Use of water birthing pools in labour
How can I use a birthing pool during labour before a water birth?
Whatever the stage of labour, you may find that when you get in the birth pool, you enjoy the sensation of the warm water and can find a comfortable position. Be guided by your own feelings and talk to your midwives, when the time comes. If you feel strongly that you want to get into the pool, you may well benefit from using it. However, don’t be in too much of a hurry to get into the birth pool. The water will probably work better for you if you wait until your cervix is at least 5 centimetres dilated.
Warm water can help if your contractions are coming quite strongly and frequently, or your back is uncomfortable and you want to relieve a feeling of pressure. Partners can get in the pool with you if you want, and it's best for everyone to shower first if possible.
Remember to drink plenty of water, juice or other fluids while you are in the pool, because you will be using up energy and sweating. Your may find it easier to drink from a straw. But it’s better to aim to keep your bladder emptied during labour to leave as much space as possible in your pelvis for your baby.
Keep the temperature of the water at or below 37ºC at all times (35º-37º is optimum during the first stage of labour and 37º-37.5º during the second). If you become overheated it can cause distress to the baby and discomfort to you.
If your labour is progressing slowly in the water, you might try moving into different positions or getting out and walking around for a while. Squatting, kneeling on all fours or going up and down stairs can help move the baby into a good position for birth.
If you feel you want to leave the pool, you should do so. You know best the needs and comforts of your body while you are in labour. If you find that the warm water isn’t sufficient to deal with your labour pain, move to other strategies. You should not feel that you have to use the pool just because it is there – you may not want to get into it at all, and that choice is yours.
What different positions can I use in the birthing pool?
You could think about trying different positions before giving birth in water:
- Kneeling, leaning on the side of the pool.
- Squatting, holding the sides of the pool.
- Using floats under your arms for support.
- Floating on your back with your hands holding the sides and your head supported on a waterproof pillow.
- Floating on your tummy with your head turned sideways, resting on a pillow.
If your birth partner gets in with you, you could try sitting with your back against him or with your arms round your partner's neck.
What is the midwife’s role during waterbirth?
The midwife’s role is to:
- Ensure the temperature of the water is right.
- Help you get in and out of the pool.
- Check your temperature, pulse and blood pressure are within healthy ranges .
- Keep a check on how often your contractions are coming, and encourage you to empty your bladder.
- Monitor the baby's condition.
She may ask if she can carry out an internal examination while you are in the water, or she may ask to do one after you have been to the toilet, while you are out of the pool. Your baby can be monitored while you are in the birth pool using a hand-held Doppler with a waterproof cover, such as a condom (A Doppler is a ‘sonicaid’ or small machine using ultrasound vibrations to listen to the baby’s heartbeat).
Can I use other pain relief in the pool?
You can use Entonox in the birthing pool (Entonox is a mixture of 50% oxygen and 50% nitrous oxide also known as ‘gas and air’) which can be inhaled during labour to relieve pain. Entonox can be supplied in cylinders for a home birth.
When might I need to get out of the pool?
Sometimes you may be asked to leave the pool during labour. Reasons for this might incude:
- changes in the baby’s heart rate;
- meconium (baby’s poo) staining in your waters;
- bleeding from your vagina during labour;
- if you develop a high temperature, pulse or blood pressure;
- if the water becomes heavily soiled.
Try to get out of the pool to go to the toilet. You may also be asked to leave the pool for abdominal palpation and for vaginal examinations (to assess progress in labour).
If your labour slows down after about two hours, it may be wise to leave the pool – you can get in again later. You may choose to stay in to give birth, or find, as many women do, that dry land suits you better when the moment arrives. You will probably get out of the pool for the delivery of the placenta.
When you get out, you need to be wrapped in a warm towel or a soft warm robe. If you are wearing a T-shirt in the water, it’s best to take it off while you are out so as not to cool down too much.
What happens when the baby is born in the water?
If you are in the pool when the baby's head is born, aim to keep your bottom and his head under water. In this way, the breathing reflex will not start too soon. The next contraction will probably bring your baby's body out.
Your baby will not float as there is no buoyancy from air in the lungs yet. The feeling of air on the skin, and a change in temperature, triggers the breathing reflex. He is still getting oxygen via the umbilical cord, which is attached to the placenta inside you.
Usually your midwife will lift him gently to the surface of the pool, face first, and hand him to you. Or she may guide you to lift him slowly yourself, being careful not to pull on the umbilical cord.
You can cuddle your baby to your breast straight away if you want to, keeping his head above the water, and body submerged to stay warm.
One of the benefits of water birth is that babies born under water are often calmer than babies born in air, and may not cry or move vigorously. Your midwife will check easily from your baby's colour whether or not he is breathing properly. Enjoy the first moments of your baby's life as he starts to look around him.
If the pool is kept at body temperature and you and your baby want to initiate breastfeeding in the pool, this will help contract your uterus to expel the placenta. Make sure your baby is warm enough.
You may be asked to leave the pool, or you may want to leave the pool for the delivery of the placenta. This is because women sometimes feel faint during the third stage of labour and it may be difficult to get you out of the water if you feel strange. Most hospitals and birth units have a policy of delivering the placenta out of the pool. You can always get back into the water later if you wish.
NCT's helpline offers practical and emotional support in all areas of pregnancy and early parenthood: 0300 330 0700. We also offer antenatal courses which are a great way to find out more about labour and life with a new baby.
The Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives have produced a joint statement on immersion in water in labour and during delivery.