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Using water in labour and birth
This information sheet has been written to help you decide whether you would like to use a birthing pool during your labour. It tells you the results of the research that has been done so far on women using water for labour and birth, and should give you a better idea of the advantages and disadvantages.
If you do decide to use water for your labour there are some practical things to consider, such as hiring or buying a pool for a home birth, or arranging the use of the birth pool in a hospital. For practical information on planning to use a birthing pool see the NCT booklet Labour and birth in water.
Why use water in labour?
While some women immediately find the idea of using water in labour appealing, others think it strange that human beings (land-based mammals) would choose to go into water to labour. The reasons that immersing in water during labour may be helpful are largely the same as those for taking a long, warm bath – it is relaxing, soothing and comforting.
There are also other benefits, and some cautions, as detailed on this sheet. Although there are several recent studies and audits on water birth, there are no recent figures for the number of women who use water during labour. In 1994–96 about 1 in 200 women giving birth in England and Wales had a water birth. Nearly one in ten of these were at home and over three quarters were in the south east of England. Many more women use water during part of their labour, and get out before giving birth.
The advantages
Different research studies show slightly different findings but, for the most part, labouring in water has been shown to have the following advantages over ‘dry land’ labour:
- Women feel more in control during their labour, and are more satisfied with their birth experience.
- Women feel more relaxed, their contractions feel less painful and they use fewer pain-killing drugs (pethidine, epidurals).
- Labours are slightly shorter, and less likely to be speeded up with a drip of oxytocin.
- You can create a quiet space around yourself, helping you to feel private and keeping interventions to a minimum.
- Having a pool available is one of the top criteria listed for improving a woman’s birth environment.
One study, which compared birth in water with birth on dry land, found the following advantages:
- Much less chance of an episiotomy (a cut to increase the vaginal opening) or a tear to the vaginal area – so less likely to need stitches.
- Fewer babies needed to be admitted to a special care baby unit after a water birth.
Click on this link to see an enthusiast for birthing pools (and NCT classes) in action...
The disadvantages
Although many thousands of women have now used water for their labour or birth, most of the research done so far has been on quite small numbers of women, so it is not possible to make a full comparison between the safety of labour and birth in and out of water. As far as we can tell, there is no increased risk of a baby dying or being damaged as a result of the mother using water in labour. Nor is there any overall risk of a baby coming to harm through being born in water, although there have been a few cases where doctors think that a baby short of oxygen may have breathed in some water just after being born. In one or two instances, this probably contributed to the baby dying.
One of the main concerns people had when women first started to use water in labour was that this would lead to more infections among both the mothers and babies. This has not turned out to be a problem – probably because of the very strict rules about hygiene which hospitals and midwives adhere to.
Which women can use a birth pool?
A joint statement produced by the Royal College of Obstetricians and Gynaecologists, and the Royal College of Midwives said that: ‘All healthy women with uncomplicated pregnancies at term should have the option of water birth available to them and should be able to proceed to a water birth if they wish.’
You may find that your local unit, or midwives, impose more precise restrictions on your eligibility for a water birth. If you are told that you are not eligible for using water in labour, but you think that it is the right choice for you, you can ask to speak to a supervisor of midwives, a consultant midwife or a senior obstetrician. If you make it clear that you accept responsibility for the decision to use water, they may be willing to record this in your notes and support you in your decision. The user reps on your local Maternity Services Liaison Committee may also be helpful.
Some precautions In order for the use of water to be as safe and helpful as possible, the following precautions are suggested. These have not been proved by research, but are based on experience and an understanding of the hormonal control of labour.
During labour:
- Don’t be in 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.
- Drink water freely while you are in the pool, according to your thirst.
- Keep the temperature of the water at or below 37ºC at all times. If you become overheated it can have a bad effect on your baby.
- If your labour slows down after about two hours, it may be wise to leave the pool – you can get in again later.
During a water birth:
- Sometimes you may be asked to leave the pool during labour. Reasons for this might be, for example, abnormal changes in the baby’s heart rate; meconium (baby’s poo) staining in your waters; or any bleeding from your vagina during labour.
- Once the baby has fully emerged from your body, bring the baby’s face to the surface as soon as possible after the birth so that it can breath air freely.
- Most units have a policy of delivering the placenta out of the pool. 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. You can always get back into a clean pool of water later if you wish.
Making the decision
If you are not sure about using water in labour, it may help to speak to other women who have done so – you can ask your local NCT branch to put you in contact with someone. One of the nice things about deciding to use water in labour is that you can change your mind at any time. Some women who have planned to have a water birth have found that when they got into the water in labour they didn’t like it. Other women have found they got in and out of the pool during labour according to how they felt. Most women love the feeling of being in water and stay in for the whole of their labour and even the birth. It is up to you.
Your local situation
Probably about half the maternity units in the country have birth pools. If you plan to use water during labour and your local unit does not have a pool, or you are going to give birth at home, then you will need to hire your own pool. Details of companies from which you can hire or buy a pool are given in the NCT booklet Labour and birth in water (please see details under ‘Further information’).
Even if your local unit does have a birth pool, there is a great difference from unit to unit in how much the pool is used. This appears to be due to the attitude of the midwives in the unit, the strictness of the guidelines, and the number of midwives who are trained to attend women in water. Asking the labour ward manager how many women use the pool per year may give you an idea of how easy it will be to obtain use of the pool. The more times it is used, the more experienced and confident the midwives will be.
If you require further copies of this information sheet, or others in the series, you can obtain them from NCT Shop.
Further Support
The NCT holds a special experience register to enable mothers to talk to other mothers who have had similar experiences. Contact the enquiry line on 0300 330 0770 or email enquiries@nct.org.uk
Further Information
Choosing a Waterbirth (£5.50). Available from AIMS www.aims.org.uk
The Use of Water in Labour and Birth . Royal College of Midwives Position Paper 1a. Available from www.rcm.org.uk
Alfirevic Z, Gould D. Immersion in water during labour and birth. Royal College of Obstetricians and Gynaecologists/Royal College of Midwives – Joint statement No.1. Available from: http://www.rcog.org.uk/index.asp?PageID=546
Do You Want a Waterbirth? MIDIRS Informed Choice leaflet 11 for women. Available from www.infochoice.org
A Guide to Water Birth, 12-minute video (£29.50).
Available from www.birthinternational.com
Useful websites
www.homebirth.org.uk/water.htm
www.radmid.demon.co.uk/waterbirth.htm
www.independentmidwives.org.uk
If you would like further copies of this information sheet (Code 1711), click here; other sheets in the series can be obtained from NCT Shop at www.nctshop.co.uk or on 0845 8100 100.
Page lasted updated 2008.
