Dr Karen Joash, obstetrician and gynaecologist at The Portland Hospital, explains the benefits of opting for a water birth

The decision to have a water birth is becoming increasingly popular amongst expectant mothers.

Water labour is often used as a tool to cope with pain, while some mothers will choose to deliver in the water, either by entering the pool from the early stages of labour and throughout, or right at the end of their labour, just before their baby is born.

Water labours are renowned for the effect they can have on relaxation during the most painful parts of giving birth.

The pool promotes the release of hormones called endorphins which are our bodies’ natural painkillers, helping us to manage pain, in turn, this can also lead to a slightly shorter first stage of labour.

It also has the added benefit of lowering the mother’s blood pressure without reducing placental blood flow.

The buoyancy effect also means women feel more mobile in water, and find it easier to get into good positions for labour.

Women that opt for a water birth are often less likely to need an epidural. For this reason, NHS UK guidance recommends water birth as a natural way of coping with labour pains.

A 2017 Care Quality Commission survey showed that 18 per cent of women are likely to use water as a form of pain relief in labour, with 10 per cent of women giving birth in the pool.

Is a water birth right for me?

Traditionally this was a birth choice mainly reserved for low-risk pregnancy, but increasingly women with other conditions, such as previous caesarean, are being allowed to go through labour in water with careful monitoring of both mum and baby.

The best time to enter the water is usually after 5cm, when the contractions are coming every three minutes: this is when labour is established.

In some cases, water immersion may slow down the contractions; in these cases, the women are encouraged to leave the pool and mobilise to encourage the contraction frequency to increase.

Once in the pool, the temperature should be keep between 35-37˚C in the first stage of labour and 37-37.5˚C in the second stage. If women become overheated, it can effect the baby’s heartbeat.

If there are any concerns about the mother’s observations or the baby’s heartbeat, she may be asked to leave the pool. If any excessive bleeding occurs or meconium is passed from the baby, she’ll be asked to leave the pool so the baby can be more closely monitored.

What happens during a water birth?

In the pool, the baby is monitored with an underwater doppler device every five to 15 minutes, depending on the phase of labour. The mother may be checked with a vaginal exam or the practitioner may use an underwater mirror to check if the head is visible. When the time is right, she’ll be asked to push.

The head will deliver, and shortly afterwards the shoulders, which may be with the next contraction. The practitioner will lift the baby out of the water on to her chest.

Some women may be asked to leave the pool for delivery of the placenta, particularly if they plan to keep it or extract stem cells.

Does a water birth reduce tearing?

The studies around water births are mixed. Some groups cite that the risk of tearing is reduced. Another study showed that the risk of third-degree tear was higher; however, this was related to a very fast pushing stage.

The birth attendant can’t support the perineal area to offer tear protection during the birth, due to the risk of stimulating the baby before it’s out of the water.

The woman should thus be encouraged to breathe slowly as the head is crowning. Techniques such as antenatal perineal massage may also be used to try and reduce the risk of tearing in the second stage of labour.

There have been some concerns about the baby inhaling water into its lungs, but the lungs aren’t inflated until the first breath is taken, and studies have shown little difference in the health of babies born in water in comparison to those in air.

The rates of infection are also similar, and there’s no increase in the rates of those requiring special baby unit care.

Current NICE guidelines are that water immersion is a safe and useful tool in labour and should be offered to all women without contraindications, such as breech babies, multiple births, herpes, pre-term delivery and some chronic medical conditions.

Recovery after a natural birth is usually quicker, due to the relaxing effects of water which promote energy conservation during labour.

Original article at https://www.baby-magazine.co.uk/water-birth-advice/