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About Water Birth
About Waterbirth 

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 see 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.  It is simply heaven!

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. 
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 whole 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.  
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.  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.

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.

With the use of an underwater flashlight, you can easily see the birth progress by shining the light onto a submerged mirror below the mother.
List of Benefits of Warm Water for Labor and Birth 

List of Benefits

  • Ease of movement and position changes for a more comfortable labor and birth
  • Feelings of more control for mother
  • Encourages relaxation
  • Quickens labor
  • Lowers blood pressure
  • Ease of movement saves energy
  • Significant pain relief
  • Reduces cesarean section rates
  • Birth is easier for the mother and gentler for the baby
  • Reduces complications and the need for drugs and interventions  Provides mother a private space
  • Softens perineum and reduces trauma and eliminates episiotomies
  • Mothers love waterbirth and choose it for their next baby
  • Midwives love it and recommend it to their clients
More About Waterbirth 

With the growing options available for birthing women, waterbirth is probably one of the most controversial and intriguing. Education is key to good decisions. If you choose waterbirth, it is likely that you will be faced with many questions and outright disapproval from well meaning family and friends. Your knowledge and understanding about waterbirth may help them except your choice, but more importantly it will help you hold on to your choice. 

What is Waterbirth?:
Waterbirth is the use of a heated water bath or pool by a woman during labor and birth. Some women use the pool for labor only, choosing to birth their babies on “land” while others stay in the pool to birth the baby, leaving to deliver the placenta, and still others stay in the pool for the entire process. There is no right or wrong way. What feels right for the mother and is safest for mother and baby is what counts. 

Is Waterbirth Safe?:
Yes! To date, there are estimates that more than 40,000 waterbirths have taken place world-wide with no reports of life-threatening complications for either the mother or the baby. The National Health Service in England has encouraged the use of water by the installation of baths in 219 British hospitals. Waterbirth has spread throughout Europe and is acknowledged by health care practitioners around the world as the best non-narcotic pain relief for laboring women. Water therapy for labor is very common in the United States and waterbirth is also growing in popularity, available in many birthing centers and even some hospitals. Home waterbirth is easily accommodated with the use of a portable pool and a few extra supplies. 

The greatest question about safety and waterbirth is the baby taking a breath while underwater. At one time it was taught that a newborn took in its first breath as a mechanical response to having been squeezed through the birth canal - compression of the chest caused a recoil, forcing the first inhalation. But scientific and physiological research, especially the hormones involved in birth, have shown us that it is not the “chest compression” at all that allows a baby to begin respiration. Healthy babies born via cesarean section breath just fine with out having passed through the birth canal. 

Breathing initiation is a response to a release of a hormone in the umbilical cord and the brain, which is in response to a change in the pH of the cerebral spinal fluid, which is in response to an interpretation of a change in environment. Get all that? There are several factors that prevent a baby from inhaling at the time of birth under the water. These inhibitory factors are present in all newborns. 

 * Increase in the Prostaglandin E2 level in the baby, which cause a slow down or stopping of fetal breathing movements (FBM) in the prenate from 24-48 hours before the birth (induction interferes with this).

 * Water is a hypotonic solution - lung fluids present in the fetus are hypertonic. So, even if water were to travel in past the larynx, they could not pass into the lungs based on the fact that hypertonic solutions are denser and prevent hypotonic solutions from merging or coming into their presence. 

 * The larynx is covered all over with chemoreceptors (taste buds) - five times as many as the tongue. When a solution hits the back of the throat, passing the larynx, the glottis automatically closes and the solution is then swallowed, not inhaled. This is called the Dive Reflex.

The above combination of things prevents a baby from “breathing” or inhaling water until it is up and exposed to a change in the air temperature and senses the difference in air pressure on the skin and the pH of the cerebral spinal fluid changes, setting the initiation of the breathing sequence into motion. So once the babies face is out of the water -  it stays out. Whew! Amazing information.

