Women have been using water in labor for thousands of years. Over the past 30 years a small percentage of women in the United States have been choosing to have a water birth. According to Egyptian hieroglyphics, some women’s babies selected to be priest or priestesses were birthed in water. The Chumash Indians of the Central California coast recall stories of women laboring in the ocean. Legend has it that dolphins would appear nearby; staying close until the infant was born. The Romans and Greeks used hot tubs to help in the cure of everything from arthritis to gout. Stories from Japan, Samoa and New Zealand are found throughout their literature. The Hawaiian’s have many families that claim water birth has been part of their heritage for a thousand generations. It would seem to be practical that women who live close to warm water would seek it out to comfort them in labor.
How does water help? Common sense would seem to prevail here. Most people feel better soaking in a hot tub after a long day or a tough workout. When the body is immersed in water to chest level, 75% of our body weight is dispersed. This buoyancy allows a woman to move about freely on her hands and knees, on her side or squatting, unencumbered by gravity. Our muscles work more efficiently and with less stress under water. Between changing positions and improved muscle function, more room is created in their pelvis, thus increasing their pelvic diameter. This allows the baby’s head to rotate more easily since it is not restricted by gravity. Water can also reduce cervical pressure. This is due to the buoyancy of the baby’s head. Buoyancy and improved muscle function will significantly enhance the babies ability to maneuver through a woman’s pelvis.
Heat, especially in the form of a tub of warm water has always been an important way to reduce pain and discomfort. Less discomfort leads to greater relaxation and decreased anxiety.
From a physiological standpoint, as a woman relaxes, her stress is reduced. Stress reduction inhibits the release of the hormones noradrenaline and catecholamine. Not only can these two hormones increase her blood pressure, but they can also slow down her labor. If a woman is comfortable and relaxed in her own environment, her endorphins will be released, allowing her to cope with and even enjoy her labor. Many women are so comfortable in the warm tub they actually fall asleep between contractions. This is of great value to all women, especially if their labor is at night.
The temperature of the tub is an important issue. It should be close to body temperature. Some women want it warmer, in which case she will need to get out of the tub frequently and increase her fluids. She should not be sweating. The goal is not to cook the baby. Some women enjoy warm water poured over their back or tummy. This can be almost hypnotic. It is helpful in maintaining a relaxed state. When labor becomes physically easier, she will be able to focus on the birth calmly.
In utero, babies continue to move freely while their mother relaxing in the water. Monitoring the baby’s status can be easily achieved with a fetoscope or a waterproof doppler. The mothers vital signs can easily be assessed without disturbing her labor.
As labor progresses, a woman’s ability to move freely in warm water will improve the speed of her labor. Just floating can allow her pelvic floor to relax even more. Because her pelvic floor is relaxed, many women do not feel an overwhelming urge to push, which allows the baby to just labor itself down. Pushing is more efficient in water. Since water improves the elasticity of skin, few women have perineal tears and those are minimal.
Some people worry about the risk of infections with a water birth. According to a 2009 study by the Cochrane Review, water birth statistically demonstrated no greater increase of infection than a traditional birth. On the other hand, hospital births pose a very real risk of infection. According to the latest Centers For Disease Control statistics, 1 in 25 patients end up with a hospital-acquired infection in a setting where those who are actively ill mingle with care givers and other patients. These are not risks that home birth women bear.
How a baby transitions to the outside world is greatly improved with water. In the early 1970’s, Dr. Fredrick Leboyer, a French Obstetrician and the author of the book, “Birth Without Violence,” was trying to improve bonding between mothers and their newborns. With the parents immersing the baby in warm water, in a dimly lit room immediately after birth he believed the baby would be calm and better adjusted to extra uterine life. This practice was a vast improvement over abruptly handing a newborn over to a stranger who would take it to a brightly lit, noisy environment and accost it with a shot, swabbing its eyes with erythromycin ointment and foot printing all before wrapping it in a warm blanket and returning him/her to their mother.
Ten years later another French Obstetrician, Dr. Michel Odent took the care of the infant one step farther. Why not let a baby arrive in warm water? Dr. Odent believes the mother should be the first to hold her baby. In his view, once the baby is born, the Midwife (and or mother) bring the baby up to the mothers chest so the baby can transition from amniotic fluid to water calmly and gently. The baby is kept calm with the beat of the mothers heart and the warmth of skin to skin contact. Thousands of women have birthed this way. Unlike birthing with epidural, there is little regret birthing in this manner. Birth is accomplished with no medication, no interventions, resulting in an alert baby and the ability to move under your own power. For healthy women with no medical problems who chose water birth, it is a life changing experience.
In addition to the benefits mentioned earlier, water birth offers pain relief without IV medication or epidural. Since there is no time limit imposed by the administration of pitocin or epidural, you are free to labor without restrictions. You can always get out of a birthing tub. However, once an anesthesiologist sticks a needle in your back or a nurse administers pitocin, it is hard to reverse their effects.
A survey on the satisfaction rates of women using water birth versus standard American hospital methodology has yet to be done. However, in my 30 years of experience in a wide variety of hospital, birth center and home settings I have found the benefits of water birth significantly outweigh the benefits of most methods offered in traditional hospitals. They include a more relaxed mother who doesn’t have to recover from administered drugs, a more alert newborn (who is also not recovering from administered drugs), nursing is more quickly established, there is minimal or no perineal pain, no recovery from IV or epidural wounds and a mother who is able to move about easily after her birth. Most importantly, mother and child have never been separated and the all important bonding process has been calm and fully facilitated.
In my experience in attending thousands of births and hundreds of water births, women who chose (or were coerced into) a birth using pitocin or epidural frequently express regret for those choices. I have found the use of birth tubs during labor greatly enhances a woman’s sense of accomplishment and satisfaction with her birth experience. But that’s what choices are all about.