Info Centre - Labour and birth in water: how and why you might use water

Why water?
Am I a suitable candidate?
Benefits of using water
Possible problems
Arranging to use a birth pool in hospital
Arranging to use a birth pool at home
Hiring a pool
How much will it cost?
Using the pool
Practical points
Other ways of using water
Some pool hire companies
Further reading

'Beneficial effects (of immersion in water during labour) include maternal relaxationi, less painful contractions, shorter labours, less need for augmentation, less need for pharmacological analgesics, more intact perinea, and fewer episiotomies.¹

Why water?

Warm water is often used by people to help them unwind and relax. A bath eases aches and pains, and a long soak at the end of a tiring day can be very relaxing.

In labour too, warm water can aid relaxation and ease pain. Birth pools have now become widely available and giving birth in water is an option for more women. Women with particular physical disabilities may find using a birth pool really helpful in labour.

A birth pool is bigger than a bath – wider and at least two feet deep – so you can move easily and keep tummy immersed in water. Many hospitals now have a birth pool plumbed in and portable pools can be hired for use at home or in hospital.

Research

There has not been a lot of in-depth comparative research, although common strands in studies show that labouring in water has these advantages over 'dry land' labour:

Women feed more in control during their labour, and are more satisfied with their birth experience.
They feel more relaxed, contractions feel less painful and they use fewer pain-killing drugs.
It is easier to move around and change positions between contractions.
Labours are slightly shorter, and less likely to be speeded up with a drip of oxytocin
There are fewer episiotomies and fewer serious tears with births in water.²
In a birth pool, you can create a quiet space around yourself. This helps you to feel private and keeps interventions to a minimum.

Am I a suitable candidate for using a birth pool?

There are no universal guidelines to indicate which women should be discouraged from using water for safety reasons. The Royal College of Midwives (RCM) has produced recommendations to suggest that the pool is most suitable for use for women who have:

Enough information to make an informed choice.
A normal pregnancy and have reached at least 37 weeks.
One baby, which is in the head first position (cephalic presentation).
Have not been given any drugs which cause sedation (eg. pethidine)
Whose waters are intact or broke spontaneously within the last 24 hours.

If you do not fit all of the criteria above, talk with your obstetrician and midwives about using water, at least for pain relief. The RCM recommends that the above criteria is used in conjunction with local policies and guidelines.

In some hospitals, or at home, you may be asked to leave the pool to deliver the placenta. In other hospitals, you may be asked to leave the pool to deliver your baby. After the birth, you may want to get back in the pool again. Talk with your midwife about the policies in your area, and your personal needs and preferences.

If it looks as though there may be any difficulty or difference between what you would like and what is offered, discuss the options well before your due date.

If you are unable to sort out your differences, it may be that another midwife, or another hospital, will be more suitable. Alternatively, contact an independent midwife.

Benefits of using water

For your baby

Your baby will be under less stress and will get a better oxygen supply if you more relaxed and warm water can help you relax. In a recent study of births in water, babies were less stressed at birth.²

You can avoid the unwanted side effects of opiate drugs affecting your baby ( pethidine, and fentanyl used in mobile epidurals), if the water helps you manage without them. These opiate drugs cross the placenta and tend to make babies sleepy, which can affect their breathing immediately after birth.

‘Sleepy’ babies can be slower to learn how to latch on and breastfeed.

In a UK observational study comparing, low-risk ‘waterbirths”, fewer babies delivered in water were admitted to Special Care.³

For you

The water supports your body so that you can move around and change positions much more easily. It might be helpful if you are a wheelchair-user and find movement on ‘dry land’ difficult. The buoyancy would enable you to rock or rotate your pelvis more easily.

Moving around in water during labour can help you cope with pain and respond to your body’s need to move the baby through your pelvis and birth canal.

Warm water can be very relaxing and may reduce pain and the need for other forms of pain relief and their side effects.

No one fully understands what stimulates newborn babies to take their first breath. If labour progresses normally and the water temperature in the pool is around body heat (37^oC) babies do not inhale while under the water.⁴

Possible problems

For your baby

Your baby’s heart-rate may increase if the water is too hot. The RCOG says water must be kept at or below 37^oC during the second stage of labour.⁵
There is some suggestion that your baby may gasp for breath too soon if the water is too cold.
In rare circumstances, a baby who is very stressed during labour may try to breathe under water.