Infection can occur from two sources. One source is germs the laboring woman might carry in or on her body and the other source is germs that might be present in the pool or water. During birth, a laboring mother will lose fluid from the bag of waters, pass urine, blood, and sometimes stool. Fluid from the bag of waters and urine are usually sterile. Blood can carry both bacteria and viruses. Stool usually carries bacteria and other types of organisms. Current research indicates that most germs cannot live very long in warm, chlorinated water. Possible infection due to water contamination is remote if you are using city water to fill your tub. Also, if there are bacteria or viruses in body products or fluids, the amounts are thinned out with exposure to a large pool of water and making the germs less able to cause infection. 

Birthing pools are cleaned well after and before each use to make sure no bacteria remains that may lead to infection. Research does not show increased incidence of infections of the birth canal or uterus with waterbirth. Water does not enter the birth canal and travel upward. 

The combination of hard, physical work (labor) and immersion in a warm tub of water can lead to loss of body fluids through perspiration. Dehydration can cause an increase in the mother’s heart rare and a low-grade fever which may in turn increase the baby’s heart rate. The laboring mother is encouraged to drink 8 ounces of clear fluids every hour to prevent dehydration.

What Are The Benefits Of Water Birth?:
Soaking or floating in a pool of warm water aids the body and mind in relaxation by providing a sense of weightlessness. Mothers are able to move with greater ease and are more likely to find the positions that give them the most comfort and allow the easiest descent of their babies. The muscles work is lessened in supporting a laboring woman in water. The entire body is evenly supported with no localized pressures to cause discomfort. Improved relaxation reduces adrenaline levels and creates a greater sense of wellbeing. This state of mind and body is key to opening, reducing pain, and improving the quality of the contractions which can shorten labor. 

Some researchers have observed that a laboring woman’s blood pressure may be lowered in warm water. This improves blood flow to all parts of the body, especially the uterus, increasing oxytocin levels. The placenta also benefits from the increased blood flow, improving the baby’s oxygen levels thus reducing risks of fetal stress. 

Being in a tub of water that is heated to normal body temperature can help the laboring woman maintain her own body temperature at a stable level. The warm water also relaxes the muscles in the pelvis and softens the perineal tissues. The natural counter pressure provided by the water on the softened perineum and slow gentle delivery help to prevent tearing. Many women express that they have less pain and a greater sense of relaxation and control while birthing in water.

Babies are able to transition from one warm, buoyant water environment to another. Once born, their heads are gently lifted out of the water to rest on mom. Most babies will display a state of calm alertness. When ready, the baby is removed from the water, dried and bundled in warmed blankets. 

When looking at all the benefits it is easy to understand the growing popularity of water birth. A relaxed mother with improved blood and oxygen levels, able to move gracefully for comfort. Warm, soft. supported body tissue that opens and stretches beautifully for birth. A baby with reduced stress, that gently slips into a womb like environment and floated up to his mothers breast, slowly taking in the non-water world. Most women who have experienced waterbirth attest to its gentleness and would do it again. 

When To Enter The Pool:
When ever you want. You may have heard that entering ‘too soon’ can slow labor. This is not proven and it may simply be a preception of ‘slower’ due to pain relief offered by warm water immersion.   If labor does seem to be slower, a woman may choose to leave the water to see if walking can reestablish a good labor pattern then reenter the water.  

It is important that your hot water tank is turned up before you go into labor. You want to be certain that you will have LOTS of hot water for your pool, showers, a postpartum bath, and clean up. It is recommended that you turn your hot water tank up to 140 degrees - be sure to warn people! It can be turned down the day after the baby is born.

Choose a place where you have privacy, you can walk around all sides, hose will reach from faucet and hose will reach to location of draining (tub, or outside through window or door), where floor boards can support additional weight, and where there will be room to get mom out and down on floor if needed.

Water temperature: 
If the temperature of the water is either too hot or too cool it can cause undue stress for the baby and greater difficulty for the mother to maintain comfort. Temperatures between 98 degree and 100degree are best. The baby’s heart rate may go up if the baby is overheated through mom’s body temperature rising from hot water. 

