The most important aspect of warm water therapy for labor and birth is not all the facts, explanations, statistics or testimonials - it is what is seen over and over again - the AHHH!!!!!!! when the woman steps into the warm pool.

Warm water therapy during pregnancy, birth and postpartum can provide many aids. But the most talked about and witnessed benefit is the ability to relax. This type of relaxation can not be achieved any other way. While pregnant our bodies become achy, heavy and awkward, stepping into a warm pool of water (the bath tub and city pool just doesn't cut it) instantly relieves the woman of weight, eases discomforts of the feet, back and abdomen and allows her to move freely. Women who suffer from pubic pain, sciatica, hip and back pain, swelling, elevated blood pressure and more can find relief and improvements with nightly deep water immersions during late pregnancy.  Relaxing in warm water is simply heaven!

We have all heard the stories of the benefits of warm water for labor. This comfort option has gained tremendous momentum over the last 10 years. Question the commonly stated "fact" that women should not enter the pool until they are at least 4 centimeters dilated because it may "slow down" labor. Enter the pool when you want the comfort of warm water.

Most women do one of two things:

1) appear to have milder contractions
2) appear to have stronger contractions.

What might be going on in situation #1 is that the woman is relaxing better and she is not displaying such intensity and is experiencing "normal" feeling contractions that do not alarm her. In situation #2 relaxation allows for improved quality of contractions and moves things along faster. It is not the water that causes either of these changes. It is the relaxation from being in warm water that brings these changes about. So jump in when you want. Worse case scenario - you get out for awhile and then get back in later.

Another missed benefit of water for labor and birth is the sense of privacy it provides. Many women feel safer and more secure - not so exposed in the water. Most women melt away to a different place. They are experiencing the AHHH response! Women also seem to be less "needy" and more whole with their birth while in water. By whole, meaning, they are the birth. They ask for less help, have less expressions of desperation and follow their bodies innate birthing process more freely. When not disturbed (talked to, unnecessary touching, exams, noise, commotion) women move naturally, changing positions as their body and baby dictates to help facilitate the baby's decent.

Most women take a kneeling position in the pool, leaning on the edge. As the baby gets lower in the birth canal they move their knees farther apart and naturally move their hand down to touch their baby's head as it begins to crown. As the baby's head emerges the mother takes a more upright squatting position and uses both hands to catch her baby. It is a very remarkable thing to witness. There is no doubt that the water aids a women in finding this innate birthing from within. Most women who birth on "land" require some directing and encouraging to birth in this manner. One is not right and the other wrong - but we can't ignore the many advantages to the use of warm water during labor and birth.

It is easy to support a woman who is in a birthing pool. Partners can sit next to the pool (birthing balls work great for this) and provide emotional and physical support as it is needed. It is also easy for the partner or the birthing assistants to reach into the pool and assist the mother or baby if needed. With the use of an underwater flashlights you can easily see the birth progress by shining the light onto a submerged mirror below the mother. Babies seem calmer when they are born into water. Once they are born they are gently lifted up to mother's chest and warmly welcomed by their parents.

Placentas deliver easily in water - they actually float or you can float a bowl in the pool with the placenta in it if mom is wanting to stay in the pool longer.

Most babies seem to unfold in the warm water after birth. Keeping their heads out of water, the parents simply allow the newborn to gently float. Many babies look around and seem to be taking in this new environment peacefully. Their first cry will often occur when the baby is lifted from the water so that mom can get out of the pool- their first feel of gravity.

Water birth has proven to be one of the gentlest ways for a baby to enter the world and is being proclaimed by birthing women to provide optimal pain relief and comfort. Water births are safe, healthy and a beautiful experience. No longer a "new trend," this method of labor and birth has become the number one option for women world wide. Read more about it:

• Mothering Magazine, Birth Stories You'll Love - From Real Families Like Yours,Sept/Oct 2009, La Bassine Pool featured in article on Home Birth.
• 60 Minutes, Mother's Choice, June 2008 - La Bassine Pool featured
• LA Times, Midwives Deliver, Dec 24 2008
• New York Times, Baby You're Home, November 2008, YourWaterbirth mentioned as largest US supplier of waterbirth equipment

1. Be realistic about what you can afford

   Our pools range in price from the Aquarium Pool for $25 and the La Bassine PRO Birthing Pool for $425.
   
