What Happens During a Water Birth?

For nine months, the baby floats and swims in the warm amniotic fluid inside the womb. And so it would come naturally to welcome the baby into this world with surrounding water as well. Water birth has been increasing in popularity in Asia.

In the Philippines, there are only a handful of institutions offering water birth. Though this has not caught up as mainstream, it has definitely piqued the interests of some.

There are reasons why women contemplate birthing by water.  Some women see labor and delivery to be very personal. Being in a body of water is as soothing as it is natural. This is one alternative to the usual labor routine.

What is Water Birth? Tracing its History 

Water birth is a method of vaginal delivery where the mother delivers her child in a bathtub or pool full of warm water. Water birth is said to have been present even during the ancient times, but the first recorded account of an underwater birth was in 1805, in France.

The warm water was said to increase relaxation of mothers. In the 1960s, the focus of water birth was on improved outcomes of the baby as Russian obstetricians Tjarkovsky and Leboyer delved into the concept.

It was popularized by French obstetrician Michael Odent, who published his experience with 100 waterbirths he performed. The idea is that during the early part of labor, being immersed in water decreases the pain. Currently, water immersion is a birthing option for healthy women with uncomplicated pregnancies.

What Happens During Water Birth

The woman may opt to have the first stage of labor immersed in water and if she so decides, deliver on the delivery table. Some women may opt to labor and deliver in the water altogether. One may also only go inside the pool or tub when she is to deliver. The options should be thoroughly discussed with the woman. 

During labor, vital signs of the mother and fetal heart rate will still be monitored as per standard guidelines. The pelvic examination may also be done underwater if the healthcare provider assessed it to be safe.

Performing an amniotomy is not recommended in water as it may be difficult to check if the amniotic fluid is stained with meconium or if it is bloody. A woman may, however, experience a spontaneous rupture of membranes while in the pool. This may only be known to the health care provider on vaginal examination.

During water birth, the baby is born fully submerged in the warm water. Once the baby is born, s/he is gently and immediately brought to the surface. The healthcare provider ensures that the baby’s head remains above the water. The baby’s body can remain in the water to maintain warmth, unless there are conditions wherein the baby is not okay (example: poor cry, limp body, meconium stained, difficulty breathing).

Risks of Water Birth

With the combination of blood, amniotic fluid, and sometimes even feces, there are concerns regarding safety of giving birth while submerged in water. Some rare complications in the newborn are as follows: 

• fresh water drowning
• neonatal hyponatremia (low sodium)
• neonatal waterborne infectious disease
• cord rupture with neonatal hemorrhage
• hypoxic ischemic encephalopathy
• and even, fetal? death. 

There are several studies comparing the outcomes of babies delivered by water birth. One extensive review by Cochrane found no evidence that laboring in water increases the risk of an adverse outcome for women or their newborns.

Although more studies are needed to further understand the impact of water birth in newborns. For mothers, possible? complication includes water embolism. This happens when water enters the woman’s bloodstream causing problems in circulation.

Situation Not Ideal for Water Birth

There are situations wherein the woman has to be counselled about not having water birth if she has any of the following:

• Active genital herpes or any open wound in the vaginal area – Herpes as well as other infected wound can readily contaminate the water where your baby is
• Intraamnionic infection – Suspicion of fetal membrane inflammation due to bacterial or viral infection is likely if the bag of waters ruptured very early into labor or even before labor. Being submerged in water may likely push the infection further
• Preterm labor
• Maternal disease complicating pregnancy such as hypertension or history of seizure
• Previous cesarean delivery
• Twin or multiple gestation
• For induction of labor – during water birth, labor induction is not advisable as close monitoring of the baby is not possible

Facilities which offer immersion during labor and delivery need to establish the following: 

• strict protocols for woman selection
• maintenance and cleaning of tubs and pools, 
• infection control procedures
• monitoring of patient and baby at appropriate intervals while immersed
• moving women from tubs if urgent maternal or fetal concerns or complications develop. 

For women still interested in water birth, always have an open mind and be ready should there be a need to shift to plan B.