The following is an excerpt from Gentle Birth Choices by Barbara Harper, RN, Director of Waterbirth International Research, Resource and Referral Service
A Gentle Beginning for a New Life
Most people find great comfort and repose with water. Perhaps because we begin our lives surrounded in liquid in the womb, this basic familiarity stays with us throughout our lives. Human beings are comprised primarily of water, and many special characteristics we have link us to aquatic mammals, perhaps carrying the memory of a time when the human species had an "aquatic interlude." A three-day old fetus is 97 percent water, and at eight months the fetus is 81 percent water. By the time a human has grown to adulthood, the adult body is still 50 to 70 percent water, depending on the amount of fatty tissue.
Human beings' natural alliance with water is best witnessed in human babies who can swim naturally and easily long before they learn to sit up or crawl. During their first year of life, babies will calmly and happily paddle underwater, gazing around with eyes wide open. When they need to breathe, they naturally paddle toward the surface of the water before taking a breath. Babies instinctively know not to breathe while their heads are still submerged underwater. They wait until they reach the surface of the water before breathing. It seems to be only later that humans lose these instincts and become more prone to drowning.
Soaking in a tub of water to ease labor sounds inviting to most women. And for women who find water soothing and comfortable during labor, they usually want to give birth in water. However, laboring in water does more than merely relax and comfort the woman. Resting in a warm tub of water actually facilitates the progression of the latter stages of labor. Many women report a sensation like an "energy surge" that moves through them as soon as they step into the water. While a woman in labor relaxes in a warm pool, free from gravity's pull on her body, and with sensory stimulation reduced, her body is less likely to secrete stress-related hormones. This allows her body to produce the pain- inhibitors, endorphins, that compliment labor.
The hormones that are released during stress, noradreneline and catecholamines, actually raise the blood pressure and can inhibit or slow labor. Dr. Serge Weisel presented his findings from a study of women laboring in warm water in Belgium at the 1987 Pre & Perinatal Psychology Association of North America conference. Weisel stated that women with hypertension (high blood pressure) experienced a drop in blood pressure between 10 to 15 minutes after entering a warm bath.
Being more relaxed physically, a laboring woman is able to relax mentally. Many women, midwives and doctors acknowledge the analgesic effect of water. One obstetrical nurse who had a waterbirth, described sitting in a tub of warm water during labor as similar to "getting a shot of demerol, but without the side effects." Others have referred to the pool in labor as "a wetepidural." Women achieve a level of comfort in the water that in turn reduces their levels of fear and stress. Women's perception of pain is greatly influenced by their levels of anxiety. When labor becomes physically easier, a woman's ability to calmly concentrate is improved, and she is able to focus inward on the birth processes.
Water helps some women reach a state of consciousness in which their fear and resistance are diminished or removed completely; then their bodies relax, and their babies are born in the easiest way possible. Mothers feel not only relief, and although exhausted, they often feel exhilerated, estatic and delighted from having the full birth experience in such a wonderful way, and knowing the baby also has experienced little or no trauma! This is a positive result unknown in hospitals not equipped for water birthing.
Many women report being better able to concentrate once they get into the water. Doctors and midwives who attend waterbirths find that the mere sight and sound of water pouring into the tub helps some women release whatever inhibitions were slowing the birth, at times so quickly that the birth occurs even before the pool is filled. Often times women get in the pool to labor and the birth happens before they can get out of the pool.
Another benefit of waterbirth is the elasticity that water imparts to the tissues of the perineum, reducing the incidents and severity of tearing and the need for painful stitches or episiotomies. On the occasion of his 100th water delivery, Michel Odent reported that in the 100 waterbirths he had attended, there were no episiotomies performed and only 29 cases of tearing, all of which were minor surface tears. A 1989 nationwide survey published in The Journal of Nurse Midwifery on the use of water for labor and birth reported less incidents of perineal tearing with less severity.