   If money is a serious issue then you will be happy with the Aquarium Pool for $25. This pool is slow to inflate with three rings with three small air valves but it will serve its purpose. This pool is tried and true being the most popular option for water birth before other products became available.
   
   If the budget is a bit more flexible then consider selecting the Electra Pool for $50. This pool is stronger then that Aquarium Pool and has one air chamber with one large air valve for inflating the sides. This means easier and quicker inflating and deflating. The I-beam construction makes this pool much stronger.
   
   If you can go a bit higher in price then the La Bassine Birthing Pool for $110 is the pool for you. This product is perfect for families who want a quality pool that is ethically manufactured: no child, forced or underpaid labor and is made from Eco-Friendly vinyl: - no phthalates, lead or cadmium. This pool has two interior handles perfect for assistance with pushing and getting in and out of the pool. This product is also marketed by women for women around the world and is not mass produced. It is strong and dependable, constructed with heavy I-beam walls and its large air valve allows for fast inflation.
   
   If you are a midwife or doula then you will want to consider La Bassine PRO Birthing Pool for $425. This is our most economical Eco-Friendly pool, comes with 10 custom fit liners and is guaranteed for one year or 10 births. Constructed like the regular La Bassine Birthing Pool with the same features but with 30% stronger material designed for repeat use.  

2. Select a pool that best meets yours needs
   
   If you are a midwife or doula select the La Bassine PRO Birthing Pool. It comes with 10 liners and is guaranteed for 10 births or one year. The Ocean Reef Pool is great for women who want to have lots of room to move or for their partner to join them. This pool does take twice the volume of water as the other pools so be certain that your hot water tank can handle the 190 gallon capacity. Your kids will love playing in this pool come summer. The Aquarium Pool is great for a tight budget. The Electra Pool is a perfect compromise between the Aquarium Pool and the La Bassine Pool. 
    
3. Order your pool early and use it in late pregnancy
   
   Order your water birth pool to arrive by 37 weeks pregnancy. You will need to allow 7 business days for shipping. Most midwives will let women birth at home as early as 37 weeks if all seems well with mother and baby. You should consider using your pool in late pregnancy for comfort measures. Your water birth pool can provide back and pubic bone pain relief, reduction of swelling, improves placental function and relaxes mom. The perfect treat before bed.

To help you decide on the pool we have put together a water birth pool handy comparison chart.

Once you choose your Pool, you need three other things:  

1. Air Pump
   
   Electric air pumps are the fastest but hand pumps work just as well. Bicycle and other tire pumps do not work. Pumps for air beds, beach balls and swimming pools will work. Consider selecting a pump that inflates and deflates (like the ones we sell). This allows you to deflate your pool flat enough for easier storage. 
    
2. Water Hose
   
   Select a water hose that is long enough to go from your water source to your desired placement of your birth pool. Keep in mind that your faucet needs to be able to accept a Faucet Hose Adapter so you can attach your water hose. Medical grade vinyl hoses (like the ones we sell) are drinking water safe and will not leach dangerous chemicals into your birth pool. 
    
3. Faucet Hose Adapter
   
   This adapter connects to your faucet allowing you to attach your water hose. Select a faucet that has a removable end piece (the part at the end of the faucet that has a screen). Our faucet adapters are designed to fit end pieces that thread internally or externally. If you do not have a faucet with a removable end piece (most kitchen sinks have this) then you may have to consider connecting your water hose to your shower pipe (the pipe that your shower head is attached to) or to your washing machine water source. These connections do not need adapter but you will need a "Y" adapter like what we sell to be able to get both hot and cold water to flow through one water hose. 

