The Wonder of Waterbirth
As we celebrate Songkran and the symbolic significance of water, midwife Emma McNerlin, explores the benefits of hydrotherapy for labour and the principles and practice of waterbirth for both mum and baby.
By Emma McNerlin
History of waterbirth
It’s a common misconception that waterbirth is a new phenomenon, riding on the crest of the natural birth movement wave (no pun intended). In fact, waterbirth has been around for centuries, with records of Egyptian pharaohs being born in water and South Pacific Islanders birthing in the shallows of the ocean (Balaskas, 2004). Even today in Guyana, South America, tribal women birth in the waters of their local rivers. With the rise in the medicalisation of birth since the turn of the last century, this traditional practice was almost completely lost in the developed world.
Women who used water for pain management and birth had shorter first stages of labour, less use of epidural and opioid pain relief, lower levels of episiotomy...and reported lower levels of anxiety
In the 1970s, the renowned French obstetrician Michel Odent reintroduced waterbirth quite by accident. A lady who was using the hydrotherapy pool for pain management in labour declined to move to dry land for the birth of her baby. Since then, waterbirths became commonplace at Pithiviers and have spread throughout low-risk midwifery practice in Europe and beyond (Odent, 1994).
Modern use of water for labour and birth
[caption id="attachment_11842" align="alignright" width="260"]
Photo credit: activebirthpools.com[/caption]Hydrotherapy in labour and waterbirth has grown in popularity. Many birthing suites are installing birth tubs in their birth rooms to meet the rising demand. With almost 30 years of recent practice, there have been extensive studies to support the benefits of labouring and birthing in water. It’s important to make the distinction between immersion in water for the first stage of labour when the cervix is opening, and actual waterbirth, where the baby is born into the water, fully submerged and gently brought to the surface (Nutter et al, 2014).
Better outcomes for mums & babies
In a systematic review of randomised controlled trials (highest-quality evidence), women who used water for pain management and birth had shorter first stages of labour, less use of epidural and opioid pain relief, lower levels of episiotomy (a surgical cut made to the perineum at birth) and reported lower levels of anxiety. There was no significant difference in the severity of perineal tearing or blood loss at birth, and the outcomes for babies were also comparable for both the land-born and the water-born groups (Cluett & Burns, 2009).
Setting the ambience
The ambience of the birth room is vitally important, in order that the labouring woman can optimise the relief provided by being in the birthing pool. Dimmed lighting, soft voices and respect of the birthing couple’s space along with a confident, well-trained birth attendant, will ensure that the conditions are right for a calm labour.
Release of oxytocin
After only 20-30 minutes of immersion in water, the body redistributes blood volume, which stimulates the release of special peptides. The complex relationship between this release and the activity of the posterior pituitary gland enhances the release of more oxytocin (Katz 1990).
Benefits of using water in labour
In the pool, the woman can tune out external distractions and tune into her innate birthing instincts. The buoyancy of the water gives her physical relief and takes the pressure off her legs, while gravity is still working to move the baby down.
Waterbirth in its truest sense is more a philosophy of non-intervention than a method or way to give birth.
The physical barrier of the birth pool also protects her from unwanted interventions such as frequent internal examinations or fundal pressure on her abdomen during pushing. Protected within the pool, she can adopt positions instinctively to help baby to descend through the pelvis to be born.
Safety of waterbirth
Some may question the safety of waterbirth; the risk of infection is a key concern. However, evidence shows that there is no increased risk of infection to mum or baby from labouring or birthing in water (Bovbjerg et al, 2016). There may also be concerns that the baby could drown. However, birth physiology and a trusted evidence-based guideline for safe waterbirth practice prevents harm to the baby. Babies are born with a dive reflex or bradycardic response (which remains for 6 months after birth) whereby if their head is submerged they automatically hold their breath (Gaskin, 2005). The room remains dimly lit, so as not to be too stimulating. The water in the birth pool is kept at the same temperature as the uterus (37˚C) to provide similar conditions to those inside the womb. The baby has been suspended in fluid throughout pregnancy. This amniotic fluid which fills the lungs at birth is denser than the water in the pool, ensuring that baby does not inhale water when submerged.
