Waterbirth
WHAT IS “WATERBIRTH”?
“Waterbirth” is the use of a heated water bath or pool by a laboring woman during labor and birth. Many women in labor find that being in water helps them relax and helps relieve pain. Some women prefer to stay in water at the time of birth and deliver their baby in the tub or pool. Others stay in water only part of the time during labor and choose to birth their babies out of the tub. This page describes some basic information about the use of a warm water bath for labor and/or birth at OHSU.
HOW LONG HAS OHSU OFFERED WATERBIRTHS?
OHSU nurse-midwives have offered waterbirth since 1997. We were the only hospital in the Portland Metro area to offer waterbirth until 2007. Our nurse-midwives believe it is an important option for women who approach labor naturally.
HOW DID WATERBIRTH FIRST GET STARTED?
The first recorded waterbirth was in 1803 in France. According to the story, a woman who had been in labor for 48 hours climbed into a tub of hot water to relax and her baby was born shortly afterward. Not much is mentioned again about the technique until the 1960s when a Russian scientist, Igor Charcovsky, began experimenting with the use of warm water immersion for women in labor. He wanted to see how the warm water affected their labor, the birth and newborn behavior. Then in the late 1970s through the 1980s various obstetric practitioners began using warm water baths for laboring and birthing women. Dr. Michel Odent in France and Dr. Michael Rosenthal in California collected information about its effects, and women who had experienced waterbirth told their stories. Interest in the idea gradually spread around the world.
WHAT ARE THE BENEFITS OF WATER DURING LABOR AND/OR BIRTH?
Soaking or floating in a pool of warm water seems to help your body relax more easily because water creates a sense of weightlessness. Your muscles don’t have to work so hard to support you during labor and there is no pressure on your body to cause local discomfort. This can lead to more relaxation and a sense of reduced pain with the contractions.
Some researchers feel that being in water improves blood flow to all parts of your body, especially your uterus. They have observed that during labor your blood pressure may be lower if you soak in a tub of warm water. They also feel that improved blood flow may protect your baby against fetal stress. Because being more relaxed and more comfortable lowers stress hormones caused by labor pain, some researchers have found that labor may be somewhat shorter if warm water immersion is used. Other researchers have not found any great difference in the length of labor.
Being in a tub of water that is heated to a normal body temperature can help maintain your own body temperature at a stable level during labor. You may be less likely to become chilled or overheated.
While research suggests that few episiotomies are performed in women who use warm water baths for birth, it is not certain that there really are fewer tears compared with delivering in a bed.
Most women who have used warm water baths for labor or birth report very positive feelings about it. They report less pain, a greater sense of relaxation and a greater sense of control.
ARE THERE ANY PROBLEMS ASSOCIATED WITH LABORING OR BIRTHING IN WATER AND HOW CAN THEY BE PREVENTED?
Labor
Some researchers have noted that if a laboring woman gets into a warm bath too early in labor, it will slow down her labor and space out the contractions. Because of this, many experts recommend that a laboring woman wait until labor is well established and her cervix is at least four centimeters dilated before using the tub.
Others have noticed that labor goes faster if the woman is four centimeters or more dilated before she gets in the water. Labor may slow down if the woman stays in the tub continuously for more than one or two hours. There is no good research on this yet. If labor slows, the logical thing to do is to walk around for a half-hour or so and then get back in the tub. Many people who have participated in waterbirths report that the pushing stage is easier and shorter.
SAFETY FOR THE BABY
Water Temperature
If the temperature of the water is either too hot or too cool it can cause undue stress for your baby. The temperature is maintained close to 98 degrees and laboring women are encouraged to stay hydrated and comfortable. Your baby’s heart rate may go up if overheated. A rapid heart rate could also indicate infection or distress, so it must be evaluated carefully.
Breathing
Another concern for your baby is what happens if your baby is born underwater and then tries to take a breath. We know that a healthy baby who is not in distress will begin to breathe only when he or she feels cool air on its mouth and nose. Thus, if you are giving birth in a tub, you must have your bottom and hips completely under water to prevent your baby from taking a breath. If your pelvis is partly in and partly out of the water during actual birth, air could touch your baby’s mouth and he or she could inhale before the whole birth is completed. Once born, your baby is raised gently to the surface and cradled in your arms with his or her face out of the water. Then your baby will start breathing safely.
Body Heat
Babies can lose heat very rapidly. It is important to make sure the water in which your baby is born is at least body temperature. That way, the baby will not get chilled. A cold baby uses more oxygen and can be slow to breathe and nurse.
