Painful water birth

Benefits and Risks of Water Birth

Written by Shahreen Abedin

Reviewed by Nivin Todd, MD on September 11, 2022

The American College of Obstetricians and Gynecologists (ACOG), which sets guidelines for pregnancy and childbirth care in the U. S., says a water birth during the first stage of labor may have some benefits but delivering your baby underwater should be considered an experimental procedure with risks. The first stage is from when contractions start until your cervix is fully dilated.

Studies show water birth during stage one doesn’t improve your or your baby’s medical outcome.

A warm bath might help you relax and help you feel more in control. Floating in water helps you move around more easily than in bed, too.

Some science suggests that the water may lower chances of severe vaginal tearing. And it may improve blood flow to the uterus. But study results about these points aren’t clear.

Stage Two of Labor: Time to Exit the Tub

Things change during the second part of labor. That’s when your cervix is completely dilated and open and you start pushing until the baby is born.

Many doctors say there isn’t enough information to decide how safe or useful water birth is during this period.

Being out of the water for the second part of your labor makes it easier to move fast in case something goes wrong, ACOG spokesman Aaron Caughey, MD, says.

“If you have to do an emergency C-section, it would be foolhardy to risk an extra 4 or 5 minutes to move you out of the water,” says Caughey, chairman of the obstetrics and gynecology department at Oregon Health and Science University.

Water Birth Risks

Here are some of the rare problems that could happen while water birthing:

You or your baby could get an infection.
The umbilical cord could snap before your baby comes out of the water.
Your baby’s body temperature could be too high or too low.
Your baby could breathe in bath water.
Your baby could have seizures or not be able to breathe.

“It’s important to emphasize the ‘rare’ part. But these are the sorts of outcomes that are severe, like drowning,” says Jeffrey Ecker, MD, who co-wrote the ACOG committee's opinion on water births.

Are You a Good Water Birth Candidate?

Some factors may keep you out of the running for a water birth. You shouldn’t try it if:

You’re younger than 17 or older than 35.
You have complications like preeclampsia or diabetes.
You’re having twins or multiples.
The baby is in the breech position.
The baby is premature.
You’re having a really big baby.
You need to be constantly monitored and it can’t be done in the tub.
You have an infection.

Water Birth Precautions to Take

If you’re thinking about a water birth, talk to your health care professional early in your pregnancy to find out if it’s a service the hospital provides. If so, who will manage your labor and delivery? A midwife can assist, but they will need backup from a physician

If it’s not done in a hospital near you, you may have to go to a birthing center or do it at home.

Regardless of where you decide to deliver, having a water birth means you should ask questions about how the labor and delivery are done. Things to look for:

You have an experienced, licensed health care professional with doctor backup to help you through the labor and delivery.
High standards are kept to ensure the tub is clean and well-maintained.
Proper infection control measures are in place.
You and your baby are being properly monitored while in the tub as required.
There’s a plan to get you out of the tub as soon your doctor, nurse, or midwife says it’s time.
The water temperature is well-regulated, usually between 97 to 100 F.
You drink water during the birth to avoid dehydration.

Getting into a warm bath too early might slow your labor.

Water Birth Costs

If your water birth is done in a hospital, it usually costs same as a vaginal birth if it’s covered by insurance. You may be required to rent the tub, which may be an extra $200 to $400.

If you buy your own tub or pool for a home birth, it can range between $65 to $500 depending on how fancy you go.

The fees for a midwife or nurse-midwife for a water birth at home will be the same as a normal birth, ranging from $2,000 to $6,000.

If you’re having your water birth at a hospital or birthing center, the midwife’s fee might be included in what you pay the facility, but usually only if they are employed by the hospital. Birthing centers charge between $3,00 and $4,000 per birth.

How to prepare for a water birth

What is a water birth?

Water birth is the process of giving birth in water using a deep bath or birthing pool. Being in water during labour is shown to help with pain as well as being more relaxing and soothing than being out of water. The water can help to support your weight, making it easier to move around and feel more in control during labour.

Can I have a water birth?

Having a water birth is an option for you if you have had a low risk pregnancy and your midwife or obstetric doctor believes it is safe for you and your baby. You can talk to them about it at any of your antenatal appointments.

You may not be able to have a water birth if:

your baby is breech
you are having twins or triplets
your baby is pre-term (under 37 weeks)
your baby has passed meconium before or during labour
you have active Herpes
you have pre-eclampsia
you have an infection
you have a high temperature in labour
you are bleeding
your baby needs continuous monitoring via CTG machine
your waters have been broken for over 24 hours
you have had a previous caesarean section
your labour is induced
you are at high risk of having birth difficulties.

