, waterproof inflatable cushions or a rubber bath mat on the bottom of the tub to cushion your knees.

How long should the baby stay under water?

Discuss with your birth attendants ahead of time. Many people feel comfortable with the time that it takes the mother to reach down and pick the baby up herself (called rapid immersion). Any longer than that is not necessary. Remember that the great benefits of water are achieved as soon as the infant is born into the warm water.

How does the baby breathe?

The baby doesn’t breathe until after its face leaves the water and its skin comes into contact with the air or it is stimulated. Until then, the baby receives oxygen through its umbilical cord, as it has done during the 9 months of pregnancy. Sometimes the babies are so calm at birth it can appear that they aren’t breathing at all but they just aren’t crying. Their heartbeat will be normal and when you gently rub their back, blow on their face or open their mouth with your finger they will gasp.

What about the placenta?

Some people choose to stay in the tub after the birth and bond with the baby. They should birth their placentas out of the water due to the “theoretical” risk of a water embolism. This ought to be discussed with your birth attendant ahead of time. If the placenta is slow to come, get out of the tub, put a bowl in the toilet and the placenta will likely come out easily into the bowl whilst you are sitting there with a warm blanket or towel around you.

Will the mother get an infection from the water?

Dr Michael Rosenthal reports that there have been no incidences of infection in close to 1000 births that he has attended. “I’ve certainly never seen one in the thousands I have attended”. This may be due to the fact that in labour and birth the action is all moving down and out, not up and in. The concentration of bacteria in and around the vagina is well diluted by the water.

Will my birth attendants get any infection I have from the water?

The infectious diseases we mostly concern ourselves with as birth attendants are Hepatitis A, B, C and HIV. The sheer volume of water these viruses are diluted in at a birth would render them negligible; no one has ever caught these from a waterbirth that we know of. It would take a much more highly concentrated volume of blood to The infectious diseases we mostly concern ourselves with as birth attendants are Hepatitis A, B, C and HIV. The sheer volume of water these viruses are diluted in at a birth would render them negligible; no one has ever caught these from a waterbirth that we know of. It would take a much more highly concentrated volume of blood to seroconvert for the average well person with good skin integrity. Even so, open abrasions or cuts should not be immersed unless well covered with waterproof dressing (for both your sakes) and long veterinary gloves can be worn by accouchers if they feel they need protection (Daniels, 1986; Lichy, 1993; Harper, 1994)

The benefits of water for labour and/or birth

• Greater comfort and mobility. The mother has much greater ease and freedom to move spontaneously and to change position to aid in descent of the baby.
• Reduction of pressure on the abdomen. Buoyancy promotes more efficient uterine contractions and better blood circulation, resulting in better oxygenation of the uterine muscles, less pain for the mother and more oxygen for the baby.
• Helps mother to conserve her energy. Immersion reduces opposition to gravity; supporting the mothers weight so that her energy can be used to cope with the contractions
• Promotes deeper relaxation. As a woman relaxes deeply in water, her hormones are released and she starts progressing faster with more rhythm: labour becomes more efficient.
• Water relaxes the pelvic Floor muscles, as it softens the vagina, vulva and perineum leading to fewer injuries to these tissues.
• Water minimises the pain so effectively for most women that it reduces or eliminates the need for analgesia.
• If analgesia is required it is in lower doses and is potentiated by the effect of the water.
• Immersion is more safe and effective than an epidural.
• Water stimulates the touch and temperature nerve fibres in the skin. It blocks impulses from the pain fibres, known as the “Gate Theory of Pain”.
• Facilitates a dysfunctional labour. Water can be an effective way to stimulate dilation of the cervix when the mother has difficulty progressing into the active stage of labour.
• Water can reduce the need for drugs to artificially stimulate labour. Often, simply getting into the tub will result in dramatic and rapid progress to full dilation within an hour or two.
• Lowering of blood pressure. When anxiety is causing high blood pressure, immersion in water often helps relieve it. The effect is heightened if the room is darkened.
• Change of consciousness. Immersion helps relive anxiety and promote relaxation. Water encourages women to let go and focus inward as labour progresses
• Easier breathing. Moisture in the air makes it easier to breathe without the mouth becoming dry and is helpful for women with asthma. Also decreases the tendency to hyperventilate.
• Facilitates the second stage of labour. Many women are less inhibited in the water.
• Many women experience rapid second stages, with the baby emerging minutes after the body begins pushing, also known as the foetus ejection reflex. (see Odent, The Nature of Birth and Breastfeeding)
• It reduces the “ick” factor for some women and encourages both parents to touch the baby whilst birthing
• Being in the tub reduces the possibility of intervention by birth attendants. Their visibility is reduced and they cannot touch the perineum or baby as it emerges unless the mother chooses to let them.
• The ability for birth attendants to intrude is reduced. They are less likely to interfere with the actual birthing without the woman’s consent & willingness to move and allow access.
• Skin to skin time is facilitated.
• Initial breast contact is also easier to initiate as the woman is already naked.
• The cord continues to pulse strongly for an extended period resulting in baby receiving his full blood volume.
• Birth in water is wholly a somehow softer, more gentle experience.

Resources: Daniels, 1986; Balaskas, 1990; Lichy, 1993: Napierala, 1994
Originally published at: http://www.bellybelly.com.au/articles/birth/preparing-for-a-waterbirth