Baby stimulated to breathe only when...
During waterbirth, the baby continues to receive oxygen and nutrients through the cord and will only be stimulated to breathe first by the touch of whoever catches them at birth and secondly by the stark decrease in temperature when brought to the surface. Stimulation of the facial nerves by the colder temperature in the room causes the baby to expand the lungs increasing the pressure in the chest and pushing fluid out to be replaced with air. It is VITAL that the baby is fully born before any touching by birth attendants or the mother. Moving to expedite baby’s arrival when only the head is born may stimulate the baby too soon and cause more serious perineal trauma to the mother and excessive blood loss. The first part of the baby to meet the surface of the water should be its head to avoid inhalation of water. It’s safe to say, that by design, babies are built for waterbirth, so long as its delicate physiology is understood and respected by the birth professional.
Contraindications of waterbirth
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Photo credit: smartparenting.com[/caption]Waterbirth is not advisable for everyone. Its use is limited to low-risk uneventful pregnancies.
It is not advised for complicated pregnancies, multiple pregnancies or for women with a pre-pregnancy BMI of 35 or over, high blood pressure, a history of complicated birth such as instrumental delivery or shoulder dystocia. Women with active herpes infection or who are Hep B positive are also not candidates for the birthing pool. If the waters have broken, then they must be clear with no trace of meconium. If opting for an epidural, it is not possible to remain or return to the birth pool after it has been placed.
If there are no medical indications that you cannot use the pool for labour and birth, it’s an option worth considering. Waterbirth in its truest sense is more a philosophy of non-intervention than a method or way to give birth. It combines psychology, physiology, technology, humanity and science. It is ancient and, yet, new at the same time. Women who have successfully birthed in water tend to want to repeat the experience.
If you would like to discuss options for waterbirth in Bangkok, contact the BAMBI Bumps and Babies Team.
References
- Balaskas J. 2004. The Water Birth Book. London: Harper Collins
- Odent, M. 1994 Birth Reborn, what Childbirth should be
- Waterbirth: an integrative analysis of peer-reviewed literature. Nutter E, Meyer S, Shaw-Battista J, Marowitz A
- J Midwifery Womens Health. 2014 May-Jun;59(3):286-319. doi: 10.1111/jmwh.12194.
- Cluett & Burns 2009 Cochrane Systematic review on the use of water for labour and birth.
- Harper, B. (2012) The seven secrets of a successful waterbirth. Essentially MIDIRS 34 Volume 3 No. 5
- NICE Guideline for Intrapartum care of Healthy Women and their Babies. Available online at: https://www.nice.org.uk/guidance/cg190/chapter/Recommendations
- Gaskin, I (2003) Ina May’s guide to Childbirth. Vermillion Press, London.
- Bobvjerg et al (2016) Maternal and Neonatal outcomes following Waterbirth available online at: https://pdfs.semanticscholar.org/675c/65b8a480a186e4de8f5f122dc193911df26d.pdf
- Katz, VL. et al, (1990) A comparison of bed rest and immersion for treating the edema of pregnancy. Obstetrics and Gynecology 75(2):147-51.
Cover photo by Martin Str from Pixabay
About the Author
Originally from Ireland, Emma is a UK-trained midwife who worked in the maternity unit at a busy NHS hospital just outside London. Emma moved to Bangkok with her husband in 2014; they have an 11-year-old son, Toby. Volunteering with BAMBI Bumps and Babies since August 2015, Emma regularly conducts sessions on pregnancy, birth, breastfeeding, and Infant First Aid. In her spare time, she enjoys baking and Muay Thai, and is an active member of her son's parent group at school.
The views expressed in the articles in this magazine are not necessarily those of BAMBI committee members and we assume no responsibility for them or their effects. BAMBI News welcomes volunteer contributors to our magazine. Please contact editor@bambiweb.org.