Labour and Birth In Water

Kate SaidiCoral Morby

Why choose a waterbirth?Natural form of pain relief

Used for labour and / or birth

Birthing pools help you achieve a natural birth and reduce the need for drugs

Waterbirth Facilities in LeedsDelivery suite at the LGI has two pools located in the

home from home rooms. We have around 100 hospital waterbirths a year.

Can self-hire pools for home births. Cannot bring hired pools into hospital.

Most of midwives are trained in waterbirthIt is possible that rooms are in use and will have to waitInform staff when you ring up that you would like to use

the pool and again on admission

Why does water help?

A long hot bath helps to sooth aching musclesWomen who labour in the pools often stay for the birth

because of the natural pain relief effectsRelax and comfortable in the waterReduces stress hormonesPromote the progress of labour

Beneficial effects of the poolBuoyancy effectWater increases support reducing muscular tensionThis conserves energy and lowers painEasier mobilityUpright position and squatting position is easierWomen with SPD find alternative positions easierIncrease women’s feelings of controlThe pool provides a private environmentYou are free to move around in your own spaceCalming effect benefits everyone

What the research saysNo evidence to show that there are any significant risks

to babies born underwaterStudies have shown that using water for labour and birth

can:Shorten the length of labour Increase feelings of control and enjoymentReduce the use of pain relief and drugs to speed up labour Increase the chances of a normal delivery

Hospital guidelinesOne midwife provides one-to-one care during labour, and

two present for the birthWhen admitted – all observations recordedIf your waters go with no contractions – seen by a

midwife and if everything well you may return home until labour starts

If your labour starts within 24 hours a waterbirth is still an option

If this does not occur induction will be required and a waterbirth is not possible

Who can use the hospital pool?In general must be considered ‘low risk’ meeting the

following criteria:Maternal weight less than 100kgs/15 1/2 stoneSingleton pregnancyHead downNo medical problems e.g. diabetes, epilepsyNo pregnancy problems e.g. high blood pressureNo previous caesarean37-42 weeks pregnantHave gone into labour yourself and be in established labour If waters have broken must be clear and not been broken longer than

24 hoursAll observations (BP, temperature, baby’s heartbeat) normal

Admitted with contractionsVaginal examination will be performed to determine the

stage of labour

If you are not in labour you will be advised to return home to await further progress

This is important if you are planning a natural birth

When would you ring delivery suite to come in?

Latent phase of labour

Head Decent

Pain relief options before entering the pool (also to be used at home)

TENS (Transcutaneous Electrical Nerve Stimulation)ShowerMassageHot towels on your lower backWheat packHot water bottles

Established labour/first stageMust be in established labour before entering the poolOccurs when contracting approx every 2 minutesAnd if this is your first baby you should be 5cmIf you have had one or more babies previously you should

be 3cmIf you have not reached this stage you will be encouraged

to mobiliseDo not get on the bed for prolonged periods, this will

slow your labour

Once in the birthing pool

Monitoring – temperatures, baby’s heart rate with underwater sonicaid, vaginal examinations every four hours, can be done underwater

During the waterbirthPain relief- gas and air (entonox)Encouraged to drink plenty,

change position and go to the toilet

Water will be kept as clear as possible, a sieve may be used

Second stage of labourOccurs when no cervix is left in front of the baby’s head

Your baby’s head will now descend and you should feel strong urges to push

The midwife will now monitor your baby’s heart rate more regular

The delivery Water temperature increased to 37oCNo assistance is required; the midwife keeps her hands

off until your baby is bornOnce your baby’s head is visible you must keep your

bottom under the waterThe midwife will use a mirror to watch the delivery and

encourage you to breathe at certain pointsYour baby is delivered completely immersed under water,

then lifted head first to the surfaceDeliver in any position which feels comfortable

Reasons why you may be asked to leave the poolAbnormal observationsSlow progressMeconiumBleedingMurky waterProblems with your baby’s shoulders

Third stageDelivery of the placentaAsked to leave the pool about 10 minutes following

deliveryThe placenta is delivered on landThis can be done naturally or using a syntometrine

injectionSkin to skin contact with your baby will be encouragedIf stitching is required this will be delayed for an hour to

allow water to drain from the tissues

Common concernsInfection – there is no evidence for this; we have strict

standards of pool hygieneCord around neck – this is very common and not usually

a problemDrowning – babies born under water don’t get the

stimulation to take their first breath. The baby instinctively recognises that it should not inhale water but that this can be swallowed. However if the baby has become distressed during labour this mechanism may be overridden.

Useful AdviceDon’t listen to the negative, think positive- most women

have a normal birth and healthy babies. Have confidence in yourself and your ability to cope

Bring anything that makes you comfortable- pillows, birthing ball, wheat bag, drinks, snacks, massage oil, lip balm, music

waterbirthslgi@hotmail.co.uk

Useful ResourcesInformed Choice Leaflets-11. ‘Do you want a

waterbirth?’(women’s) Women’s Informed Choice Consumers pack (21 titles) £6.80 www.infochoice.org 0800 581009

The National Childbirth Trust - Using water in labour and birth, Straightforward birth, Home birth information sheet (50p each)www.nctsales.co.uk 0870 112 1120

Birth pool hire www.birthpoolinabox.co.uk