In the order of most useful first:  

1. Debris Removal Net - any size.
   
   When we push out babies out, we also move what ever is in our colon into the pool. Use your Debris Removal Net to scoop and throw away. Line your net with a small piece of paper towel to prevent debris from sticking to the net then trailing back through the water on your next scoop.
    
2. Y-Hose Adapter and End Cap 
   
   Attach the "Y" Adapter between your Faucet Adapter and your Water Hose. The hose is on one branch of the "Y" and you access water from the other branch of the "Y".
    
3. Hand-Held Mirror
    
   Most women will labor and start pushing in a hands and knees position. This position makes it impossible to see the baby as it emerges. Place the mirror below the mother and aim a flashlight beam on the mirror (which will reflect light up to her bottom). Now you can see the baby's progress easily.
    
4. Underwater Flashlight
    
   These lights provide perfect light for monitoring the baby as it emerges. Standard flashlights beams break up and make visibility poor.
    
5. "Wet" Deluxe Pool Patch
    
   A must have for every waterbirth in an inflatable pool. If a leak occurs, these patches can be applied right through the water. No need to drain the pool.
    
6. Floating Thermometer
    
   If maintaining water temperature is important to you then these thermometers make the task easy and add fun to your pool.
    
7. Submersible Water Removal Pump
    
   Our portable sump pump means you can drain a pool without having to find an electrical outlet. Our electric sump pump is more powerful and will drain the pool even faster. A Submersible pump is a must for a hospital birth or for any family or midwife wishing to get the job done fast.
    
8. Shoulder Length Gloves
    
   Help keep you dry when listening to heart tones, checking dilation and assisting with deliver. Put these gloves on and place your sterile gloves over the top.
    
9. Protective Gowns
    
   Keep your helpers dry and clean.

1. How do you keep the water warm?
    
   The thick air walls of all our inflatable pools keep the water warm for hours. La Bassine will hold its water temperature for over five hours within one degree. Adding one to two soup pots or tea pots of boiling water, carefully to not touch the pool or mom, while bring the temperature of the water up several degrees without adding too much water to the pool.
    
2. What keeps the baby from breathing underwater?
   
   There are four main factors that prevent the baby from inhaling water at the time of birth: Prostaglandin E2 levels from the placenta which cause a slowing down or stopping of the fetal breathing movements. When the baby is born and the Prostaglandin level is still high, the baby's muscles for breathing simply don't work, thus engaging the first inhibitory response. Babies are born experiencing mild hypoxia or lack of oxygen. Hypoxia causes apnea and swallowing, not breathing or gasping. Water is a hypo-tonic solution and lung fluids present in the fetus are hyper-tonic. So, even if water were to travel in past the larynx, they could not pass into the lungs based on the fact that hyper-tonic solutions are denser and prevent hypo tonic solutions from merging or coming into their presence. The last important inhibitory factor is the Dive Reflex and revolves around the larynx. The larynx is covered all over with chemo-receptors or taste buds. The larynx has five times as many as taste buds as the whole surface of the tongue. So, when a solution hits the back of the throat, passing the larynx, the taste buds interprets what substance it is and the glottis automatically closes and the solution is then swallowed, not inhaled.
    
3. How long can the baby be left underwater?
   
   Here in the US, practitioners usually bring the baby out of the water within the first ten seconds after birth. There is no physiological reason to leave the baby under the water for any length of time. There are several water birth videos that depict leaving the baby under the water for several moments after birth and the babies are just fine. Physiologically, the placenta is supporting the baby with oxygen during this time though it can never be predicted when the placenta will begin to separate causing the flow of oxygen to baby to stop. The umbilical cord pulsating is not a guarantee that the baby is receiving enough oxygen. The safe approach is to remove the baby, without hurrying, and gently place him into his mother's arms.
    
