Risks and Safety Concerns
Your care team will work with you to safeguard the health of you and your baby during waterbirth. Being well informed is essential and will help you avoid frustrations and complications.
Safety for the baby
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.
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.
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 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 germs less able to cause infection.
A new tub liner and hose is used with each patient. 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.
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.
Umbilical cords vary in length. As the baby is brought up to the surface of the water, it is important that the umbilical cord is not pulled. Tugging hard on the umbilical cord could tear it, which might cause the baby to lose blood through the cord. This is a rare event. The midwife will assist you with bringing the baby to the surface gently so that the cord is not pulled.
During birth, it is common to find the umbilical cord wrapped around the baby's neck. When the birth happens underwater, we may have to unwrap the cord or move the baby through the cord just as we do when the birth occurs out of the tub. Sometimes, the midwife may ask the woman to change positions or stand up in order to unwrap the cord.
Safety for the laboring woman
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.
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.
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
Length of 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.