Waterbirth Myths and Realities

Lois Wattis, RN, RM, IPM, FACM, IBCLC

Waterbirth Myths and Realities
A true story
A pregnant woman who attended a major hospital for antenatal care and a
booking-in visit was told by a senior consultant obstetrician that she must abandon
her plan to birth in water because her baby would drown. Although the woman
knew the obstetricians advice was nonsensical, she found his assertion confronting
and confusing and discussed the comment with her midwife caregiver the next day.
he woman was reassured that labour and birth in water is perfectly safe, and
provides many benefits for herself and her baby when conducted by attendants
skilled in supporting normal labour and birth in water. !hether the obstetrician
was ignorant of the truth or deliberately misinforming the woman is unsure, but in
giving this "advice he perpetuated the most common myth associated with birth in
water.
No, babies do not drown if they are born underwater. They live in a watery
environent until labour heralds their transition fro the uterus to the air!filled world
outside. The stiulus to breath at birth o""urs when the baby is e#$osed to air, $lus
the draati" "han%e of te$erature, noise and li%ht.
&urin% a waterbirth this o""urs when the baby is lifted u$ out of the water. 'is
ubili"al "ord, his lifeline, "ontinues to $rovide o#y%enated blood while he res$onds
to the new stiuli and fills his lun%s with air for the first tie. (iultaneously his
heart fun"tion "onverts to in"lude the o#y%enated blood $rovided by his lun%s, no
lon%er solely relyin% on the $la"enta. &elayin% "la$in% and "uttin% of the ubili"al
"ord is very benefi"ial to baby)s transition to life outside the uterus. If allowed the
ubili"al "ord ay "ontinue to $ulsate for soe tie, $rovidin% baby with his full
*uota of blood volue via the $la"enta, a#iisin% $erfusion of his newly
fun"tionin% lun% tissues and su$$ortin% his transition, unhurried, into his new world.
How does water help the woman during labour?
The benefit of usin% water to redu"e the $ain of "hildbirth is well established
and a""e$ted, and the use of a shower or hot wet towels for $ain relief is "oon
$ra"tise in ost "are settin%s. +hen iersed in dee$ war water the buoyan"y
enables a woan to ove ore easily than on land, allowin% freedo to anouver
and wor, with her "ontra"tions assistin% the des"ent of the baby. Iersion redu"es
o$$osition to %ravity, $rovidin% ease of oveent and "onservation of ener%y.
The "ofortin% water environent $rootes dee$er rela#ation allowin% the
woan)s horones to res$ond a$$ro$riately, fa"ilitatin% endor$hin release and
effi"ient $ro%ress of labour, in"ludin% rela#ation of the $elvi" floor. This alleviates
$ain and o$tiises the $ro%ress of her labour.
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Waterbirth Myths and Realities
Lois Wattis, RN, RM, IPM, FACM, IBCLC
+oen who wish to labour and.or birth while iersed in dee$ war water
,now it is a si$le way of assistin% the to "o$e without the use of stron% dru%s. A
redu"tion in the use of $ain relievin% dru%s not only benefits the other who is ore
alert and res$onsive after the birth, but the baby will also benefit "onsiderably.
+oen also ,now that labour in water in"reases their "han"es of %ivin% birth
naturally and norally with a iniu of interferen"e or edi"al intervention. A
$ros$e"tive observational study in (wit/erland in -000 found waterbirths had the
lowest rate of anal%esia use, the lowest e$isiotoy rate and lowest in"iden"e of 1
rd
and 2
th
de%ree tears, as well as the lowest aternal blood loss.
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The birthin% $ool
$rovides an environent whi"h enhan"es a woan)s sense of $riva"y 4 a /one whi"h
is her own 4 $ereated only by those entrusted and $eritted by the labourin%
woan. This ay be $arti"ularly i$ortant to woen who have been sub5e"ted to
se#ual abuse in the $ast.
What about the babys wellbeing?
Iersion in water durin% labour redu"es $ressure on the woan)s
abdoen, and buoyan"y $rootes ore effi"ient uterine "ontra"tions and better blood
"ir"ulation. This results in better blood "ir"ulation and o#y%enation of the uterine
us"les, and ore o#y%en for the baby durin% labour. The (wiss study also found
babies born in the water had the lowest rate of neonatal infe"tion, and the avera%e
A$%ar s"ore at 6 inutes was si%nifi"antly hi%her after waterbirths.
7ther waterbirth studies failed to dete"t differen"es in the in"iden"e of
neonatal orbidity or ortality between water and land birth and found fewer babies
ado$ted defle#ed $ositions durin% the first sta%e of labour when their other)s used
water iersion for $ain relief.
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+ater born babies are ty$i"ally rela#ed and alert at
birth as their others have not re*uired dru%s durin% labour. 7ne study has
deonstrated that babies whose others had e$idural anaesthesia were still showin%
adverse effe"ts of the dru% u$ to si# wee,s later.
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What about after the birth?
+ater offers a labourin% woan an environent where she "an behave
instin"tively and feel in "ontrol. +hen a woan feels in "ontrol durin% "hildbirth, she
e#$erien"es a hi%her de%ree of eotional well!bein% $ostnatally.
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Many studies have
"onfired that woen who %ive birth in the water have a ost satisfyin% birth
e#$erien"e.
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Common misconceptions about labour in water
My waters were broken so it wasnt safe for me to labour in the water
No studies have indi"ated any in"reased ris, asso"iation between ru$tured
ebranes and water iersion in labour. If the ebranes have been ru$tured
lon%er than -9 hours the ris, of infe"tion in"reases whether the woan is labourin% in
or out of water. Most "are%ivers will re"oend intravenous antibioti" treatent if
this situation o""urs, and all other fa"tors relatin% to the wellbein% of other and baby
will be ta,en into a""ount when de"idin% whether it is a$$ro$riate to "ontinue to
labour in the water if desired. If everythin% is noral it is safe to "ontinue to labour
in the water.

