Janine Gard: Water births our aquatic past

Birth and parenting educator Janine Gard.

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Janine Gard is a diploma qualified birth educator and founder of Bellies to Babies. She has taught more than 2900 parents to feel confident, informed, supported and prepared.

When it comes to birthing your baby, how you plan to do it is a personal decision. If you're considering a non-medicated vaginal birth, water birth may have benefits for you. Here we'll discuss the facts, along with the pros and cons of water birth, providing you with plenty of information that may help in this big decision.

What is a Water Birth?

Pretty much as obvious as it sounds, labouring and/or birthing in the water. This can take place in a hospital setting, a birthing centre, or at home. Some people choose to use the warm water while they labour and birth out of the pool and some choose to labour and birth in the pool, again, this is a conversation for you and your LMC.

How long has water birth been around?

We tend to think of labouring in water as relatively new. However, that's not so. There are legends of South Pacific islanders giving birth in shallow sea water and of Egyptian pharaohs born in water. In some parts of the world today, such as Guyana in South America, women still go to a special place at the local river to give birth.

Giving birth in water is a relatively recent development in the Western world. The first water birth that we know about in Europe was in 1805 in France. A mother whose labour had been extremely long and difficult was helped into a warm bath. Soon after immersing herself in the tub, her labour progressed, she started to push, and gave birth to her baby in the water.

In the 1960s, the Russian water birth pioneer Igor Tjarkovsky experimented with babies being born into cold rather than warm water (eekkk!!). His thinking was that this would help protect the baby's brain and enhance the baby's cognitive abilities. Understandably, this approach to water birth didn't last long.

Next, in the 1970s, some midwives and doctors in France became interested in ways of helping babies make the transition from life in the uterus to life outside as smoothly as possible, by using warm water.

The approach was to use a warm bath for the newborn baby a short time after the birth, after a period of skin-to-skin with the mother and a natural third stage.

This influenced the next water-birth champion, French obstetrician Michel Odent, who installed birth pools in each room at the birth unit where he worked in France.

Michel noticed that as well as helping women cope with the pain of childbirth, being immersed in water seemed to help labour progress. He found that water births also seemed to offer babies a more peaceful journey from the uterus into their mum's arms.

Why choose a water birth?

There are some advantages to a water birth. Women labouring in water report feeling more in control, with less painful contractions. They are less likely to need epidurals for pain management or drugs to speed up their labour. It also seems that the first stage of labour might go more quickly.

But generally, LMCs agree that water births are suitable only for women who have a low-risk pregnancy and are healthy, have reached 37 weeks and who are having only one baby, which is lying head down.

Pioneers, such as Michel, thought that babies may feel more comfortable being born into water because of our aquatic past. Many evolutionists now support what's called the 'aquatic ape theory', based on the idea that we had a long period in our evolution when we lived by the waterside. This explains why our babies are born with a subcutaneous layer of fat, the ability to swim at birth, and the reflex that prevents babies from breathing when they are born into water.

Some physical advantages of using the bath can include

● Decreased need for medical pain relief. Whether you end up having your baby in the water or not, the main motivation for most women getting into a bath during labour is to use a natural form of pain relief. In most cases it helps them avoid using medical forms of pain relief (although a few women will use the gas in the bath as well).

The warmth of the water directly relieves some of the pain, but the main way a bath works is by helping you feel more relaxed and less fearful. Within half an hour or so your body produces less of the of 'fight / flight' hormones (adrenaline and noradrenaline). These are the hormones you release when you are feeling anxious or threatened. As these are reduced the body produces more endorphin hormones, which give you natural pain relief.

● Fast dilation of your cervix. Studies so far on this are inconclusive but there are many documented cases of women getting into the bath in established labour (more than 4cm) and becoming fully dilated (10cm) within an hour or two. It is believed that the body's response to being immersed in the water increases the release of the hormone oxytocin. This usually only lasts for an hour or two, so for women who get into the bath too early (less than 3-4cm) they may find they progress well for a while but then their labour slows.