4. How is the baby monitored during waterbirth?
   
   The manufacturers of monitoring equipment and hand held dopplers have developed water proof varieties of monitoring equipment. In typical waterbirths the baby’s heart tones are listened to every 30 minutes during first stage and after every pushing contraction during second stage.
    
5. Is waterbirth safe?
   
   The safety of water birth needs to be judged in looking back at the number of cases that have been reported world wide and the number of problems that have occurred as a result of birth in water. To date, over 100,000 documented cases of water births gives us a good look at the statistics. The opinion of practitioners is that water birth poses no threat to mother or baby if all the normal parameters are met during labor and birth. If complications arise they are evaluated and sometimes the mother is asked to leave the water before the birth takes place. Everyone’s goal is to keep mother and baby safe and to facilitate a satisfying birth experience. The British government stated in a published health report that any woman who wants a waterbirth should be able to have one and that it is up to the practitioner to become familiar with the technique if they are not already educated.
    
6. When should you enter the water?
   
   You can use the labor pool whenever you want. Some women have found that if they get into the water in very early labor, before contractions are strong and close together, the water may relax her enough to slow or stop labor altogether. This is is why some care providers want you to wait until the cervix is dilated to at least 5 centimeters. There is some physiological data that supports this rule, but each and every situation must be evaluated on its own. Some mothers find a bath in early labor useful for its calming effect and to determine if labor has actually started. If contractions are strong and regular, no matter how dilated the cervix is, a bath might be in order to help the mother to relax enough to facilitate dilation.
    
7. Can I be in water if my amniotic sac has ruptured?
   
   When the amniotic sac ruptures, or the water breaks, a woman can labor in the water. Studies show that the risk of infection does not increase from laboring in the water, whether the amniotic sac breaks while the mother is in the tub, or whether it was already ruptured before she got in the water. Therefore, it has been suggested that the bath be used in a "trial of water" for at least one hour and allow the mother to judge its effectiveness. Midwives report that some women can go from 1 cm to complete dilation within the first hour or two of immersion. The first hour of relaxation in the pool is usually the best and can often help a woman achieve complete dilation quickly.
    
8. How warm should the water be?
   
   Water should be monitored at a temperature that is comfortable for the mother, usually between 95-100 degrees Fahrenheit. Water temperature should not exceed 101 degrees Fahrenheit as it could lead to an increase in the mother's body temperature which could cause the baby's heart rate to increase. It is a good idea to have plenty of water to drink and cold cloths for the mother's face and neck. A cool facial mist from a spray bottle is a welcome relief for some mothers as well. Generally speaking, the water temperature can be what the mother desires as long as it is not too hot.

Home Birth

Advantages

• Statistics show homebirth safety for low risk women with adequate prenatal care, and a qualified birth attendant.
• Labor can progress naturally, without unnecessary interventions.
• Women can eat, drink, walk, make noises, shower, bathe, etc.
• Cost of home birth is less than hospital.
• Continuous care given by a midwife throughout labor, birth and postpartum.
• Women are encouraged and supported while they maintain control of their birth experience.
• Care-givers establish a trusting relationship with the birthing family. Mother/baby bonding is enhanced and breastfeeding is supported.

Disadvantages

• Women must assume a greater responsibility for their own health.
• Negative judgments and lack of support from people that view hospital birth as socially correct.
• Cesareans, forceps and anesthetics are not readily available requiring transport if necessary.
• 24 hour maternity nursing care is usually unavailable.

Birth Center

Advantages

• Facility is only provided for pregnancy and birth events.
• Offers more personalized care than most hospitals.
• Pregnancy is considered a natural and healthy process in a birth center.
• During pregnancy, women are encouraged to take charge of their own health.
• Greater parental control, freedom to move and eat, and the choice of birthing positions.
• Lower cesarean and forcep rates than hospitals.
• Women are allowed to return home within hours.

Disadvantages

• Screening process eliminates many healthy mothers, i.e., VBAC; mothers over 35, etc.
• Mother must travel to center and labor away from home environment.
• Many centers have protocols requiring transport to hospital for prolonged labor, etc.
• Many communities do not have birth centers.

