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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.