A mother who wants to labor in water should be allowed to chose this as an alternative to drugs or unnecessary interventions. However, she should be mindful of the timing. If she enters the water too soon, she can stall her labor. If she enters the water for half hour increments beginning in active labor, she will not only speed the labor along, but she will gain from the period of relaxation that the water provides, and then when that half hour is up, she can exit the water and use gravity to help her baby move down. Her partner and/or her doula can help her get into optimal positions to support dilation and effacement. They can also help her if she wants to float in the water by supporting her back and legs, making it easier to enjoy the benefits of the weightless environment of the water.
Some mothers want to birth their babies in the water. Unfortunately in the United States, this is not always an option. Many hospitals only allow the woman to labor in the water, but they must exit and birth flat on their backs on the bed. Birth centers are much more water birth friendly. Home birth gives the woman the flexibility to make her own decisions. If birthing her baby in the water is an option, she can easily get into a squat position, or hands and knees, to create the ideal circumstances for pushing. When the baby emerges from the water, let him or her float there for a few seconds to get used to the lack of confinement. This will ease the baby into the world in a gentle way.
Some of the proven benefits to using water during labor include greater comfort and flexibility, reduced pressure, deeper relaxation, lower blood pressure, and a decrease in perineal trauma. Let's cover each of these benefits and how a doula can facilitate each one.
Greater comfort and flexibility come from the soothing temperature of the water and the buoyancy and weightless effect of free floating in water. The mother can move around at her leisure. One of the best ways to unwind at the end of a hard day is to take a warm bath. Why wouldn't this also be an option for the laboring mother? The water should be heated to no more than 98 degrees; otherwise, the mother may become overheated which will raise her blood pressure and overheat the baby. While laboring in water, she must be careful to remain hydrated. The warm water and lower pressure produce a deeper relaxation than laying in a bed would. The warm water also helps to lower the woman's blood pressure due to her more relaxed state. Her doula can advise on optimal conditions for the water temperature and reassure the mother and her partner that everything is normal. If the mother becomes overheated or simply wants a break from the water, the doula and partner can help the woman to carefully exit the water and move around more. The doula can also place a cool rag on the woman's neck to bring down her body temperature if it should rise too high.
The lower gravity in water produces the effect of reducing pressure on the woman's body. She doesn't have to fight gravity as much when she moves in the water. This results in a concentration of strength in her pelvis area and effective pushing effort. As said before, any member of the support team can help the woman float in the water, space permitting, which will allow for an even greater reduction in pressure.
The water also softens the skin of the perineum, decreasing the risk of perineal trauma during the pushing stage. The skin is softer and more flexible under water and can more easily stretch to allow the passage of the babies head through the vaginal opening. The doula can advise on perineal massage during the prenatal visits as well, which will increase the flexibility of the skin.
There are many myths surrounding water births. There is worry about infections, drowning, temperature of the water, and increased pain. These worries are unfounded and the evidence shows that none of them are necessarily a concern.
Between 40-50% of women will have a bowel movement during labor. Experts believe that the water dilutes any possible bacteria that may be present, thus lowering the risk of infection. Birthing in the water also allows for less interventions which can increase the risk of infection, such as breaking the bag of waters and vaginal exams.
It is impossible for a baby to drown if they are born in water. Babies spend 9 months in an aquatic environment. They receive all of their oxygen from the placenta. The baby's physiology prevents them from breathing for air until they are exposed to it and to gravity. The baby can float around in the water after birth for many seconds before it becomes necessary to raise them out of the water. As long as they are attached to the umbilical cord, the placenta is their sole source of oxygen.
The temperature of the water is a valid concern. As stated before, the water must remain at 98 degrees. If the water is colder than 98 degrees, the mother will get tense and uncomfortable which will negate the soothing benefits. If the water is warmer than 98 degrees, the mother will become overheated and the baby will overheat, resulting in fetal distress and an increase in the mother's blood pressure.
All of these benefits of water birth show a decrease in labor pain for the mother and a smoother transition for her baby. The flexibility of movement is far superior to the birthing process than confinement to a hospital bed and allows the mother more control over her birth experience. Every birthing woman deserves water birth as an option, just as every woman is allowed to choose if they will birth naturally or with drugs.
A doula can advise the mother and her child on all of these benefits, as well as possible risks and contraindications. She can also research and advise the woman on the hospitals and centers in their area that are water birth friendly, and if there are any providers in the area who specialize in water birth. If the woman chooses to have a home birth, the doula can point out midwives who perform water births, as well as places to do more research and rent the supplies they will need if the midwife does not supply them.