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Waterbirth Myths and Realities
Lois Wattis, RN, RM, IPM, FACM, IBCLC
I got into the pool too early and my labour stopped.
It)s *uite li,ely that this woan was not in established labour. +ater
iersion durin% the very early latent $hase of labour will soeties rela# the
woan si%nifi"antly and "onse*uently her uterine a"tivity ay also redu"e. +ater
iersion "an $rovide a very useful and safe reedy if the woan)s $relabour
uterine a"tivity is "ausin% dis"ofort and fati%ue, and ay allow her to "at"h u$ on
soe slee$ $rior to labour establishin%.
So when is the best time to get into the water?
It)s best to use alternatives to iersion in the $ool durin% early labour, su"h
as tryin% different $hysi"al $ositions and obilisation, assa%e, sittin% or standin% in
the shower. +hen these alternatives are no lon%er hel$ful at all it)s $robably tie to
%et into the water. (oe "are%ivers will want to "onfir that the "ervi# dilation is
2" or ore, while others will avoid unne"essary va%inal e#ainations and be %uided
by the woan)s inter$retation of her needs and visible si%ns of labour $ro%ression.
When should I leave the water?
If the $ro%ress of the labour is very slow or stalls it is often hel$ful to leave the
birth $ool and obilise, ta,e soe food and fluids and return to the $ool if desired
when the "ontra"tions in"rease in stren%th and fre*uen"y. The woan should %et out
of the $ool to $ass urine, or a bowl or bu",et $la"ed under her as she stands in the
$ool to urinate. The woan ay be as,ed to leave the $ool for va%inal e#ainations
to be $erfored althou%h this is not absolutely ne"essary.
If the $ro%ress of the labour deviates fro noral the woan ay be as,ed to
leave the water. Probles with the baby)s heart rate, either very slow or very fast
ay indi"ate baby is havin% diffi"ulties and "loser onitorin% out of the water ay be
indi"ated. Me"oniu!stained li*uor :"aused by baby)s bowel a"tion in the anioti"
fluid; durin% labour ay be an indi"ation to "ontinue the labour out of the $ool. If
e"oniu is $resent but undete"ted it ay be seen floatin% out of the baby)s nose,
outh or ears as the baby is born into the water.
It is "oon for the baby)s heart rate to slow sli%htly durin% the $ushin%
$hase of the labour due to "o$ression of the baby)s head in the va%ina. Provided the
des"ent of the baby $ro%resses norally this is not usually suffi"ient "on"ern to
warrant leavin% the water. Many "are%ivers want the third sta%e of labour to be
"o$leted out of the bath so that blood loss "an be "arefully onitored. (oeties
the $la"enta is born soon after the baby. If this o""urs in the water it is not a $roble.
If the woan)s te$erature be"oes elevated it ay be advisable for her to
stand for a while, or leave the $ool to allow her body to "ool. The baby)s te$erature
is -de%ree hi%her than the other)s easured e#ternal te$erature, and $rolon%ed
te$erature elevation ay be harful to the baby. If a $roble o""urs durin% the
e#$ulsion of the baby :dysto"ia; the woan ay be as,ed to stand to assist delivery
of the baby.
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Waterbirth Myths and Realities
Lois Wattis, RN, RM, IPM, FACM, IBCLC
General guidelines for labour and birth in water
It is i$ortant for the woan to be well hydrated durin% labour whether she is
in or out of the water, and to $ass urine fre*uently. It is not advisable to add salt or
essential oils to the water. The woan should be free to leave the bath if desired, and
birth $lans should allow for fle#ibility as well as definition of the woan)s wishes for
the birth.
The baby ust be born either fully suber%ed or fully out of the water, and it
is i$ortant for the woan to understand this is her "hoi"e at the tie of birth. (,in
to s,in "onta"t is fundaental to the birth and bondin% e#$erien"e as well as
$rovidin% warth and "ofort to the newborn. &ryin% the baby)s fa"e and head and
a$$lyin% a hat will also assist in ,ee$in% baby war. +arth and an undisturbed
environent iediately followin% the birth are essential for the woan)s
$hysiolo%i"al fun"tionin% to safely "o$lete the third sta%e of the labour.
<

