The World of Pregnancy

Water Birth: Is this a Safe Method?

There`s nothing more relaxing than staying in a bathtub with warm water. And if staying in water is something so relaxing, water birth maybe has meaning.

Water birth is a rather new method of birth that has an increased popularity among pregnant women, and which involves immersing the pregnant woman in water. This procedure needs to occur at a temperature of 37 Celsius degrees once those painful uterine contractions have started. Generally, the dilatation of the uterus needs to be of 3 – 4 cm.

The standard size of the birth tub should be of 2 x 1.5m and a depth of 80cm. The water needs to be warm, and the temperature needs to remain constant during labor and birth. The water`s temperature can be easily adjusted using a special device.

Some pregnant women choose to only carry labor in water, other ones give birth in water, while others even choose to expel the placenta into the water.

Water Birth: Revolutionary Method!

Although it seems like a revolutionary method, this isn`t the case.

The first water birth experience began in 1960 as a result of studies performed by Soviet researcher Igor Charkovsky which revealed the benefits of this procedure. His studies were continued and put into practice by some French obstetricians known as Michel Odent and Frederick Leboyer. They used basins with heated water for pain relief during labor.

The theory behind this procedure consists in the fact that the fetus spends 9 months of intrauterine life in the amniotic liquid, and birth in a similar environment is gentler for the baby and less stressful for the mother. This type of birth is a common practice in lots of European countries in New Zealand or Australia, and lately in the United States as well.

There are few studies regarding the risks for this procedure. Still, this specific procedure is performed under the supervision of specialized medical personnel. The monitoring of the mother and baby is made constantly, so the medical staff could perform the necessary conventional methods to the mother if any complications appear and continue with a natural birth. The monitoring of the fetus is performed with a special system of hearing the fetal heart beats simultaneously with registering the uterine contractions (external cardiotocography) but at “distance” (telemetry with no cables) and with special electrodes for immersion. The spontaneous rupture of membranes is preferred, but if intervention is still required, this will be performed as late as possible.

Benefits for Water Birth

During labor, immersion in water decreases the need for analgesic medication. When the birth occurs underwater, the vaginal trauma can be reduced. In addition, perhaps the idea of the baby moving in a liquid environment (amniotic liquid) in another liquid environment (the water from the bathtub) is appealing.

For the Baby

Birth is considered a stressful experience for the baby. Immersion in warm water facilitates a gentler transition of the fetus through the birth canal into the real world, because the warm water is considered similar to the intrauterine environment.

For the Mother

In the liquid environment, the effect of the force of gravity is reduced:  the mother can change her position without any effort, thus focusing on regular breaths during childbirth. At the same time, water birth produces a sense of intimacy which reduces inhibitions, anxiety and fear. The active role of women is supported by a calm and enjoyable atmosphere.

Pain Management

This method of birth if an efficient form of hydrotherapy in controlling pain for a variety of medical conditions and especially for low back pain (which is frequent among pregnant women). Immersion in warm water stimulates the physiological responses of the maternal organism which reduce pain (for example, redistribution of blood volume with a better cellular oxygenation) and stimulates the release of hormones which regulates uterine contractions.

Keeping the Perineum Intact with a Lower Rate of Episiotomy

This birth method contributes in relaxing the perineum and increasing its elasticity, reducing the risk of uncontrolled tears. This decreases the need of performing an episiotomy (perineal incision performed by the doctor in order to enlarge the vaginal opening and, thus to enlarge the release of the fetus). Perineal trauma is generally low, especially in multiparous.

Disadvantages of this Procedure

Possible disadvantages and risks to giving birth in the water are still debated, this being fueled by the lack of clear and concrete conclusions of the studies made over time.

In general, it can be said that this is a procedure with risks comparable with those of conventional birth.

Baby`s Aspiration

If the water if kept at the body`s temperature, it seems that there isn`t any risk of triggering the baby`s respiratory effort during birth. The baby needs to be born entirely in the water and then lifted, his head being the first part of his body exposed to the environment. He`ll breath when his body comes in contact with the environment`s cold air. Therefore, the body shouldn`t be externalized before the head, and the face (nose, mouth) should be final (no re-immersion is allowed).

However, the aspiration phenomenon is rare, but it extremely serious when it appears. The baby starts to breath in the water only if there are problems with his intake of oxygen or complications during birth which are stressful for him, a case in which the inhaled water reaches the lungs and can lead to his death.

The Possibility of Accidental Rupture of the Umbilical Cord after Childbirth

Due to the water`s relaxing effects, sometimes labor in water is associated with a decrease in the intensity of contractions, and therefore, with a prolonged labor. Consequently, some hospitals have adopted the rule of 5cm, meaning the access in the water basin is made at a cervical dilation of 5cm when the contractions are well installed, thus avoiding the extension of the initial phase of labor. The rupture of the umbilical cord is a rare complication.

The Infectious Complications of the Child Due to the Pollution of the Immersion Environment

This occurs especially during the effort of expulsion. The decrease of this complication`s incidence can be made by changing the water continuously so it can always be clean. There`s also a device which detects the emission of urine, feces, blood or amniotic liquid in the water.

The Amount of Maternal Blood Lost Is Bigger and More Difficult to Assess

At any moment during this procedure, the pregnant woman can be subject to complications which require emergency medical maneuvers, even if before labor she was evaluated with low risks and no contraindications for this type of birth. Consequently, if labor is very slow, if there`s bleeding, if the mother`s blood pressure increases or she`s fainting, the woman needs to leave the birth tub. Otherwise, the required measures in these situations can be delayed.

Another possible disadvantage is the reduction degree of the pain sensation.

Due to lack of adequate prenatal information, erroneously, water birth can be considered a painless event. In fact, labor is an experience which involves a certain degree of pain, even if it proceeds in water, and some pregnant women can be disappointed by the efficiency of this procedure.

When Is This Procedure Contraindicated?

Water birth is contraindicated in the following cases:water-birth

  • Fetus in breech presentation;
  • Hear or renal diseases, maternal hypertension (pre-existent or pregnancy-induced), diabetes, bleeding disorders, active genital herpes, hepatitis, HIV, epilepsy;
  • Multiple pregnancy;
  • Premature birth;
  • Birth after C-section.

Related Fears

  • What happens if water breaks in the bath tub? The amniotic liquid is sterile. If water breaks while you are in the basin, it won`t be necessary to change the water. On the other hand, the water from the tub doesn`t increase the risk of infection.
  • What happens if I`ll have a stool during labor or water birth? This is one of the fears of most women who choose this procedure to give birth to their future baby. If you`ll have a stool while you are pushing to give birth, you don`t need to worry as the water in the basin is changed constantly to be kept clean all the time. The basin is equipped with a special device which detects emission of urine, feces, blood or amniotic liquid in the water.
  • Is there any risk for the baby while is in the water immediately after birth? Babies are born with a diving reflex which blocks their breathing when they are in the water. Still, there isn`t any guarantee that the baby won`t inhale some of the liquid in his lungs and there were even cases of almost drowning during this procedure.

What to Do when Giving Birth in Water?

Not all doctors support this idea. If you are interested by this method of giving birth, you should try and find as much information as possible. Watch some videos online, check various info on medical websites or talk to anyone you know have already tried this.

In addition, before choosing this procedure, the future mother needs to be informed by her doctor or clinic`s medical personnel and to be prepared for what`s waiting for her.

It`s recommended to also follow some courses for water birth, practice some specific gymnastic exercises and have a discussion with the doctor in which you should have any doubts cleared with 2 – 3 weeks in advance. Therefore, in the end, you`ll be able to take the best decision together with your obstetrician.

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