Know-how: Waterbirth

If you give birth underwater your baby will be quickly brought to the surface after being born and usually placed on your chest as he draws his first breaths.

Once your baby is born you may be allowed to remain in the pool for delivery of the placenta or you may be asked to leave the pool, depending on hospital policy or your midwife's reading of the situation.

How is waterbirth and labouring in water beneficial, and is it safe?
As the use of water for labour and birth is a relatively new phenomenom in western societies, there aren't that many scientific studies on its benefits and risks: common sense and anecdotal evidence weigh in most heavily in its support. However, there is enough supporting evidence of the benefits of labouring in water that the UK's Department of Health has recommended that it be an option available to expectant mums since 1993.

Just as people use a warm bath to generally ease aches and pains and help relax and unwind their bodies, labouring in water can help to ease the pain of contractions and relax a mother's body, reducing the tension that can slow down dilation. Water also supports a pregnant woman's weight, making it easier for her to move around and change position to whatever is most comfortable at different times during labour.

For birth itself the supportive nature of the water can help channel your energies into pushing as well as supporting you in the position that you find most suitable, even if that is fully upright. Being in the water will take the edge off the stinging sensation when your baby's head crowns and provides lubrication, helping your perineal tissue to stretch.

For the baby, it is thought that being born into water provides a more gentle introduction to the world as they move from the womb to the familiar wet environment of the water, rather than into the cold air and bright lights of the delivery room. Research has shown that babies born into water cry less than those born on land, although they may still need to cry to expand their lungs.

There's no need to worry about the baby inhaling the water, as your baby is born with a reflex, the dive reflex, which suppresses the urge to breathe until the baby is brought into the air.

What about the possibility of infection?
Available research has shown that babies born in water are no more likely to be at risk or infection than babies born on land. If you are labouring in a hospital pool then the pool will have been thoroughly cleansed and sterilised between uses. If you are labouring at home then you and your partner will be responsible for ensuring that the pool is sterile before use - birthing pools to buy or hire will come with instructions and sometimes equipment to help you sterilise the pool.

To protect you from the transmission of aids and hepatitis, midwives assisting at waterbirths wear long gloves and will make sure that they have no cuts or grazes before assisting. It might be advised that you yourself have an HIV test before a waterbirth.

When can I use water for labour and birth?
In a normal, low-risk pregnancy many women will be able to take advantage of labouring in water if the option is available. In the absence of national guidelines, individual hospitals and birthing centres have created their own protocols for deciding when it is suitable to labour and birth in water. In some cases you may be allowed to labour in water but then be asked to leave the pool for the actual birth. This may be the case if:

• It is a multiple pregnancy
• You are suffering mild pre-eclampsia
• The baby is in breech position
• The midwife and/or doctors are concerned about how your labour is progressing, or have concerns about how either of you are doing
• If you have had a previous c-section birth
• If you have had a bad tear with a previous birth
• If you want to receive certain pain-relieving drugs that cannot be given in a birthing pool

In some cases it may not be considered suitable for you to labour in water at all. These include:

• When the baby has already shown signs of distress
• When labour is premature
• When labour is induced
• If more than 24 hours have passed since your waters broke
• If you have had recent bleeding
• If you have already received any drugs with a sedative effect (such as pethidine and tranquilizers)
• If you are suffering from pre-eclampsia

Advantages

• Water can provide wonderful pain relief. Some women may feel the effect as soon as they enter the pool while others may find it takes fifteen to twenty minutes for them to feel the difference
• Warm water usually relaxes your body and soothes your anxieties
• As the water reduces your body's stresses and anxieties it promotes the release of your body's natural pain-relieving hormones
• The relaxation of your muscles and lessening of tensions leaves your body more energy to direct into labour itself
• In many birthing pool rooms of hospitals you will have the option of setting the atmosphere with music, aromatherapy and varied lighting to enhance the relaxing effect of the water
• The water offers a supportive environment of buoyancy, sparing your energy and allowing you maintain positions and move between them more comfortably
• You are more likely to be able to give birth in an upright position if labouring in water, which increases efficiency and so may speed up delivery time
• Many women find that labouring in water increases their sense of control over their labour
• Labouring in water may reduce the likelihood of you needing medicinal pain killers
• Labouring in water reduces the likelihood of interventions such as episiotomies and c-sections
• One universal protocol is that women labouring in water should have a midwife present at all times, so you won't be left alone by your midwife as you might be with labour on land
• Giving birth in water may provide a calmer and more reassuring welcome for your baby as he moves from your womb to the familiarity of warm water

Disadvantages

• Waterbirth isn't for everyone: You may find water is more off-putting than reassuring
• You may find it embarrassing or upsetting to see by-products of labour and birth floating to the top of the pool and being removed. If you can't stand the thought of bits of mucus and faeces being netted up from the pool by the midwife or your partner they you're unlikely to be comfortable
• If you become too attached to the idea of a waterbirth then it may be upsetting and demoralising if it doesn't work for you and you need to leave the pool for drugs or intervention of some kind
• Research shows a slightly higher incidence of snapped umbilical chords after babies are born in water. This should not pose a serious problem for your trained midwife however, and it is thought that the small chances of this happening can be further reduced by the midwife taking care not to pull on the chord as the baby is delivered into its mother's arms

Availability
Given the huge increase in interest in waterbirths over the last two decades it is now very common to find birthing pools available in hospitals. However, if you're keen to have a waterbirth and want a hospital or birthing centre delivery then you should check a couple of key points with the staff first. First of all find out how many birthing pools are available to share between how many patients - you may be able to get an answer to asking what the likelihood is of a pool being available if you want to use one. Next check the number of available staff who are trained in waterbirth, it might be that not all the midwives have experience of waterbirth and that there isn't always a trained member of staff available. It's also a good idea to check what the centre's protocols relating to waterbirth are.

If you plan to have a waterbirth at home then you'll need to be sure to have a midwife happy with assisting. While at home you can be sure that there is always a birthing pool available, your midwife will still be subject to protocols governing waterbirth, so it's a good idea to check what these are. For a home waterbirth you can hire birthing pools, although given that you won't know when exactly your little one will be arriving you might find it makes more sense to buy a pool - there are several reputable retailers - and you can always use it as a paddling pool for the children later.

If you do have your heart set on a waterbirth then try to keep an open mind about it and not be too fixed on the idea. Bear in mind that circumstances might change or your labour might progress in a way that makes other birthing options better for you.