The ease of the mother who labors and gives birth in water becomes the ease of the child who is born in the water, as well. Gentle alternatives that make birth easier for the mother most likely will make birth easier for the child. Their body responses are intricately linked. While the child is in the womb and when he is passing through the birth canal, the mother's experience influences the child's experience. The emotions the mother feels can also be felt by the child because the hormones her body secretes in response to her emotions are absorbed by the child.
In a medically controlled birth, any drugs or synthetic hormones that the mother receives would also be received by the child. If the mother's delivery is easy and smooth, so too is the child's birth. He spends less time in the cramped birth canal and is free from the fear, frustration or other painful emotions which a long and difficult labor might arouse in the mother.
The baby emerges into the water and is "caught" either by the mother herself or the birth attendant. In the water, the child has freedom of movement within familiar fluid surroundings. A baby's limbs can also unfold with greater ease during those first moments when he leaves his mother's body and enters the water. The water offers a familiar comfort after the stress of the birth, reassuring the child and allowing his bodily systems time to organize.
During the birth babies often open their eyes, move in all directions and use their limbs. The shock and sensory overload which are so often an inextricable part of birth are mitigated. Lights and sounds are softer when perceived from under the water, and even the touch of his mother's skin to his own tender skin is softened by the presence of a familiar element: water.
Also, in some cases, the mother may wish the entire family to be with her during this very special time for everyone.
This element of water, familiar and secure for the baby, becomes comforting and relaxing for the mother. The mother and baby together are profoundly affected by this gentlest of gentle births.
Waterbirth : The Power of Water
By Dr. Sarah Buckley
First published in Australia’s Parents Pregnancy, Winter 1999, as “The Power of Water”
Water. It’s the first medium of life, and where we all began. When we are pregnant, our bodies are the pool in which our babies float; perhaps this is why water holds a particular attraction in pregnancy, labour and birth.
There are stories of babies being born into water from all over the globe, and as far back as ancient Egyptian times. However it is only with the advent of modern plumbing that warm water has become an accessible resource for most western women during labour and birth.
Water birth as we know it was pioneered by Russian Igor Tjarkovsky in the 1960’s, and developed by Michel Odent in his natural birth clinic in Pithiviers, France from 1977. Odent noticed how helpful water could be, especially when labour was slow or painful, and that women using the birthing pools had little need for pethidine. Births that took place in the water were unplanned, but Odent trusted the labouring mother’s instincts, and soon accumulated an experience and understanding of water birth that is still unparalleled.
Janet Balaskas, the founder of the Active Birth movement, was also very influential in promoting water birth, and her 1992 video ‘Water and Birth’ remains a classic. The first water born baby in Australia was born in a converted concrete pipe that was lifted by crane into a home in South Melbourne in 1983.
In the late 1990’s, the use of water in labour has become widespread, with purpose-built tubs being used in many hospitals in the UK, parts of Europe, North America and New Zealand. In Australia, where consumer preferences have less impact on services, there is still much fear and conservatism around the use of water. Tubs are available in some hospitals but hospital policy may not permit their full use, and women may be asked to get out when their baby’s birth is imminent.
Some of this reticence is due to hospital staff’s lack of experience and expertise in this area. There is also a world wide lack of research on the effects of water on mother and baby. However, the First International Water Birth Conference, held in the UK in 1995, heard experiences and evidence from over 19 000 underwater births, with participants reporting excellent safety and satisfaction outcomes.
In particular, no baby had drowned or aspirated water after a carefully supervised water birth. There was no increased risk of infection for mother or baby. Water born babies were generally in good condition, although it was noted that babies’ wellbeing could be compromised if a woman labouring in water became overheated. One recommendation was that pool temperature should be below 35C in the first stage of labour, and 35 to 37C at the time of birth. The labouring woman’s temperature should be checked regularly.
Women often experienced rapid progress after entering the water, especially if they used the pool when labour was well established. They also had little need of intervention or pain relief, had fewer episiotomies or serious tears, and were more satisfied with their experience than mothers birthing on land.
UK consumer activist and author Beverley Beech points out that the staff who are most opposed to the use of water because of the theoretical risks, may be the first to suggest other labour interventions such as epidural pain relief and routine electronic monitoring. Such interventions have been shown to pose real risks for mothers and babies.