You will probably be advised not to have a water birth if you have any of the risk factors above because it may be difficult to get you out of the pool safely in an emergency. If you have an infection, you may be at risk of passing it onto your baby in the water.

If you are at high risk of bleeding, being in the pool can be dangerous because it is difficult to measure how much blood has been lost in the water.

Ask your midwife if any of the above apply to you.

What are the advantages of water birth?

The warm water can help to relax, soothe and comfort you.
The support of the water means you can try different positions and move more freely.
When upright in the water, gravity will help move the baby down towards the birth canal.
Being in water can lower your blood pressure and reduce feelings of anxiety, making your body more able to release endorphins, which can help ease pain.
The water can help to improve back pain and the feeling of pressure, especially when you are fully dilated.
Being in the pool during labour and birth can be a “cosy” experience, making you feel safe.
The water can help your perineum stretch gradually as the baby’s head is being born, reducing the risk of injury.

'I was surprised by how warm it was in the water, and so nice and relaxing! They were able to check the baby’s heartbeat while I was inside the pool. I hadn’t eaten so they even made me some toast and my mum had to feed me while I was in the birth pool.' Jade (read her full story)

Are there any disadvantages of having a water birth?

You will not be able to have some pain-relief options. For example, you cannot have any opiates, such as pethidine, for at least six hours before you get into the pool, and you cannot have an epidural.
You will be unable to use a Tens machine.
Your contractions may slow down or get weaker, especially if you go in the pool too soon.
If the pool water is too cool at birth, your baby is at risk of hypothermia. But your midwife will check the water temperature regularly. If your baby’s temperature is low, skin to skin contact with you and warm towels will help.
You might need to leave the pool if there is a complication.

'When I had my water birth, I was in the pool from about 12.30pm until 3pm but unfortunately my contractions slowed down a bit, so I had to get out of the pool and finish off labour on the bed. 'Jade (read her full story)

Can my baby drown if I give birth in water?

Many women wonder whether there is a risk of their baby drowning if they give birth in water but it is very unlikely to happen.

Babies do not need to breathe when they are in the womb because they get oxygen from the blood that comes from their mum through the placenta. When they are born in water, their body behaves as if they are still in the womb until they take their first breath of air, at which point their lungs open up. As a baby comes from water (in the womb) into water (in the birth pool), the lungs are not open and no water can enter.

After your baby is born in the water, you and your midwife will bring them to the surface slowly. Your baby will only be under water for a short time and won’t take a breath until they are out of the water.

Your baby is only at risk:

if their head is brought above the water and brought down again
if their oxygen supply from the placenta is affected
if their temperature changes suddenly.

Your midwife will be careful to make sure this does not happen.

Where can I have a water birth?

At home, with a hired birthing pool
In a birth centre
On the labour ward.

Find out more about where you can give birth.

What should I wear for my water birth?

You can wear what feels comfortable for you, keeping in mind that you will be in what is essentially a large bath. Many women choose to wear a bikini or tankini. Others choose to just wear a bra. You can wear a t-shirt or vest top if you want to be a little more covered. It can be twisted up and tucked into the neck if it’s very long. Some women prefer to be naked.

Whatever you feel comfortable with wearing on your top half is fine.

It is best to take your bottom half off so that the midwife can see what is happening as you approach birth. However, if you wish to leave your pants on until that stage, that is fine too.

What other pain relief can I have in the water?

Water is sometimes referred to as ‘nature’s epidural’ or ‘aquadural’, because of the support and pressure it gives you. However, if you need a little extra, it is common to use gas and air (Entonox) while you are in the birth pool. The Entonox tubing is waterproof so this can be used in the pool too.

Find out more about pain relief during labour.

Can I have optimal / delayed cord clamping if I give birth in the water?

Delayed cord clamping (DCC) has become very normal. Most birth centres, labour wards and home birth teams will try to do DDC for every birth. This is because holding off from cutting the cord until the blood from the placenta has stopped going into your baby can increase your baby’s iron levels and the amount of stem cells they have, which will help with their growth and immune system. Although many centres practise DCC as normal, you can add this to your birth plan just in case your hospital does not.

The only reason DCC would not happen is if you or your baby are suddenly unwell just after birth. If the baby is slow to breathe, or you are bleeding more heavily than normal, the midwife may need to cut the cord earlier than usual.

Your and your baby’s safety during and after a water birth is very important and this will always take priority.

Find out more about delayed cord clamping.

How do I deliver the placenta if I have a water birth?

