Water Birth – Benefits, Risks, and Practices

There are multiple ways of using water in labor as a comfort measure. Whether you desire to give birth in a birthing pool or utilize water during your labor, there are both benefits and risks to consider. Is it safe to have a water birth? What are the benefits of laboring in water? Are there safety precautions that should be addressed? Which care providers allow water births? We will delve into these topics in this post.

Where Can I Have a Water Birth?

Water births are a common occurrence when giving birth at home and also at birthing centers. Most hospitals will not encourage or allow water births, which is something to consider. Due to common protocols in hospitals such as continuous fetal monitoring and IV fluids, laboring in water is often not allowed. If planning a hospital birth, learn all you can about that hospital’s policies and the tools they have available to you. Some hospitals have tubs and showers that can be used during labor, and you can talk to your care provider about your wishes. If you plan to use water during labor, add this to your birth plan and make sure your birth team is informed about your wishes.

Water In Labor – The Midwife’s Epidural

Using water in a tub or birthing pool during labor has been nicknamed “the midwife’s epidural” because of how much relief it brings to the laboring mama. When striving for an unmedicated birth and skipping an epidural, the birth pool can bring much pain relief and help your body to relax. Regardless of your birth plans, water can be used in early labor. Midwives are typically more comfortable with using water in labor and even advocate water births more often than other providers.

Laboring In the Shower

A hot shower is a great comfort measure utilizing water and heat to bring pain relief, especially in early labor. Using a handheld shower wand to direct water onto specific painful or tense areas of the body is extra helpful. Getting in the birth pool for extended periods of time before reaching active labor has been known to slow labor down. Once labor starts, it should be allowed and encouraged to progress, so it is wise to wait until active labor before spending much time in the tub. For this reason, showers can be a lifesaver by still allowing the use of hot water outside of the tub. By standing or sitting in the shower, you are also utilizing gravity to encourage your labor to progress and baby to descend.

The Birthing Pool

A birthing pool or tub can be a bathtub, inflatable pool or other tub lined with plastic. It is important for your birth team to pay attention to the water temperature, especially if you plan to give birth in the tub. The accepted temperature range is between 96 – 100.4 degrees. If the water gets too hot, it can make mama’s temperature get too high and cause a fever. Your body is already working hard and can easily get hot during labor so be careful not to get extra hot by being in the water. Your birth team can help by supplying you with fans and cool wash cloths. When the baby is born into the water, the goal is for the water temperature to be similar to mama’s body temperature so they will not be too hot or cold. If the water is too cold, it could cause baby to breathe too soon under the water, which is dangerous.

Benefits of Water in Labor

There are many benefits to laboring and giving birth in water. Mamas love the relief that the warm water brings and the fact that it helps them relax. When submerged in water, there is less tension on your body and joints, which helps your body release and labor more productively. This is a reason why being in the birth pool has been seen to help labor progress. When a skilled provider is present who is trained in water births, giving birth in the water is considered safe for low-risk pregnancies.

Risks and Precautions with a Water Birth

Water births are not without risks and precautions so make sure to address these with your care provider. These risks include the baby getting an infection from the water, breathing prematurely under the water, a slight increased risk of snapping the umbilical cord and a less visible environment when assessing bleeding after the birth.

To prevent the possibility of baby getting an infection, midwives have ways of keeping the water clean, including using a net to scoop out any floating material. If the water becomes soiled, they will have you get out of the water. To help keep the baby from breathing prematurely, it is important to keep the water between 96 -100.4 degrees. A simple way of protecting against the rare occurrence of snapping the umbilical cord is to slowly and gently bring the baby up out of the water when it is born. This helps to keep tension off of the cord. If either you or your provider are concerned about the possibility of excess bleeding, get out of the tub before or immediately after delivering the baby.

When You Should NOT Have a Water Birth

There are times and circumstances when water birth and laboring in water are dangerous or unadvised. In high-risk pregnancies, cases of high blood pressure, history of postpartum hemorrhage, twin pregnancies and other high-risk circumstances, your provider will warn you against water birth because the risks outweigh the benefits. Research your options, learn alternative comfort measures and work with a provider you trust to guide you through your specific situation.