I was drawn to water during each of my three pregnancies, but only seriously considered using a tub in labour for Jacob’s birth - my third at home. I wanted my older children Emma (then 4) and Zoe (2) to be present for the labour and birth, along with a good friend to care for them; add in the doctor, midwife and Nicholas, my partner, and there was room full. Using a birth pool would allow me, I figured, some private space, and help me to be less concerned about my surroundings, especially if I laboured in the daytime.
The tub I hired from my midwife was excellent. It was quick to set up, and was not too high, so that I could step into the pool relatively easily. We had a practice run to see how many tanks of hot water would be needed to fill it, and how long it take, allowing for time for the hot water tank to reheat ( three tanks, and about four hours ). During the practice run I managed to cook the water-bed heater that kept the tub warm onto a piece of foam, and I had to buy a new heater!
Labour started for me at 1am, and I woke Nicholas to fill the tub around 2.30. This labour was very slow and gentle, and I spent time both in and out of the water. I found that I couldn’t sway my hips as well in the tub - at least not without causing a tidal wave - but I certainly relished the water as I rested between contractions. Other women have found that the water gives them an increased mobility that encourages movement. Zoe, who was naked from early on, spent much of the labour trying to get in with me, and then contented herself with floating her dollies in the water.
We had the tub in our family room, and Nicholas had purposefully grown some beautiful cinerarias in the adjoining garden, which I could watch through the window. My task in this labour was to slow down, and go with the gentle pace- getting out and walking around didn’t speed things up for me, as it does for some women after a few hours in the tub.
When the contractions became strong, later in the morning, I found the water soothing and supporting. I had a feeling that this baby would be born in the water, but it was important to not be fixed on this idea. I remembered how important it had been to me to have my feet on the earth, and allow gravity to help me give birth to my second baby, who was born posterior (face up). In most centres, around 2/3 of women who labour in the water feel the need to get out of the tub to deliver their babies.
At transition, before the urge to push was strong, I felt the reality of this baby; that I would soon be holding him in my arms. I felt a wave of fear, followed by a strong connection and commitment. Michel Odent calls this “physiological fear”, as this emotion often parallels the release of the fight or flight hormones that give us the power to push our babies out in the second stage of labour. As his head came lower, we saw a mass of white in the water; the soft creamy vernix that covered his skin was floating out as I pushed.
I was kneeling, supported by the side of the tub as he was born at around midday. My midwife caught him in the water and passed him to me. In contrast to other water born babies, he cried quickly and vigorously. In the exhilaration of the moment, we didn’t think to check his sex, and we had another wave of ecstasy when we discovered that we had a son.
I stood up out of the water to deliver the placenta, mostly for ease and comfort. Michel Odent advises this, and points out that allowing water to enter the placental site in the uterus could theoretically be risky. There have been no problems reported worldwide, so far; however some centres routinely advise women to leave the water after delivery. This also helps the midwife to assess the amount of blood loss, which can be difficult in a pool.
We chose not to cut the cord (a practice known as lotus birth), and so we floated the placenta in an ice-cream tub until I was ready to get out, about 60 minutes after the birth. Before this, Emma and Zoe climbed in, and said hello to their new brother.
After the birth, we siphoned the water onto the garden, which made clean-up very easy.
If you are interested in water birth, contact your local hospitals or birth centres and ask if this option is available. If this is not possible, ask if you can bring in your own pool.
If this is also not possible, you could consider writing to the hospital director, asking why this service is not provided - this will at least let the hospitals know that there is a demand for water birth.
Independent or home birth midwives in your area (look in the yellow pages under pregnancy) will know about local hire services. Most independent midwives are experienced in assisting water births at home, and may be able to support you in hospital as well.
- There is no evidence that labour or birth in water poses extra risks for mother or baby
- Evidence suggests that women who labour
in water need less pain relieving drugs,
interventions and fewer episiotomies or serious tears.
- Water is most efficiently used when labour is well established
- Water temperature should be around 35-37C
- If labour or birth are not normal, water
may not be appropriate. Check with your
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