Pain Relief in Labour III: Waterbirth, AKA, "The Aquadural"

This isn’t a medical guide, and should not replace advice from your doctor or midwife.

I am writing from the UK, so options may be different where you are.

I remember when I was having my first baby, I heard of waterbirth and assumed it was something silly hippies did. (Sorry!) I was a bit like Mark Corrigan (pictured) but less accountant-y.

I couldn't imagine why you'd want to wallow about in mucky water, with your partner at your side, wielding a little net for "debris". (Poo. The net is for poo.)

A good friend of mine who was pregnant at the same time as me assured me that she had recently been for a hospital tour, and the "pool" was basically a skip painted blue with some wiggly lines on the side. I laughed and put the idea out of my mind.

I did not go and look for myself. I didn't do any research on the subject. I dismissed it completely out of hand - more fool me.

The best part: where do you think this conversation happened?

In a mother-loving swimming pool!

Why was I in a swimming pool, you may ask?

Because I loved being in the water, that's why.

Sometimes, I'd like to reach back across the years and give silly-me a shake.

I told myself I was going swimming regularly so I would be fitter, and in better shape to cope with labour, and that was partly true. But I also enjoyed the water taking the weight of my bump for me. I spent a fair chunk of time "hippoing" at the side. I liked the soothing warmth. I relaxed. It felt good.

A few years later, when I was pregnant with my second baby, I revisited the idea of waterbirth, and this time, I gave the idea a fair shake. I asked women who had done it why they chose it, and what it was like. I heard it referred to as an "aqua-dural", and oh boy, didn't that tickle my whiskers and get my attention.

I'd had no epidural with my first baby, so I knew just how challenging those sensations could be. I wanted to give this "hippie" idea a shot.

Ladies, and other ladies - I did give birth in a tub and it was glorious. Nothing at all like I'd initially imagined.

Here is what I learned along the way.

Some facts about waterbirth

- The water needs to be about body temperature (36-38 degrees C).

- It should be plain with nothing added to it in case baby is born into it (think about baby’s eyes). Remember this if you get in the bath during labour – no bubble bath, no aromatherapy oils.

- Babies are protected from breathing in water by the dive reflex. They are in water right now, remember - and they won't be stimulated to breathe until they come into contact with the air.

- For this reason, it needs to be good and deep, and your bottom well down under the water. A proper birthing pool is infinitely better than a bath.

- The relief from the birth tub only lasts an hour or two. Get out, move around, and get back in to experience the relief again. This is a good opportunity to go to the toilet. If you don’t want to get out, you might use gas and air to help manage the contractions.

- If the baby is born into water, it might take them a moment to take a breath or cry. This is very normal. They should still be getting oxygen through the cord. Some babies born in water don’t cry at birth.

- If born into water, your baby might not be completely pink straight away. This can also happen on dry land if your baby arrives in a big hurry. Your midwife will be watching closely to see whether your baby’s muscle tone is good, and their colour is changing to a nice healthy pink.

Benefits of giving birth in water

This is a good option for lots of women, and can make the entire process of birth, not just more manageable, but actually enjoyable! Let's break down some of the advantages and look at them in more detail.

1. Good relief for contractions. How effective it is varies from woman to woman. It can be 100% effective, but from talking to lots of mums, for most it's probably more like 70-80% for a good hour or two.

2. Comfortable crowning. Crowning is a very weird sensation. It can be very intense and can come as a shock if you've not experienced it before. It tends to be much easier in water.

3. A feeling of privacy. We need to feel private and safe for birth to unfold normally. The process is often inhibited by people looking and prodding. Being in water gives you a feeling of being in a safe, private bubble.

4. Allows you to relax. Relaxing is just as important as feeling private. Staying calm means adrenalin isn't buzzing around your body slowing things down. Keeping your muscles relaxed means contractions will be more effective and easier to manage. Tension will make it worse!

5. A gentler entrance for your baby from womb to world? - Some people believe that this is a gentler experience for the baby as well. Your baby is suspended in warm water for the nine months of pregnancy, and being born into it is thought to ease their transition to the outside world.

6. Catching your own baby is easy! This experience will be one of the most incredible moments in your life. Your baby emerges into the water, and you pick them up. Simple and beautiful.

7. Protecting your perineum - while studies have shown more minor tears and grazes with waterbirth, the chance of severe tearing is lower.

Disadvantages

1. The tub might not be available - Keep in mind, lots of units only have a limited number of pools. Some only have one - and it might already be in use when you want it, or it might be being cleaned.

2. Access to it might be restricted for other reasons - The midwife might recommend waiting to get in until labour is more established. Some think that getting in the pool too early might ease the pressure of head to cervix, slowing labour. (It's possible it looks like labour has slowed because the relief is so effective. There's also this high-tech option available if submersion in the water does slow things down: get out again.) Using a pool might be incompatible with other care that is being recommended (for example, some types of monitoring).

3. Some staff might not feel comfortable attending a waterbirth - For example, they might not have attended one before. This can leave them feeling like they aren't able to offer you the best, most confident care. With waterbirth becoming more and more popular, this doesn't seem very likely, though.

4. You might be asked to get out of the pool for checks or monitoring - Normally, the midwife can listen to your baby's heartbeat periodically the way she does at your antenatal appointments without you needing to get out of the water. Staff might ask you to get out so that they can monitor you more closely, or give you other help. They should be able to assess your progress (including a VE) without expecting you to move, but some will request you to get out or change position.

What can you do about it?

- Be vocal about your wishes - TALK to your midwives. Write a birth plan, and include waterbirth on it. Make sure your birth partner knows about it, and when you arrive at the unit in labour, they can be a squeaky wheel for you. The squeaky wheel gets the pool! This does not guarantee anything (there are no guarantees) but it stacks the odds in your favour.

- Be realistic and flexible - Have other strategies for relief if you aren't able to use the pool.

- Consider staying at home - If you are having a healthy pregnancy, and expect a straightforward birth, this is a reasonable option. Some midwives and doulas have a tub they loan out, or you can arrange your own. This is quite straightforward, and almost completely eliminates the worry that you won't have access to one when you want it.

- Use water in other ways - Showers and baths can also offer some relief. You can direct a shower-head onto your bump or lower back, or your partner can do this for you.

- Give feedback - if your requests could not be met, or you were asked to get out or change position to allow a cervix check, give feedback to the Trust so that practises can be reviewed and more training can be given where appropriate.

Other pain relief

You can still use gas and air in the pool when the effects of the water start to ease off.

If you want to have an opiate based drug (like Pethidine or Meptid), you will need to get out. These medications will make you very drowsy and staff could consider this a contraindication for using the pool safely. They are likely to want to monitor you and baby more closely, as these drugs have stronger side effects than Entonox.

The good news is that, all being well, you're unlikely to need anything more than gas and air anyway.

Notes for birth partners:

- Encourage the mum-to-be to get on her knees. This will keep her off her pelvis, which is important to let it flare back and allow baby through more easily.

- You can pour water on her back during contractions. This helps in a similar way to a TENS machine, but if you start doing this you need to be prepared to keep going – maybe for a long time! No one except mum is allowed to complain about being tired, sorry!

- Remember your net!

Wise ones:

Have you given birth in water? What was your experience?

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Here's the other posts in my Pain Relief in Labour series:

Entonox (Gas and Air)

Paracetemol

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Book your antenatal class with yours truly!