!e believe that waterbirth will lose its "outsider status and will, in the next
few years, take up a fixed place in obstetrics. #t leads to minimal intervention
and is a woman-friendly method and thus results in higher satisfaction of the
mother. $ hni % &ussner, 'euters (ealth, )erlin **+,+-./
References
-. Burns, =, >it/in%er, ( :3??-; Midwifery %uidelines for use of water in
labour. 7#ford "entre for health "are resear"h and develo$ent,
7#ford Broo,es @niversity
3. =berhard, A B Ceissbuehler, D :-000; Influen"e of alternative birth
ethods on traditional birth ana%eent, "ited in Burns ==. 3??2.
1. Burns, == :3??2; +aterE what are we afraid ofF Pra"tisin% Midwife,
<E-?, $$-<!-0
2. Rosenblatt &B, et al :-09-; The influen"e of aternal anal%esia on
neonatal behaviourE II e$idural bu$iva"aine, BrA7bCyn, 99E2?<!-1
6. Creen, AM, Cou$land, DA, and >it/in%er, AA.D :-00?; =#$e"tations,
e#$erien"es and $hysiolo%i"al out"oes of "hildbirthE A $ros$e"tive
study of 936 woen. Birth. -<E- $$-6!36
8. (ee 3
0. +attis, LA :3??-; The third sta%e a/e 4 +hi"h $ra"ti"e $athway for
o$tiu out"oesF The Pra"tisin% Midwife. 2E2 $$36!3<.
For further inforationE
AIM( $ubli"ation Ghoosing a Water !irthH by Beverley A Lawren"e Bee"h.
The National Childbirth boo,let G"abour and !irth in Water # $ow and
Why %ou Might &se Water available fro www.n"ts."o.u,
www.yourwaterbirth."o $rovides a "o$rehensive list of lin, sites
For s$e"ifi" %uidelines for idwives interested in "ondu"tin% waterbirths, I re"oend
! (tandard -?!1 GLabour and Birth in +aterH 3??3, fro +oen)s and Children)s 'os$ital,
Adelaide, (outh Australia
! Covt.of (A 4 &e$t of 'ealth P7LICI 4 BIRT' IN +AT=R $df www.health.sa.%ov.au

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