Waterbirth: Exploring the Benefits and Considerations

In recent years, waterbirth has gained popularity as a natural and empowering way to bring your little one into the world. But what exactly does waterbirth entail, and what should you consider before making this choice? Let’s dive in.

Waterbirth is not a new concept, it has been celebrated for its therapeutic properties for centuries. Ancient carvings in Egypt suggest that some pharaohs were born in water around 8000 years ago, while the Minoan civilisation on Crete constructed temples where women could labour and give birth in water as early as 2700 BC. In Hawaii, waterbirth has been a tradition for countless generations and across various cultures, from Japan to Panama to New Zealand, waterbirth appears not as a modern trend but as an age-old practice. In 1805, the first research account of a water birth was published in a French journal.  In 1983, Dr. Michel Odent published a well-known article in the Lancet journal detailing 100 water births in a French hospital. By 1992, the UK parliament advocated that all women should have the choice to labour and give birth in water. By 1993, almost half of the labour and birth units in the UK had installed birthing pools. In 1994, both the RCOG and the RCM endorsed water birth as an option, provided birth attendants were skilled and confident. Their endorsements were reaffirmed in 2000, 2006, and 2015. In 1995, London hosted the inaugural International Water Birth Congress, where 19,000 cases were presented to 1,500 attendees worldwide.

The warmth and buoyancy of water offer unparalleled comfort and pain relief during labour, facilitating mobility and promoting relaxation. For many women, the option of water immersion during labour and birth has become increasingly appealing. However, it’s important to note that waterbirth is subject to guidelines and policies set forth by healthcare authorities, such as the Government of Western Australia Health Department, to ensure the safety and well-being of both mother and baby.

One of the primary concerns surrounding waterbirth is safety. While some sectors express reservations due to limited randomised controlled trials (RCTs), numerous prospective studies, case-control studies, and case reports suggest that waterbirth is generally safe when practiced under appropriate guidelines and with skilled attendants.

The Cochrane Database, a respected source of evidence-based information, supports the use of water immersion during labor, citing reduced need for epidural/spinal analgesia and no evidence of increased adverse effects on mother or baby. However, softer outcomes such as maternal satisfaction and midwives’ opinions also play a crucial role in evaluating the benefits of waterbirth.

So, what are the potential benefits and considerations of waterbirth?

Benefits:

1. Pain relief and relaxation
2. Increased mobility and autonomy during labour
3. Reduction in the need for drugs and interventions
4. Lower rates of perineal tearing and cesarean sections
5. Enhanced bonding between mother and baby

Considerations:

1. Possibility of slowed labour progression if the woman is not in active labor
2. Neonatal water aspiration (if baby breathes underwater) if water temperature uncontrolled
3. Maternal hyperthermia and neonatal hypothermia risks if water temperature uncontrolled
4. Infection concerns for both mother and baby if environment is unclean
5. Challenges in estimating blood loss and assessing maternal well-being

To be eligible for waterbirth, certain criteria must be met, including being low risk, having a singleton pregnancy, and having no contraindications such as preterm labour or excessive vaginal bleeding for example. Additionally, it’s essential to maintain normal maternal and fetal observations throughout labour and birth. The pool should be filled with clean tap water, and maternal and water temperature should be monitored regularly as well as fetal heart assessment as per guidelines. It’s important not to touch the baby during delivery to minimize stimulation underwater. After birth, the baby should be brought to the surface immediately.

Finally, during the third stage of labour (placental delivery), the woman may choose to remain in the water for a physiological delivery of the placenta. For this, cord clamping should be delayed until pulsation ceases and the cord turns white.

As midwives, our priority is to ensure your safety, comfort, and satisfaction throughout the birthing process. Waterbirth offers a beautiful opportunity for a gentle and empowering experience, but it’s essential to weigh up your suitability, benefits and considerations carefully.

If you’re considering waterbirth, I encourage you to discuss it with your healthcare provider, explore your options, and make an informed decision that aligns with your birth preferences and needs.