Water Birth

Giving birth in a bathtub or a pool full of warm water is a recent tendency in the western community, and is defined as water birth. Although, this alternative method of giving birth still raises various concerns among communities, currently some hospitals in the United Kingdom and other countries around the world are offering water birth as an alternative option for delivery. In fact, some internet websites are encouraging this new trend by renting or selling inflatable tubs for water births at home.

Practitioners believe that water birth has countless benefits for both mother and infants and is a safe alternative to normal birth.  In contrast, there are risk factors to the mother and infant and there are also many concerns toward this new trend. Although water birth is not a common way of delivery, this article will argue that it is an effective way to give birth and it will discuss and evaluate the efficacy of water birth for both women and infant.

Throughout history warm water was used for many reasons to reduce menstruation and labour pain.  According to Balaskas et al (1992) there are legends and stories of water birth that reached by word of mouth amongst the American Indiana.  Moreover, it was said that in ancient Egypt some babies were born in water, although there is no supporting evidence to these legends.

Research was conducted during 1960 to examine the safety and the benefits of the water birth by a Russian researcher called Tjarkovskys, he stated the principle of water is “the cradle of life on earth” (Garland, 2002).  In the late 1960, the practice of water birth was developed by two French obstetricians for many reasons, to facilitate the transition from the uterus to outside world, to decrease the effect of any possible trauma, and as a pain relief for the mother (Wikimedia website, 2007).  Therefore, many women had water birth in France and after that water birth spread all over the western countries (Garland, 2002).  The use of water birth began in Britain in the mid 1980s according to Balaskas (2004; p.11).

Benefits of water birth have been studied by various practitioners such as midwives, doctors and researches around the world. Water birth was highly rated by women in a recent study of 1,300 water births.  In contrast, a minority of them found it ineffective (Balaskas, 2004; p.48-49). Overall it was found there were common physical and emotional benefits for both mother and infant.  Unfortunately, no one can assure women that water births are safer than normal births, because they have not been studied broadly.  However, according to Gilbert (1999) (as cited in Balaskas, 2004:p.22) a study has found a decrease in the perinatal mortality rate (1.2 per 1000 of water birth).

One of the main reasons and benefits that make women prefer water birth is the comfort and mobility the water allows during delivery, as changing position under the water is easier than on the land especially in the case of overweight mothers or those carrying large babies. Balaskas and Gordon (1992; p.34) state that “weightless induced by the buoyancy of the water reduce opposition to gravity”.  It is almost certain that reduction of abdominal pressure causes efficient uterine contraction and better blood circulation therefore better oxygenation to uterine muscle and for the baby, which indicates less fetal distress.  As a result, changing position during labor is highly beneficial for mother and baby.

Warm water can be a wonderful aid to help mother relax during delivery and this is another benefit of water birth.  When the mother is relaxed, birth will have fewer complications, required less need for medical intervention and both mother and baby will be safe.  Hydrotherapy in the role of pain management is a safer alternative treatment in contrast to anesthesia and narcotic drugs, especially back pain which is the most common women’s complaint.  Accordingly, muscle relaxation can be provided by warm water in order to reduce labor pain.

In my experience as a midwife in the labour ward, women usually suffer from labour pain and have a greater demand on narcotic drug, whilst alternative methods of pain relief are refused.  A study of water birth was conducted by clinical audit and presented by Garland (2002) (as cited in Balaskas, 2002; p51) which found only 3 per cent of women who used water birth needed pethidine which is a sedative drug. In comparison to 60 per cent who delivered on land required this narcotic drug.  Therefore, water birth needs more case-by-case evaluation.

Nevertheless, There is some concern that early labouring in water could slow contractions down. Hence, woman should not get in the tub, until her cervix has dilated around five centimetres and she is in active labour.  However, women perhaps respond to pain differently in various ways and water does not provide complete pain relief, it usually minimizes it to a certain level that can substitute other pain relief methods (Balaskas, 1992; p34).

A further reason or benefit for mother relating to water birth is, an intact perineum.  Water can offer perineal muscle support by slowing down babies’ head descending (Garland, 2000).  As a result, the rate of tears and episiotomies are declined. In the UK in 1998 (as cited in Balaskas, 2004) a collaborative assessment of water birth at four birth units found that 57 per cent of first-time mothers complain of no perineal tears in comparison of 51 per cent on land.  These findings indicate that water can provide support to the perineal muscle.  In addition, warm water has softening effects on the perineal tissue therefore less percentage of tears will occur.

Despite the fact that birth process can be a stressful experience to babies, water birth is safe and non-traumatic experiences for them because warm water promotes the transition from the uterus to the outside world along with softening the light, colour and noise.  Babies are extremely sensitive during birth.  Therefore, Balaskas and Gordon (1992;p125) stress the importance of water birth for the babies by mention the significant evidence by psychotherapies, that mother experience during birth can impacts on the baby strongly and originates emotion which can persist into adult life.  Child birth in warm environment will help to ensure that baby was born in safe and welcome atmosphere.

Infant aspiration of water is the main concern for most parents who are planning to have water birth. However, oxygen is transferred to the infant through the umbilical cord, unless it is cut or the placenta is removed.  Several physiological factors can prevent infant from aspiration of the water after delivery.  First of all, water temperature has the same body temperature of the infant between (35°-37°) therefore it helps in minimizing the stimulation to the infant’s lung.  Secondly, there is less possibility that water could enter the infant’s lung during delivery because the fetal lung is filled with fluid including amniotic fluid thus air pressure is needed to stimulate the lung to eject their fluid and after that allowing for oxygen and carbon dioxide exchange.  Finally, diving reflex, which is located in fetal larynx, allows the water to be swallowed rather than to be inhaled.

Balaskas and Gordon (1992; p.168) assure many parents who are concerned about the possibility of the baby inhaling water at birth, that the only stimulus that makes a baby breath after the head emerges is the contact with cold atmosphere and baby is oxygenated by the placenta during birth, they also mention the fact that there is no risk of water inhalation as long as the baby is brought to the water surface soon.

Mothers should be familiar with the precautions including the water temperature, and planning for unexpected complications that may occur during water birth.  Water births appear to be more suitable for women with low risk pregnancies, and who need less medical intervention.  However, close monitoring and observation of fetal heart rate is required by experienced obstetrician or certified midwife during water birth.  In addition, water birth has less harmful side effects when compared with normal delivery. On the other hand, water births are also encouraging natural physiological child birth.  Nevertheless, Water birth does not provide sufficient pain relief for mothers such as narcotic drugs; therefore women should be warned that water birth is not pain free.

Women still have many doubts deciding to have this new alternative method of delivery, because the lack of information regarding the process, benefits and the expected risk of water birth.  Therefore, antenatal classes are essential, to assist women during their pregnancy and to prepare them physiologically and psychologically.  Clearly a well managed and monitored water birth by experienced obstetrician or certified midwife results in a decrease of birth complications.  Additionally, water temperature should be monitored and maintained to the same degree of body temperature to prevent any expected problem.

In conclusion, water birth requires further research and studies by health practitioners, to reduce the need for drugs and medical intervention, to investigate more about the efficacy of water birth and to minimize any possible risk that could appear in the future.    Finally water birth is an effective method of giving birth.  However, further education, studies and research is required.

References: 

Balaskas, J. and Gordon, Y. (1992) Water Birth.  The concise guide to using water during pregnancy, birth and infancy, Thorsons,London

Balaskas, J. (2004) the Water Birth Book. Thorsons,London.

Garland, D. (2000) Waterbirth: an attitude to care. 2nd edn, Books for Midwives, Edinburgh.