Hospital Birth

Advantages

• Some mothers feel safest laboring in a hospital.
• Emergency cesarean is readily available in hospital.
• In some cases it is the safest environment for the high risk mother or baby.
• Immediate pediatric care for newborn needing medical care.
• 24 hour maternity nursing care is available.

Disadvantages

• Parents do not have control of their birth.
• Less privacy and increase of fear in some women.
• The father is less likely to be actively involved during labor and birth.
• Routine separation of the mother and baby is almost unavoidable.
• Birth is managed by people trained in pathology, not normal birth.
• Risk of having an unnecessary cesarean or episiotomy is higher.
• Risk of infection or iatrogenic complications to mother and baby is increased.
• Proper nourishment during labor and adequate rest is limited due to hospital protocols.  

If you have decided to have your baby in a hospital or birthing center, ask if they have a birthing pool. If the hospital you plan to attend does not have a birthing pool, they may still have the facilities available for you to bring in your own pool. Discuss with your doctor or midwife about what your options are for having a water birth in a hospital.

In England, a water birth has become so common, it is considered an option for childbirth and not an alternative. Most English hospitals are now equipped to accommodate the request.

In North America, attitudes are not quite so forward thinking, but an increasing number of hospitals are recognizing the growing demand by women to give birth in water. Some hospitals do have birthing pools or, at the very least, Jacuzzis and hot tubs that are designed for elderly or disabled people but can easily be used by pregnant women. However, be aware that in many hospitals, while it is fine to remain in water during labor, actually giving birth in water is discouraged. 

About Midwives Aren’t medical doctors more experienced in complications?

Yes. And midwives will refer their clients to medical doctors when the rare complication occurs. But most women do not benefit from the medical model of care. A model that treats every woman as a patient. Women are subjected to testing, screening and often serial ultra sounds, all looking for potential problems. This pathological approach seriously undermines a pregnant woman’s emotional well-being. The message is that childbearing is dangerous and her body is not capable of conceiving, growing and birthing her baby safely without all the testing.

What qualities are found in a good care provider?

Each woman will have different needs. A good care provider is willing to modify their services to fit the individual. You should feel comfortable with your care provider, being able to openly discuss your concerns and wishes together. A good care provider will celebrate this joyous experience without personal fear of pregnancy and birth. A good care provider is humbled in the perfection.

How do I find a qualified birth attendant?

Midwives may be listed in your phone book, but ask around to see if there are other midwives in the area. Ask at the local health stores, farmer’s markets, La Leche League, Chiropractors or other homebirth families. Call pregnancy support centers, clinics, and check the internet. Talking with several midwives will help you find the one that is right for you.

Are there different kinds of midwives?

Yes. A certified nurse midwife (CNM) acquires a masters in nursing then completes a midwifery program. CNM’s often work within the medical model attending births in the hospital but may also work independently attending in birth centers or at home. A direct entry midwife may carry the initials LM - licensed midwife, CPM - certified professional midwife, or no initials calling herself a traditional midwife or lay midwife. Direct entry midwives are not nurses and usually attend births only at home. Some have completed courses at midwifery schools or through correspondence courses, others through years of apprenticing with senior midwives.

Is midwifery care a good option?

Yes. Most midwives follow the Midwifery Model of Care - a model that focuses on the individual. Midwives specialize in normal childbearing. Counseling and encouraging their clients to focus on their well-being to ensure a normal pregnancy, birth and postpartum. Midwives have been supporting birthing women since the beginning of birth. Midwives are mentioned in some of the earliest recorded history. The health of mother and baby are a vital concern to any care provider. Your midwife should provide you with a standard schedule of all prenatal testing available. This should include an explanation of why they are done, what benefits and risks they present, and what additional testing you may need to have if you have any positive results. If a midwife does not do prenatal teasing, she will be able to refer you to a care provider that can.