Different Standards Between Providers

Depending on your care provider, they will have different standards and ways of doing things. Some providers are comfortable with water births, while others will only allow you to labor in the water. Other providers, especially in hospitals, will not allow any use of water during labor. Due to the potential risks associated with water births, some midwives are more comfortable with allowing you to labor in the tub but give birth outside of the water. It is also less convenient for providers to allow water births. Your care provider will have to get into uncomfortable positions in order to assess you if you are in the water. It is admirable when they lay these inconveniences aside in order to do what feels best to you.

Change of Plans

Sometimes there are changes of plans in labor and birth. One of my clients planned to have a water birth, but it worked out better to get out of the water to use gravity in birthing the baby. She enjoyed the benefits of laboring in the water, and it turned out to be better to give birth outside of the water. It is important to listen to your body and the advice of your birth team to make the best decisions for yourself and your baby.

More Comfort Measures

While it is sometimes necessary to get out of the water or forgo it altogether, there are other comfort measures that can be used instead. Position changes are extremely important in order to help your baby descend. Changing positions also encourages labor to progress and helps you feel most comfortable. Some mamas like to resort to positions and comfort measures that helped them in previous labors. Listening to your body and its natural movements and instincts is vital. Your care provider and doula can also give you helpful suggestions to try. The use of counter pressure, hip squeezes, massage, movement, heat, cool cloths and fans are other amazing comfort measures.

Now that you have been introduced to the benefits and risks water births, what are your thoughts? Would you choose a water birth? Does water sound soothing to use in labor? I’d love to hear your thoughts and experiences in the comments below!

~Hannah

Labor Positions Matter

Labor positions are super important when it comes to giving your baby room to fit through your pelvis. Changing positions in labor not only aids your baby, but it helps you to be more comfortable and makes labor more efficient. But did you know that certain positions are much more effective than others at different points of labor?

Your Pelvis

Your pelvis has three parts – the inlet (top), the mid-pelvis (middle), and the outlet (bottom). As your baby moves through each part of your pelvis, certain positions are helpful in opening up that specific part. For example, the stereotypical position of pushing on your back with legs wide is not actually ideal for multiple reasons. Gravity is an important factor when it comes to labor positions and so is opening the pelvis. Opening your legs wide while pushing actually narrows the outlet (bottom) of the pelvis which should instead be fully open. Understanding the pelvis’ structure and how it moves is key to understanding why it is important to use ideal positions.

Labor Positions for the Inlet of the Pelvis

The inlet (top) of the pelvis is the first part that your baby passes through. Positions with your knees wide and ankles close together open this part of the pelvis. Towards the end of pregnancy, try these types of positions. Deep squats, sitting on a birth ball with knees wide, propping your feet up on a squatty potty or books while sitting on the toilet, and side lying with pillows between your knees are all good ways to open the inlet of your pelvis.

It is common for babies to move through the inlet and settle into the mid-pelvis by the time labor starts. This is referred to as the baby being engaged. If your baby is engaged when labor starts, utilize positions that open up the mid-pelvis to make more room for baby. If baby is not engaged, continue these positions with knees wide and ankles turned in to open up the top of the pelvis.

Labor Positions for the Mid-Pelvis

The mid-pelvis is the narrowest part, and uneven hip movements help to make the most room for baby. Doing asymmetrical or uneven movements allows the mid-pelvis to open on one side or the other, making more room for baby to descend. Side lunges, curb walking, propping up one foot while sitting on the toilet or birth ball and swaying side to side are examples of uneven hip movements. Your body will help you know which positions are ideal at a given time by what feels most comfortable. If you naturally want to sway side to side in labor, then it is quite possible that your baby is in your mid-pelvis.

Labor Positions for the Outlet of the Pelvis

The outlet (bottom) of the pelvis is the last part that baby has to navigate. Labor positions at this stage should be the opposite of what is done to open the inlet (top) of the pelvis. Pointing your knees in and keeping your ankles apart is ideal for opening up the outlet. Without feeling awkward or exaggerated, the goal is to keep your ankles wider than your knees so the bottom of the pelvis can open wider. Try doing the hands and knees position with your ankles wider than your knees. You can also try side lying with pillows or a peanut ball between your ankles while keeping your knees close together. Sitting on the toilet or birth ball with your knees in and ankles out are other simple ways to encourage the outlet of your pelvis to open up.

