Thinking of using a birth pool in labor and have questions ? Lina Duncan, Midwife (Mumbai Midwife) shares what you can expect if you decide it’s for you.
What is water birthing?
Water is a medium we often use for comfort. We like hot or cold water to drink, to shower in, our bodies are mostly made up or water. Babies grow in water in the womb. Women may choose water as a harmless pain relief. They may or may not continue on to birth in water, although many do as it’s mostly too comfortable to move out of. The aim of water is to be a useful tool for the mother. Movement is easy in water. Forward leaning positions oxygenate the baby well (as opposed to lying down etc as in most hospitals) The mother can get in and out as she pleases. We encourage her to hydrate herself with fluids and to eat regular little snacks for energy. The baby’s heart beat can be monitored regularly with a waterproof doppler so the mother does not need to get out for check ups.
Is it safe?
Yes. It’s very safe. Like any choice in childbirth ,the mother and her companion will have gone through options with her care provider and checked what choices are suitable for her. It’s not safe to be in water if :
- The water is too hot. It shouldn’t be over 38 degrees.
- The woman has a fever (over 99.5 or 37.5)
- The baby’s heartbeat varies frequently out of the normal range and does not maintain a stable baseline. (normal range is 120-160 beats per minute)
- If the mother does not like and feel comfortable in water, she should not be pressured to be there
Water birth vs. Just Laboring in the Water
Many women report a 40-60% pain relief once they enter warm water. I see 100% smiles when women first enter the small pool and sink their hard-working body into the warm water. We encourage movement in the pool and also for the women to hydrate and frequently use the bathroom to pass urine so a full bladder does not block the baby’s pathway. Being in water is very calming and helps women relax. It’s more private and dignified. Some women who only envisioned using water for pain relief, surprise themselves by staying in, and birthing in the water. As a midwife we have no goals or expectations at all. We try as much as possible to follow the wishes of the woman and her partner. It’s up to her where and how she eventually gives birth.
Can anyone have a water birth ?
There are some conditions of pregnancy or pre-existing conditions where it is not recommended.
- If the woman hates water (maybe a family member is keen, but if she does not like water, forget it!) Ive seen it happen!
- Conditions that rule out natural spontaneous labour such as PIH Pregnancy Induced Hypertension, Diabetes, A very high BMI (overweight) . These are not absolute rules, but guidelines, and each woman must evaluate what she wants and what is possible for her situation. Water is not magic! If a woman is unfit and unhealthy and unprepared for birth it probably would not be of help to her. In the same way the care provider cannot just start facilitating water births if their mindset of birth is very medical.
- Induction, augmentation, episiotomy and other medical interventions should not be done in water. For Indian doctors wanting to pursue water birth, it’s best to first practice non-interventive births outside of the water, avoiding episiotomy, letting the birth proceed at it’s own pace as long as mother and baby are well etc. Its also good to work alongside midwives with experience in waterbirth.
What are the benefits of delivery in water?
One of the main benefits is the gentle nature of the birth for the baby. We rarely consider the baby when it comes to childbirth. For the woman it’s very private and dignified. Women say the water made them feel safe and like they their own space where people could not just invade that. In the water women often feel less inhibited to reach inside and touch their baby’s head just before it’s born. This can give her a huge encouragement for those last few minutes. She can easily catch her own baby. We encourage women to reach out for their baby as it emerges into the water. How special to be the first one to touch your own baby! Baby is often very calm and enjoys the mother’s skin and gentle touch and hearing her voice. When the baby is with the mother there is no trauma of separation as most babies experience in hospitals around the world. Often the parents choose OCC or DCC Optimal / Delayed cord clamping. This is the guideline in the UK, to let the stem cells and blood go to the baby as intended. “Research has shown that when umbilical cord-clamping is delayed for 5 minutes, a newborn’s blood volume increases by 61% to 126 ml/kg, for an average total of 441 ml. This placental transfusion amounts to 168 ml for an average 3.5 kg (7.7 lb.) infant. One-quarter of this transfusion occurs in the first 15 seconds, and one-half within 60 seconds of birth” (Robin Lim) Babies with optimal cord clamping have better iron levels at 4 months of age.
Also, water often speeds up the process of birth. The woman can change positions with ease as the weight of her baby and body is buoyant in the water.
Can I be in water if my amniotic sac has ruptured?
Yes as long as the mother has no signs of infection.
How is the baby monitored during water birth?
With a waterbirth doppler and also with extra monitoring as required For example when a woman wants to use water and has a previous cesarean. She may choose water for labor for a VBAC (Vaginal Birth After Cesarean) It is recommended by UK guidelines to have a 4 hourly monitoring on the Electric Fetal Monitor machine, She would have to get out of the water for this as currently there are no underwater CTG machines in India.
*These are pictures from home births and water births attended by Lina Duncan
What keeps the baby from breathing underwater?
The baby has a “dive reflex” which prevents the breath happening until the baby arrives into the air. Think about the birthing pool as an extension of the womb. The baby grows in water and is born in water. It is very gentle.
An experience to remember -Lina Duncan
‘The first water birth I attended in India was outside a small bungalow in a compound building in Thane. The American woman and her Indian husband chose to birth at home and they had purchased a paddling pool from Crawford market. It was boiling hot in April and May and for relief from the heat the pregnant mother would often go relax in the water to cool down. She made a little enclosed area with bamboo and sheets for privacy. Of course it wasn’t sound proof though! I remember clearly the birth day. My colleague and I jumped on a fast train to Thane and then got a rickshaw to their home. The home birth bag was already kept ready and we had previously met her lovely doctor. He had told us “I am here for you 150% and go off and have a lovely birth. I hope I don’t see you”
It’s important to have a doctor involved in case at any time we need to shift into a medical setting, or the mother chooses to.
So we arrived and were greeted by some of the numerous dogs of the house! Our friend was already looking quite active and soon we were filling the pool with clean water. Her mother – in law came to help at some point. It was sweet to see her hiking up her sari , enter the rather large pool, to rub her daughter in law’s back and comfort her, without words. She was a strong and silent supporter, these are the best kind! As dusk arrived so did the baby. We had a torch and some soft lighting. His mama had moved, danced, relaxed, jiggled and aided her son on his journey earth-side. He had 3 cords looped around his neck (we call them necklaces, not nooses) but that wasn’t a problem and we untangled him gently as he arrived onto his mama’s chest where he was greeted in love and peaceful welcome. I had made some phone calls to other midwives in India (there are only one handful) and they had generously given their wisdom and experience to me and offered to answer my phone if anything was needed. It’s great to have support from people in the same tribe / mindset and we went on to have such a special waterbirth at home.
Midwives and doulas are guardians of the birth process. We “hold” the space so women feel comfortable and strong in themselves to birth their babies. Sometimes we are also panni wallas and photographers too!
What to know about a Doula ? Read more stories here
*These are pictures from home births and water births attended by Lina Duncan