Water Birth - Birth and Beyond

Introduction:

Among the natural birthing techniques, water birth has gained recognition over the last several decades. Water births are usually practiced in birthing centers, but some hospitals do offer water births. Though it helps in relaxation and eases discomfort during labor, the American College of Obstetricians and Gynecologists (ACOG) does not recommend immersion in water beyond the first stage of labor due to its potential risks and safety concerns.

What Does Water Birth Mean?

Water birth is a natural birthing process that takes place in a birth pool or a deep bath filled with warm water. A water birth takes place in a birthing center, a hospital, or at home, depending on the patient’s preference. Birthing centers are hospital-like facilities that offer natural birthing options for delivering a baby. Throughout the birthing process, a doctor, a nurse, or a midwife guides the patient. Some women may labor in the water and choose to get out of the water to deliver the baby, while some women choose to stay in the water for delivery. A birthing pool helps ease the pain and discomfort, shortens the labor, and helps avoid the need for anesthesia. Women find it relaxing while floating in a tub of warm water during labor. However, ACOG guidelines recommend that water birth may provide benefits during the first stages of labor but delivering underwater should not be considered due to its procedural risks.

What Are the Benefits Associated With Water Births?

Immersion in water during the first stage of labor helps shorten the duration of labor. It also offers pain relief and helps decrease the need for spinal or epidural anesthesia for pain relief. Studies have shown that the cesarean section rate is reduced in women who birth by water, and they also experience birth satisfaction. It also includes the following benefits:

• Women experience comfort and relaxation while floating in the water.

• The effect of buoyancy lessens the pain during contractions.

• Birth pool lowers blood pressure due to anxiety and also reduces stress.

• Water relaxes the perineum (area between the anus and the vulva) and reduces the need for episiotomy (a surgical cut that is made to widen the vagina during the process of birthing).

• It also offers benefits for the baby, such as providing an environment similar to the amniotic sac and increasing the sense of security by easing birth stress.

What Are the Risks Associated With Water Birth?

Though water birth has gained popularity over the years, very little research has been done regarding the risks associated with it. Some studies have shown that mortality rates (death rates) are similar between conventional births and water births. Research has shown that water birth may increase the risk of a water embolism (blocking of an artery by a water bubble) when water enters the mother's bloodstream. It can also pose the risk of water aspiration when the baby enters the water and breathes. Other risks include

• Babies may acquire infections.

• Risk of umbilical cord damage.

• Chance of respiratory distress in the baby.

• Asphyxia (a condition in which the baby finds it difficult to breathe and may become unconscious or dead).

• Seizures (sudden uncontrolled movements due to changes in the electrical activity in the brain).

Who Is Eligible for a Water Birth?

According to ACOG, water birth is recommended for pregnant women between 37 and 41 weeks, six days of gestation. It is performed if it is a healthy and low-risk pregnancy, the labor is progressing normally without any complications, the amniotic fluid is clear, and the baby is in a head-down position.

What Are the Contraindications for a Water Birth?

Water births are not recommended for preterm labor and if the mother has had two or more cesarean section deliveries previously. It is also not recommended if the following conditions are not present:

• Blood or skin infections in the mother.

• Presence of fever in the mother.

• Presence of herpes infection.

• Excessive bleeding.

• Difficulties in tracing the heartbeat of the fetus.

• The presence of shoulder dystocia (a condition in which the baby’s shoulders become stuck during labor as the baby’s head passes through the vagina).

• Breech position of the baby, in which the feet come out first. However, water births may be recommended for some cases with breach presentations.

• Twin pregnancies. Water births may not be recommended in some cases with twin or multiple pregnancies.

• Water birth is not recommended for preterm labor (two or more weeks prior to the estimated date of delivery).

• It is not recommended if excessive meconium (first stool of the baby) is present. However, mild to moderate meconium does not pose any problem.

• It is not recommended in mothers with preeclampsia (a condition characterized by increased blood pressure and protein levels in the urine during pregnancy).

How Is Water Birth Performed?

A water birth happens in a birth pool or an inflatable tub filled with warm water. It can be performed in a birthing center, hospital, or at home. It happens under the guidance of a doctor, nurse, or midwife. A birth pool can be used only during the first stage of labor or throughout the labor till the birth of the fetus, depending on the recommendations of the healthcare provider. The mother is asked to sit and relax in the birth pooling during the first stage of labor. The first stage refers to the onset of contractions until the complete dilation of the cervix. A birth pool helps ease pain, shorten the labor, and also helps avoid anesthesia during the first stage of labor. The mother feels relaxed and comfortable while floating in the birth pool, and it also reduces the risk of severe vaginal tearing.

The mother is asked to exit the birth pool during the second stage of labor, which is when the cervix is completely dilated. It is recommended to exit the tub for delivery to avoid the risk of complications for the baby. Though birthing in the water may be recommended in some cases, ACOG guidelines do not recommend it due to the procedural risks and risk of complications such as birth asphyxia and respiratory distress in the baby.

Conclusion

Water birth is a natural birthing technique that is preferred by many women around the world. It has gained recognition over the last several decades. It helps ease pain during labor and offers birth satisfaction for the mother. The benefits and risks of this birthing process can be discussed with the healthcare provider before opting for this procedure.