Knowledge Is Power

Understanding how your body works and is made to give birth is so important as you head into labor. Work with your body and intuition as you labor your baby into the world. By learning about the different parts and functions of the pelvis, you now know how to move and position your body most effectively. Practice these different types of positions in pregnancy so they will be familiar to you when you utilize them in labor. I hope this introduction to ideal labor positions and your pelvic structure will empower you to be confident in your labor and birth. You were made to do this, and you are capable of birthing your baby!

~Hannah

Comfort Measures

Comfort measures are a helpful bag of tricks when it comes to labor. They are often used in the absence of pain medication or epidurals, but a number of them can be used regardless. Comfort measures used in labor include position changes, controlled breathing, massage, counter pressure, hydrotherapy, heat and ice packs.

Doulas are trained in these comfort measures and teach the mother and her partner how to do them during pregnancy so they can practice them before labor begins. Your doula will help you perform them during labor, but equipping your partner to assist you is helpful too. Regardless of your birthing location, these comfort measures can be utilized at home in early labor as well as throughout the birthing process.

Position Changes

Movement during labor is super important, and changing positions can help mama’s body to open up and give the baby an easier way out. Depending on the stage of labor, some positions are better than others to help open up the pelvis for baby to descend. Squats, lunges, walking, swaying, moving on a birth ball, getting on hands and knees, side lying and using a peanut ball are all effective ways to move and change positions during labor. Your doula can give suggestions about position changes and ideas for how to let your body work most effectively.

Controlled Breathing

Learning and practicing controlled breathing during pregnancy helps prepare mama to breathe effectively and stay calm during labor. Both mama and baby need plenty of oxygen during the labor process. Various types of controlled breathing include deep breaths in early labor, shorter and more shallow breaths in active labor and panting as baby is crowning to keep from pushing hard. Controlling your breathing will help you get enough oxygen, stay calm, and keep you from hyperventilating. Your doula and partner can give you reminders and help by breathing with you when necessary.

Massage

Massage can help relax painful areas during labor. Each mama is different and has her own preferences. Some women like to be touched and massaged while others do not want any physical touch. Let your birth team know what feels best to you. Hand and foot massages can be done to ease tension and are often helpful if a mama has been walking a lot during her labor. Lightly touching a tense brow, jaw or shoulder can remind mama to let it go and relax that part of her body.

Counter Pressure

Mamas often love when pressure is applied to a painful area such as their back or hips during labor. This is usually done by her doula, partner or both. Steadying her back with one hand, they can apply firm, steady pressure where she directs, usually through a contraction and then taking a break. The “Double Hip Squeeze” is a form of counter pressure and is done by applying pressure at the same place on both hips. Your doula and partner can take turns doing this or do it together by each applying pressure to one side.

Hydrotherapy

Water is an amazing pain reliever and helps mama to relax. In early labor, taking showers can be soothing and help with the pain. A handheld shower wand can be used to direct hot water onto the painful spot. Mamas who decide to have unmedicated births often like to use a birth pool. These are commonly referred to as “the midwives’ epidural”. Talk to your midwife or doctor about the preferred time to get in the pool. It is wise to wait until active labor before getting in the pool for very long. By getting in too soon, labor could slow down in the early stages. Mamas should ALWAYS have supervision while in the pool to ensure safety.

Heat – A Relieving Comfort Measure

Utilizing heat during labor is a simple and effective comfort measure. A heating pad or hot water bottle wrapped in a towel can be applied to a sore spot to bring relief. Hot water in the shower is soothing and helpful too. Never apply heat, however, to any part of the body that is numb.

Cold – Another Simple Comfort Measure

Labor is hard work, and mamas often get hot. Cold, damp wash cloths can be applied to her forehead, neck and chest to help her stay cool and comfortable and keep her from overheating. Ice packs on her sore back can bring relief as well. As is the case with heat, never apply cold packs to any part of the body that is numb.

Support

Encouragement and affirmation are so important and can go a long way. Choose a birth team that will support you and the desires you have. Partners can learn helpful ways to encourage and give practical reminders so that their input is well received.

Comfort measures help by giving pain relief, encouraging relaxation and letting your body work effectively as it births your baby. Learn them during pregnancy so you can come prepared and use them in your labor and birth. You won’t regret it!

~Hannah

Photo Credit – Lauren Reed