Infection
Infection can occur from two sources. One source is germs that you might carry in or on your body and the other source is germs that might be present in the pool or water. Because the birth always involves the release of body fluids, researchers have looked at the potential for infection. During birth, you will lose fluid from the bag of waters, pass urine, blood and sometimes stool. Fluid from the bag of waters and urine is usually sterile. There are normally no germs in those body fluids. 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.City water has chlorine in it to kill germs, and city water is what goes into our tubs So the chance of infection due to water contamination is remote. Also, if there are bacteria or viruses in body products or fluids, the amounts are thinned out with exposure to a large tub of water. That makes the germs less able to cause infection.
The tubs go through a thorough cleaning process with special cleaning products that kill germs after each use. To prevent cross-infection between you and healthcare providers, healthcare personnel wear special gloves and gowns during examinations and the birth.
Fetal Distress
Labor is stressful for both you and your baby. Nature has equipped healthy babies and mothers to handle that stress. Fetal distress occurs when your baby’s ability to cope with labor is compromised in some way. A problem can show up in labor and be recognized by changes in the baby’s heartbeat, or a problem might show up shortly after birth. Sometimes a stressed baby will have a bowel movement in the amniotic fluid before it is born. Checking on how babies are handling labor is managed the same way for all babies whether or not you labor or give birth in water. Typically babies are monitored electronically for 20 minutes or so when you first arrive in the hospital. In active labor the heartbeat of every baby is monitored with a waterproof Doppler (special stethoscope) every 15 minutes. If there are indications that your baby is experiencing a problem, you may be asked to leave the tub and the electronic heart rate monitor will be used.
SAFETY FOR THE LABORING WOMAN
Infection
The same principles about infection described above apply to the laboring woman. Research shows that water does not enter the birth canal and travel upward during labor and there is not increased incidence of infections of the birth canal or uterus because of a waterbirth.
Bleeding
It is very hard to estimate the amount of blood a woman passes after she delivers the placenta (afterbirth). This is true whether the woman is delivering in a bed or a tub. There is some research that suggests a slightly greater amount of blood loss after a waterbirth. The nurse or midwife will check your uterus frequently to make sure there is no excessive bleeding. If there is a concern, you may be asked to exit the tub for an examination and/or treatment.
Hydration
The combination of hard, physical work (labor) and immersion in a warm tub of water can lead to loss of body fluids through sweating. Dehydration (not having enough liquid in the body) can cause an increase in your heart rate and a mild fever. You will be asked to drink at least 8 ounces of clear fluids every hour to prevent dehydration
WHAT KIND OF EQUIPMENT DOES OHSU HAVE FOR WATER USE IN LABOR OR FOR BIRTH?
All of our birthing rooms are equipped with a Jacuzzi bathtub and shower. A woman in labor can use either one. The Jacuzzi is not very deep and is not big enough for using for a planned waterbirth. A special waterbirth tub is available to you if you have requested this option and have registered with the nurse-midwives. The tub can accommodate you and your partner comfortably. Cost for use of the tub is $100. This fee covers the cost of single use liners, special cleaning and equipment and a mandatory waterbirth class.
WHAT HAPPENS IF THERE REALLY IS A PROBLEM?
The health and safety of you and your baby are the primary factors that influence decisions about your care. A problem for you or the baby will be handled in the same manner whether you are planning a waterbirth or a birth in bed. All maternity patients at OHSU have access to monitors, medication, obstetric specialists, pediatric specialists and surgical procedures as needed.
Certain kinds of problems would not permit the use of the water tub. If a particular concern arises when you are already in the tub, you may be asked to move back to the bed. In general, your pregnancy must be normal with no sign of high blood pressure, diabetes, previous c-section, or problems with the baby. If you have medical or obstetrical problems that put you and your baby at high risk, you would not be allowed to give birth in the tub. In some instances, you may labor in the tub, but would be required to come out of the tub for delivery only.
IF I WANT A WATERBIRTH, HOW CAN I ARRANGE IT?
You must be a patient of the nurse-midwifery practice to have a Waterbirth.
To make an appointment with the nurse-midwifery service
Please call the OHSU Center for Women’s Health at 503 418-4500.
WHERE CAN I GET MORE INFORMATION ABOUT WATERBIRTH?
The organization Waterbirth International was formed to encourage research, distribute accurate information and help people who were interested in the concept successfully implement the use of water baths for labor and birth. Waterbirth International has sponsored several international conferences on waterbirth. It is a great resource for books and videos.
They may be reached by phone, 503 673-0026. Their Web site is http://www.waterbirth.org.