Your midwife is likely to ask you to get out of the pool to deliver the placenta because gravity can be helpful in the third stage of labour. It also makes it easier to help you in case of an emergency, as some new mums can feel faint after birth, or during the third stage of labour. If you do suddenly feel lightheaded, it may be difficult to get you out of the pool quickly and safely.

Most hospitals, birth centres and home birth teams have a policy on how the placenta should delivered, and most of these are on a bed, toilet, birth stool or floor mat for your safety. Please ask your midwife about this policy.

Find out more about the third stage of labour.

Can I have the injection to deliver the placenta more quickly?

You can be given an oxytocin injection to speed up the delivery of the placenta in the pool. Your thigh or bottom will need to be slightly raised out of the water for this to happen. You will then need to leave the pool within a few minutes to deliver the placenta.

When might I need to get out of the pool?

If the midwife sees meconium (when the baby does a poo whilst still inside).
If you start to bleed heavily from the vagina.
Your labour becomes abnormal, changes in your temperature or blood pressure for example.
If the baby’s heart rate changes.
To go to the toilet (you can leave and return).
For your midwife to examine you to check your progress.
If your labour slows down or if your contractions get weaker.
To deliver the placenta.

Can I change my mind about having a water birth?

Yes. Even if it is in your birth plan, if you decide you don’t want to get into the pool then you don’t have to.

If you get in the birth pool and don’t like it, you can get out again.

Do not be worried about changing your mind. Midwives are happy to support you as long as you and the baby are safe.

'I’m so glad I went for a water birth and would definitely recommend it! If I have another baby in a few years, which I hope to do, I'm really hoping the birthing pool is available for me to use again!' Jade (read her full story)

Water birth - advantages and disadvantages of the method in the maternity hospital, Moscow

Water birth is one of the alternative methods of childbirth, which is starting to gain popularity again. For the first time, this practice arose in the early 1980s, but then it began to decline. Now there is a lot of talk about natural childbirth in water with minimal medical intervention and that water helps. However, there is an opposite point of view: even mammals that live in water go to give birth on land.

Water birth and being in a bath in the first stage of labor to relieve contractions are two different things. In this article, we will touch on the topic of childbirth in water, when a child is born in a bath.

Water birth preparation

The first thing to do for a woman who decides to give birth in water is to consult a doctor. Childbirth in water is permissible only with an ideal pregnancy and the absolute health of the woman.

If there are no contraindications, it makes sense to attend childbirth preparation courses, where they will tell you in detail how to behave and what to expect from such childbirth. Especially if you're having your first water birth.

In addition, you need to choose a maternity hospital, where there are conditions for childbirth in the water. Water births in Moscow are available at the EMC maternity hospital on the street. Truth. We do not recommend giving birth in the bathroom at home. However, if you still decide to do this, consider the possibility of an ambulance on duty near the house. During childbirth, unforeseen situations may arise when the life and health of the mother and child may depend on the speed of providing qualified medical care. Take childbirth responsibly!

How is childbirth in water?

If a woman decides to give birth in water in a maternity hospital, then most often she spends all periods of childbirth in the bathroom. Water helps ease contractions. However, if desired, a woman can walk around the maternity ward, sit on a fitball, etc. If a woman is in the bath all the time, then the water is periodically changed so that it is clean. After the baby is born, it is laid out on the stomach, then pulled out of the water and the umbilical cord is cut after it stops pulsing. An experienced doctor or midwife clearly knows at what point you need to get the child out of the water so that water does not enter his lungs.

Benefits of water birth

Water makes it easier to endure pain, helps to relax the muscles of the whole body, and has a calming effect.
It is believed that the newborn experiences less stress at birth in the water.

Disadvantages of water birth

Childbirth is not the cleanest process. In the water in which the woman is located, amniotic fluid, blood discharge, and stool come out. And in the same water a child is born.
There is a risk of infection due to lack of sterility.
When a woman is in the water, there is no constant monitoring of the condition of the fetus (CTG), it can be difficult to quickly determine the onset of bleeding, as well as control the condition of the cervix.
There is a risk of aspiration (water entering the lungs) of the newborn. Some babies inhale immediately after birth, until the moment they are taken out of the water.

When is water birth impossible?

For any complications of pregnancy, such as preeclampsia, fetal hypoxia, breech presentation of the fetus, clinically narrow pelvis and large fetus, placenta previa, diseases of the cardiovascular system in the mother and other complications that the doctor will tell you about.

Water birth at EMC maternity hospital

The EMC maternity hospital has created conditions for any childbirth. The birthing ward has a comfortable bathtub for water births or relief of contractions in the first period.

