Water as an Aid to Labor

The use of warm water during labor is a great comfort measure. It is safe, widely available, inexpensive, and effective. Warm water immersion in labor can diminish stress hormones, catacholamines, which increase pain and slow labor. It also directly reduces pain by increasing the body's production of natural pain relievers (endorphins), can ease involuntary muscular tension, and enhance relaxation during and between contractions. It can also lower blood pressure within minutes and increase the efficiency of uterine contractions. In addition, use of a larger tub increases mobility so that it is easier for a woman to change position to aid the progress of labor, especially when she is becoming tired. Birth into water can reduce the incidence and severity of perineal tearing. The water encourages relaxation of the pelvic floor and provides natural support to the perineum.

Waterbirth may have benefits for the baby as well, and often provides a gentler transition to life outside the womb. Many pregnant women are drawn to water, especially during labor, and women all over the world give birth in labor tubs, tide pools or natural springs. The advantage of tubs specifically designed for birth is that they are portable, heated, and large enough to accommodate movement and a variety of labor positions.

Rented tubs can be used in the hospital or at home, and might be just what you need for a more comfortable labor. Some women choosing hospital birth use rented labor tubs at home, often with the services of a doula, to help them comfortably stay home longer. This enables them to enter the hospital when labor is well established, which can often help them avoid unwanted interventions. A bathtub or shower can also provide pain relief and relaxation, and should be available wherever you choose to give birth.

There are some practical considerations to using water as a comfort measure. If a woman is using it for pain relief or reduction of blood pressure and edema, it is important to have enough depth to be fully immersed. Her whole body should be under the surface. Less water than this will still be helpful, but not as effective. Be sure to use water that is close to body temperature, 98 to 100 degrees Fahrenheit. If it is too cold she could become chilled and waste energy shivering--energy better used for labor! For this reason, have plenty of towels and blankets handy, since many women will be in and out of the tub several times during labor. If the water is too warm she may become overheated, flushed and dizzy; if this happens she can simply leave the tub for a while and have someone add cold water. In any labor it is important to keep drinking liquids, but especially while in the tub, to avoid dehydration. Have a non-slip surface-bathmat or similar item-nearby for when the mother gets out, and a person or two ready to assist if necessary.

A woman can use the pool whenever she wants. However, if a mother chooses to get into the water in early labor, before her contractions are strong and close together, the water may relax her enough to slow or stop the labor altogether. That is why some care providers limit the use of the pool until labor is established and the dilation of the cervix is a least 5 centimeters. (The tub is ideal to have at home for women who experience lots of preparatory or "false" labor, since it can sometimes help her get some rest.) But some women have found that entering the pool helps them relax enough to really get labor going! It can sometimes be helpful to wait until active labor so the mother has something in reserve for when labor becomes more difficult. According to Barbara Harper of Waterbirth International, the first hour of relaxation in the pool is usually the best and can sometimes help a woman achieve complete dilation even in that short amount of time.

For many women the question of safety needs to be addressed. There are no known hazards to laboring in water, whether or not the bag of waters has broken, and waterbirth is completely safe as well, as long as some basic precautions are used. First, there are several factors that prevent the baby from beginning to breathe underwater after birth. The water temperature is close to that of the amniotic fluid in the womb, so there is no shock of a temperature change. The baby is also receiving oxygen from the umbilical cord just as it has for the previous nine months. In addition, the baby has an autonomic reflex, called the dive reflex, which prevents it from inhaling any substance that is in the throat and causes it instead to swallow. (This reflex disappears after about six months.) There is a complex chain reaction of hormones and chemicals that cause the breathing process to begin; just know that it is impossible for a newborn to breathe until up in the air. The baby should not be left under the water for an extended period of time (longer than half a minute). There are several waterbirth videos that show babies under water longer than this, who do just fine since the placenta is till supplying the baby with oxygen, but it can't be predicted when the placenta will begin to separate and stop the flow of oxygen. The safest approach is to remove the baby unhurriedly, face down so that water drains from the nose and mouth.

A note about waterbirth: the use of water during labor always works best when there is no expectation that the birth will happen in the tub. Although the water can be a valuable tool, some women need more assistance from gravity or find that contractions slow down in the tub. The best approach is to be flexible. Michel Odent, French waterbirth expert and author of Birth Reborn, says that "The baby can be born underwater when there are suddenly irresistibly powerful contractions and the mother does not feel like getting out of the pool; it should not be the objective…Often women need to get out of the pool for the very last contractions, at a phase when paradoxically a short rush of adrenaline can help. Women who are prisoners of the project of giving birth under water may be tempted to stay too long in the bath."

There are several ways to use pools during labor. Many homebirth midwives are experienced with and enthusiastic about waterbirth. Tubs can be rented for home use, whether the birth will happen there or in the hospital; some hospitals are also receptive to allowing use of rented tubs, but this changes often so ask your care provider. The emphasis on technology and monitoring in hospitals sometimes makes this a controversial request, but be persistent-in this setting the reintroduction of natural elements such as water can be a real lifesaver. Abbott Northwestern in Minneapolis has hydrotherapy pools available for labor, but will ask you to get out for the birth; waterbirth options and a tub are available at St. Joseph's in St. Paul, Woodwinds Health Campus in Woodbury, and Hennepin County Medical Center midwife unit in Minneapolis. Labor tubs can be rented from Waterbirth Resources at 612-822-3263. As this option becomes well known and more women request it, expect more hospitals to offer water immersion for labor and birth.

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