What are the benefits of using water during labour?

• There is evidence that immersion in warm water can lower blood pressure during labour.
• It is much easier to maintain active birthing positions in the gravity reduced environment of the pool.
• Water supports the mother during labour reducing the pressure during labour.
• Women have used water as a form of pain relief for hundreds of years.
• Warm water on the lower back (which is the area of the spinal chord that receives the nerves from the lower abdominal region) can reduce labour pain.
• Relaxation in the days leading to the birth (particularly those moments when you wake up in the middle of the night and can't get back to sleep)
• As an added bonus the pool can be used for special family time together before the new arrival (Children sleep very well after an hour in the pool)

 

How long can I be in the water?

As long as you need/want to be, it sometimes happens that water slows things down to a point where the midwife suggests that you get out and walk about for a bit. How long you can stay in the pool if things have slowed down will depend on

1. the experience and open-mindedness of your midwife.
2. how able you are to challenge her request to leave the pool if you don't want to. (Your birth partner and birth plan can help you here)

Why might my midwife ask me to leave the pool?

There are occasions when the midwife might require you to leave the pool for good reasons.

• An abnormal foetal heart beat
• Meconium
• Abnormal maternal observation such as high temp, pulse or BP
• Agreement on the need for an internal examination
• Midwife's intuition

The role of the midwife is to assess that labour is progressing normally, and if deviating from normal to take appropriate steps. How she assesses, and what the appropriate steps are will to a degree depend on her knowledge, experience and intuition. Therefore it is fine for you to ask for her rationale in asking you to do something you might not want to do, and to expect a reasonably detailed explanation. However, you may not be able to take in all the information, and your partner (and/or doula) can help here. When all is said and done, the midwife is legally responsible for the safe delivery of baby and mother, and if she has real concerns for you then it is advisable to accept her recommendation.

When can I get in?

When labour is "established". This is about 4-5cms dilated, or when contractions are about 2 minutes long, regular, and about 5 mins apart. Use this "tool" when you find that other techniques like massage, TENS, dancing, no longer help, when you begin to think; "now I really need something". Often, getting into the pool at this point gives a wonderful whooshing release of tension. This relaxes the muscles, eases fear and anxiety, floods the body with endorphins and quite often moves you along the road of labour quite a way.

Once in, will I be able to get out again?

You can get in and out as often as you need to. The temperature of the pool is constant there is no need to get out while the pool heats up. A plastic stool is provided to help you get in and out.

Why does the baby not drown?

A baby born without distress into water will not receive the stimulus to breathe.

Breathing may be stimulated by

• A significant drop in temperature
• Having received some distress during delivery
• Excessive handling while still underwater

The baby is still connected to the umbilical cord and receiving an oxygenated blood supply via the placenta. In water, the cord remains soft and continues to pulse after the baby is delivered, so the baby does not need to breathe until after the cord is cut.

Can I deliver the placenta in the pool?

Some midwives may prefer you to leave the pool for the third stage because it is very hard to assess blood loss in the water. You should discuss this with your midwife either before or during the early stages of labour. The advantage of leaving the pool to deliver the placenta outside it is that the water may still be reasonably clean, and you may be able to hop back in it for a quick wash while everything is being tidied up.

Why are some midwives more at ease with water birth than others?

The Midwife's Code of Practice states that midwives should operate within the sphere of their expertise. Some might interpret this to use as a get -out clause if they have not been trained in the use of water. However, the Royal College of Midwives clearly says that it is also the duty of the midwives to gain knowledge in this area in order to offer it as part of normal practice.

1. Make sure that the Community Midwives office knows that you are intending to use water and to request that an adequately knowledgeable midwife attend you.
2. Give an unfamiliar midwife a chance to extend her sphere of knowledge by accepting that she has limitations, but negotiating to go beyond them together

What is the importance of water temperature?

It is absolutely fine to have the water at any temperature comfortable to you using the pool before labour for relaxation. However, it is very important that the labouring mother does not become overheated as this may be a factor which can cause distress to the baby.

The recommended range is between 34 - 37.0 degrees C during the first stage of labour and 37.0-37.5 in the second stage. If a baby is delivered in water it must not be cooler than the average body temperature. However, remember that it is nigh on impossible to get readings accurate to half a degree in a constantly moving body of water. The important thing is to observe the floating thermometer, the thermostat and the labouring woman all together.

You may need to lower the set temperature of the thermostat.

Can I use other forms of pain relief while in the pool?

Use of other forms of pain relief such as massage, acupressure, homoeopathy, aromatherapy to mention but a few, along with loving and encouraging words from birth partner or midwife, breathing, visualisation and maybe gas and air will all help you in your "tool kit of pain relief options" which may include many of the above and others that are unique to you.

There are no side effects connected to the use of water as pain relief so it does not preclude any other form of analgesia that may be appropriate at a later time. Using water as pain relief can help you get further down the road of labour without closing doors on other options.