Before giving birth, the doctor, together with the expectant mother, draws up a plan for childbirth, which takes into account all the wishes of the woman. If there are contraindications for a particular method of delivery, the doctor talks in detail about all the risks and ways to prevent them. If a woman is aware of all the shortcomings and risks, there are no medical contraindications, the doctor can take birth in the water. The price of the contract will not change from this. In the event of an unforeseen situation and danger to the mother and fetus, doctors can immediately change tactics, and even perform a caesarean section directly in the maternity ward - there is all the necessary equipment for this.

Is water birth dangerous?

Water birth ㅡ is when a woman is in a bath of warm water both during labor and at the time of childbirth. During childbirth, their own rules apply: when and how long you can stay in the bath, the doctor and the mother decide. This service is not available in all hospitals.

Many women say that childbirth is the most painful moment in their lives. Therefore, the option to give birth in water looks attractive, because many people associate water with relaxation, rest and positive emotions.

Let's face it: water births are not well understood. There is no convincing evidence of their safety. In addition, little is known about the long-term condition of women and children after childbirth.

Maternal

Less Pain

Studies show that warm water during childbirth is safe for mother and baby. Water relieves the woman's pain, there is no need to use an epidural ㅡ a pain relief method that causes numbness below the waist and blocks pain. The results of studies prove that the use of painkillers during childbirth in water is decreasing.

Relaxation

Think about the situation when you come home after a hard day's work and get into a warm bath. Water brings peace and relaxation. So it is during childbirth in water: muscles relax, the load on the joints decreases, it becomes easier to move, the feeling of anxiety decreases.

Water reduces stress hormone levels, allowing the mother's body to produce endorphins, which act as pain inhibitors. Also, due to the redistribution of blood flow and vasodilation, blood pressure decreases.

Better contraction of the uterus

Due to the effect of buoyancy, the mother's body weight is reduced, movements become smoother. In addition, buoyancy contributes to more efficient uterine contractions and improved blood circulation, which leads to better oxygenation of the uterine muscles.

Reduced risk of ruptures and reduced delivery time

Water makes the perineum more elastic and relaxed, which reduces the frequency and severity of ruptures, the need for episiotomy (surgical incision of the perineum and back wall of the vagina) and suturing.

Water birth reduces the risk of ruptures by 82% due to its relaxing effect.

And the time of childbirth in water is reduced by 66%.

Lower risk of postpartum hemorrhage

One of the dangers of the postpartum period is uterine bleeding. Pulmonary embolism can also develop ㅡ when a blood clot from the lower extremities enters the lungs and clogs the artery.

The results of the study showed that the risk of admission to the intensive care unit for these reasons is lower in women who gave birth in the water.

For a child

There are advantages for a child too:

water provides an environment similar to the amniotic sac in which a baby grows and develops in the womb;
water reduces the stress associated with childbirth, giving the baby a sense of security.

Lower risk of complications during labor

Shoulder dystocia can occur during labor, in which one of the baby's shoulders rests on the pubic bone and becomes stuck in the birth canal. Studies show that the risk of dystocia during a water birth is 63% lower than during a conventional birth.

Higher clinical Apgar score

To determine how healthy a baby is after birth, doctors evaluate their condition and physical development using a special Apgar score. For each sign give 0, 1 or 2 points.

Five indicators are analyzed:

respiration;
heart rate;
muscle tone;
reflexes;
skin color.

Normal, loud cry

Assessed in the first five minutes of birth. If the Apgar score is less than 4 points, the child needs resuscitation, an indicator above 7 is considered normal.

Scientists who assessed the health risks of the baby on the Apgar scale during conventional and water births found that the risk of getting less than 7 points at the age of five minutes was 28% lower in the water birth group.

Race against time

If an emergency caesarean section is required, being in the water will take longer to get the woman to the operating room. And this is dangerous for the baby and mother.

Risk of water embolism and infection

During childbirth in water, amniotic fluid embolism may develop, in which placental abruption occurs due to amniotic fluid entering the mother's pulmonary circulation. The woman's blood pressure drops sharply, the level of oxygen in the blood decreases, fainting is possible. Being in the bath can make emergency care difficult.

In addition, there is a risk of infection, because the water is not sterile.

Suction

There is a risk that the child will take his first breath in the water and start to suffocate. In addition to water, meconium (feces) can enter the respiratory tract. In this case, the baby may need artificial ventilation.

The umbilical cord can break

When a baby is born in a traditional environment, it is easier for healthcare professionals to control the process. During childbirth, the child is raised to the surface in the water and the umbilical cord may break. But this can be avoided if care is taken when lifting the baby onto the mother's chest.