If your midwife has any concerns about your baby’s condition during labour, she will advise you to leave the pool. Babies must be brought gently to the surface, face first, as soon as they are born.

For you

Getting into a pool may slow down your labour, so it can work well to wait until the contractions are regular and strong and getting difficult to cope with – then the soothing water can give relief but be prepared to get out for a while if your contractions slow down.

If you are asked to get out of the pool, you may suddenly feel the contractions more intensely.

“My contractions slowed right down and in the 30 minutes I was in the pool, I only had four contractions. I didn’t feel right in the water, much to my surprise. I felt I needed to be in contact with the ground”.

Arranging to use a birth pool in hospital

Many hospitals now have birth pools and each hospital will have its own guidelines on pool use. Some hospitals require women to get out of the pool to actually give birth.

The staff should provide written information as well as discussion on using water in labour and birth.

Find out how often the birth pool is actually used in your local hospital – or at different hospitals if there is more than one within reach of where you live. If the pool is used often, then it’s a good sign that the midwives are experienced in assisting women having a waterbirth.

Usually hospital birth pools cannot be booked. They are available on a ‘first come, first served’ basis. Discuss what will happen if another woman is using the pool when you go into labour.

If you decide to hire a pool to ensure that you have access to one, you can give birth at home – or may be able to arrange to take the pool into the hospital with you.

“The water was lovely. It didn’t take the pain away but helped me to cope with it. The buoyancy was a welcome relief and enabled me to change positions easily.”

Arranging to use a birth pool at home

If you are planning to have your baby at home, ask for a midwife with waterbirth experience. You may need to contact the Supervisor of Midwives at your local hospital to seek her support to help in finding a suitably experienced midwife.

If you have any difficulties, you could contact the NCT, the Association for Improvements in the Maternity Services or an independent midwife.

Think about where you will set up the birth pool:

Is your room big enough? Birth pools vary in size but are generally about 5 feet by 4 feet. Smaller inflatable pools are also available from some hire companies.You can now buy inflatable pool from NCT Shop.
Is there room for the midwife to sit beside the pool and enough floor space in case you decide to leave the pool at any time?
Is the floor strong enough to hold a large pool full of water? Talk with the pool company about the weight of their different pools when full and which one would be most suitable for your home.
Is there a convenient supply of water? How long will it take to fill the pool?
How will you empty the pool? Where is the nearest drain?
Do you have a partner or friend who can set up the birth pool and keep the water warm for you?
Is your hot-water system efficient enough to heat all that water? Or would it be better to hire a pool with its own thermostatically controlled heating system?

Hiring a pool

Birth pools come in various shapes and sizes. Some are inflatable, others more permanent structures. Some have built-in heaters; others have to be filled with water from your own hot-water system. It’s worth spending some time online, looking at all the websites of the various pool hire companies and considering the options. Companies will be happy to give you lots of information by post or over the phone as well.

Many pool hire companies also hire out videos and run workshops or study days on waterbirth.

Equipment

Equipment supplied should include some or all of the following:

Birth pool
Disposable pool liner
Pool cover to keep the water warm if you get out for a while
Two long hoses, one to fill the pool and one to empty it (never use the output hose to fill the pool)
Tap connectors
Water pump for emptying the pool
Water thermometer, sieve and bucket
Instructions for use.

You will also need plenty of hot water, unless you hire a birth pool with built-in heater. Provided that you can top up the pool with hot water when needed, there is no particular need for a water heater.

It is your responsibility to check with the company that their pool is insured and meets the safety and hygiene requirements of the NHS.

How much will it cost?

Pools are hired as ‘packages’ to suit individual needs. There is a minimum hire period, which differs from company to company, and different prices are charged for different types of pool. A pool with its own heating and filtering system obviously costs more than one without. Extra accessories are usually included as part of the package but the charge for delivery is added on separately. Pools can be delivered and collected by national carriers, so you do not have to hire from the company nearest you.

Costs (at time of publication) vary from about £110 to £400 depending on the type of pool you choose and the length of hire period.