● Lowering your blood pressure. For women who have mildly high blood pressure, sitting in a warm bath will generally lower it back to within a more normal range. This is partly to do with relaxation and partly to do with dilating the blood vessels in the skin, which in turn lowers the blood pressure. (Water birth is not suitable for people that have high or uncontrolled higher than normal blood pressure).

● Less need for an oxytocin drip. If you are having a long and difficult labour or you feel you are not progressing because you are concerned or anxious or not dealing with the pain, then the bath may do the trick. Although inconclusive at present, some studies have shown that people who used the bath were less likely to need an oxytocin drip to augment (re-start or speed up) their labour.

● Less tearing and episiotomies. Although not all studies support this, there appears to be 12-18 per cent decrease in tears for first time mothers who give birth in the water. The most startling finding is the dramatic reduction in episiotomy rates for women who give birth in the bath. The physical reasons for less tearing could be attributed to the water softening or making your perineum more flexible, but more likely to be the warm water allowing the mother to relax your perineum more effectively, increasing the ability for it to stretch.

● Satisfying birth experience. Surveys of people who have used water during labour and birth, generally reflect a positive birth experience. Women appreciate their ability to retain control of their labour and birth, the comfort and relief from the warm water, feeling 'insulated and protected' from the clinical surroundings and perhaps the satisfaction in being able to avoid medical forms of pain relief.

Water birth questions to ask your LMC.

Before finalising your birth plan (if you're writing one), have an in-depth discussion with your LMC. There are a few questions you may want to have answered before you decide. Some considerations may include whether —

● Do they support a water birth for you? (not all LMCs offer/enjoy this service)

● What experience your LMC has had previously with water births?

● How will monitoring of you and your baby will take place and frequency?

● What is the plan for getting out of the pool if needed (reasons why are below)

● How is the water kept at a well-regulated temperature and how often is this checked

Being asked to exit the pool

You may be asked to get out of the water at some point, the reasons could be any of the following.

● You feel faint or drowsy

● There's a problem with your baby's heartbeat

● Your labour is progressing slowly

● You start bleeding

● Your blood pressure creeps up

● Your body temperature goes up

● Meconium (fecal matter from your baby) is in the pool

Risks of water birth.

● Unpredictable availability of birthing pools in all hospitals

● You cannot have an epidural or opiate pain-relief drugs if having a water birth

● Can slow down your contractions (as mentioned above)

● You may not like being in the pool

● Small chance baby may try to take a breath spontaneously under the water - see below

● Getting in and out of the water if you require medical pain relief and this may add stress

There is a very, very small chance that a baby may try to take a breath spontaneously under the water themselves before being brought up to the surface. However, if this occurs your LMC will take appropriate action to help.

If you decide to have a water birth at home, what supplies will you need?

A pool is the first item you need to obtain. You could choose to buy one, rent or hire from local or national suppliers or your LMC may be able to supply one. Once you've found the pool you'll use, you need to decide where in your home to put it. You should consider the weight of the pool when filled with water. Another consideration is getting it in and out of your space. A bathtub may be used, there is not a lot of space and you may feel cramped in this space.

For a birth at home, the next step will be to gather your other supplies. Most LMCs will provide some suggestions and may bring some of these items with them.

● A birth pool liner

● A strainer for scooping solid materials

● A new garden hose that is long enough to stretch from your sink to the tub

● An adapter that will allow you to attach the garden hose to your sink

● A tarp for putting under the pool to protect your flooring

● A thermometer

● Plenty of towels

At the end of the day, it's your decision where and how you might like to birth. Gather all the information you need to make an informed decision. And, think about whether you'd like to use warm water while you labour as part of your coping technique, there's nothing quite as nice as a relaxing warm pool to ease aches and pains.

■ For information about antenatal classes near you, check out From Bellies to Babies www.hbantenatal-classes.co.nz or phone 022 637 0624.

Medical disclaimer: This page is for educational and informational purposes only and may not be construed as medical advice. The information is not intended to replace medical advice offered by physicians.