Warm Water For Pain Relief 

 Warm Water: The Liquid “Epidural”

The benefits of warm water during labor and birth are numerous. Warm water used in labor and birth reduces the hours and stress of labor, offers bodily support and relaxes the mother, helping to ease the baby’s journey. The baby makes its transition to breathing air in a familiar, gentle medium. It offers the woman the chance to move more freely and take up any position she wants and also reduces her energy consumption. As is well known, if the labor is easier on the mother, it will be easier on the baby.

Heat dilates blood vessels and speeds the removal of the painful by-products of muscle work. Actually, both heat and cold can reduce muscle spasms and increase your pain threshold. In labor, a good long soak in a pool or bath or warm water can promote overall relaxation and decrease tension and pain.

Most doctors recommend you avoid the tub if your water has broken, especially in a hospital where bacteria is more prevalent. Other practitioners believe that it’s safe to take a bath in your own clean tub because it contains household bacteria to which you are already resistant. In fact, a Danish study revealed no increased infection in women who bathed throughout labor. Another study proved that water does not enter the vagina when a woman remains upright in the tub.

Dr. Michel Odent became famous for using a warm water pool at his clinic in Pithiviers, France, to help women relax in labor. Odent wrote that water gave a laboring woman these benefits:
·          Water reduces a woman’s inhibitions toward giving birth by diminishing catecholamines, the stress hormones.
·          Water allows women to enter a different, more primitive level of consciousness.
·          Water promotes relaxation, especially if the room is semi-dark and sounds are reduced.
·          Water makes contractions more effective and less painful, thereby shortening labor.
Occasionally a shower is sufficient to gain these benefits, particularly if it affords a woman the privacy Odent believes is essential to the laboring process.

Soaking in warm water during labor can be invaluable for a woman with painful contractions, especially if she’s experiencing back labor. It is not uncommon that labor stalls at around five centimeters or transition, just before full dilation, are the times when many women ask for painkilling drugs. Dr. Odent observed that if a woman waits to get into the pool until she is five centimeters dilated, her cervix often dilates completely within about one or two hours after she gets into the water.

Odent discovered other benefits of water included no episiotomies and only superficial perineal lacerations Babies born underwater experienced a gentle transition to life outside the womb and seemed to cry less or at all. Odent concluded that underwater birth did not seem to pose any serious risks for the healthy mother or her baby.

Dr. Michael Rosenthal, who has assisted at almost 800 water births at the Family Birthing Center in Upland, California, comments on the different reactions of doctors and mothers. “Pregnant women rarely ask why one would use a bath in labor; physicians usually do.”

Women who actively seek out underwater birth for their babies report resting in a tub of water heated to around 100 degrees and easing their babies out while still surrounded by warm water. Adherents of underwaterbirth say it reduces birth stress and unnecessary interventions for both mother and baby.

Other forms of water therapy during labor include soaking the feet or hands in a basin of warm water, hot compresses applied to the lower back to alleviate back pain, or a hot water bottle or heating pad placed where you need them the most; on your lower abdomen or groin, your back, your upper thighs, or your perineum. One mother says, “During labor, I sat crossed-legged with an overstuffed hot water bottle at the small of my back. It felt great.”

In many hospital birthing rooms and home deliveries, the woman’s companion or birth attendant frequently applies hot compresses to her perineum to ease the intense stretching that takes place during birth. One mother recalls, “Tim boiled hot water for the compresses which the midwife applied while I was pushing. This felt wonderful and it helped me to relax and stretch those muscles that allowed the baby to be born without any tearing.”

More and more women and men are demanding the use of water (hydrotherapy) to achieve pain relief without the risks associated with drugs, and also to establish a soothing environment for their newborn’s entry into the world. Water provides a wondrous alternative to drugs during labor. To birthing women, water is like a liquid “epidural.”
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