It’s worth asking about:

Any hidden extras you may have to pay for
How much deposit is required
When you need to pay
The minimum hire period
Any refund if you are unable to use the pool for any reason.

Company policies vary significantly on these issues. You should also enquire about what happens if you keep the pool for longer than intended. There may be special arrangements if you are on income support.

Using the pool

Late pregnancy

If you are having a home birth, you can use your hired birth pool to relax in during the last weeks of pregnancy. This can be especially useful if you find it difficult to sleep at night.

Use of liners

It is important to make sure the pool lining is sterilised each time you use the pool. Some hire companies recommend that you use a sterile, disposable liner each time. Other companies recommend simply draining the pool, then disinfecting the liner after each use.

Water must not remain in the pool longer than 24 hours, unless a filtration cleaning system is fitted. It has been suggested that everyone using the pool should shower before entering the water.

During labour

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. If you feel you want to leave the pool, you should do so.

“It was lovely to sink into the warm water and within minutes, my waters broke with a real ‘pop’ – quite a release of pressure – it felt like the baby was suddenly ‘in contact’. Pete sponged water on my back which was lovely and relaxing.”

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.

If you 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.

“I was so lost inside myself, I decided not to get out of the pool. My daughter emerged into a new watery world a few minutes later.”

You know best the needs and comforts of your body while you are in labour. You may choose to stay in the pool to give birth, or find, as many women do, that dry land suits you better when the moment arrives.

Never feel guilty, or that you’ve failed, if you find that the warm water isn’t sufficient to deal with your labour pain. Everyone’s experience of labour and birth is different. What matters is that you get the support to make the choice which is right for you on the day.

“The pool was amazing. I was able to totally relax between contractions. The lights were low, we had music playing in the background and candles flickering. At one point I said out loud, ‘This is bliss”’ and it really was!”

Practical points

If you hire a pool, it is useful to try assembling it and filling it in late pregnancy, or at least have one dummy run.
Some pool hire companies recommend using a new sterile pool liner (cost approx £30) each time you use the pool. Other companies recommend sterilising the liner yourself.
Pools generally take about 30-60 minutes to fill.
The baby can be monitored 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).
You can use Entonox in the birthing pool (Entonox – a mixture of 50% oxygen and 50% nitrous oxide (also known as ‘gas and air’) which can be inhaled during labour to relieve pain. Can be supplied in cylinders for a home birth).
You will usually be asked to leave the pool for abdominal palpation and for vaginal examinations (to assess progress in labour).

Be prepared! You may need:

Water to drink
A t-shirt if you want to wear something in the water
A small plastic bucket or stool to sit on or use to climb in and out of the pool
An inflatable pillow or towel, as a head rest
A folded towel or mat for kneeling on in the pool
Sieve or fish net for removing mucus or bowel motion
Large, warmed towels for you and your baby
A thick bath robe.

Never leave children alone with a pool containing water.

Other ways of using water

“Once labour was established I had a great urge to get into a bath. I knelt on all fours with my round belly surrounded by warm water. The luxury of all the lovely warm water around me soothing my pain! However, I had no intention of staying in the bath for the actual delivery. It was such a peaceful, happy event, I felt fully in control.”

If you are interested in the idea of using water but find that a pool is not available, relaxing in a bath or shower can provide some of the benefits.

Helpful hints

Blu-Tack blocking the overflow of the bath will give a greater depth of water, although you can’t move around freely in the bath.
You can use an upturned plastic bucket or plastic chair to sit on under a shower.
Warm water can be poured over you from a jug.
A strong shower jet directed against the small of the back helps some women.

Some women have found that being in a birth pool gave them a sense of freedom and privacy, which enabled them to follow their instincts and to trust their own body during labour. Other women have found the same sense of freedom, privacy and trust in their own bodies without the help of a birthing pool.

Some pool hire companies

Many of these suppliers run waterbirth workshops and study days for parents and professionals, as well as hiring or selling videos on labour and birth in water.

Active Birth Centre

http://www.activebirthcentre.com/

Birthworks

http://www.birthworks.co.uk/

Blue Lagoon

http://www.bluelagoonbirthpools.co.uk/

Gentle Water

http://www.gentlewater.co.uk/

Splashdown

http://www.waterbirth.co.uk/