I have attended women for over 18 years, many of whom have chosen to birth in the water. It is my intention to help you understand how useful water can be to birthing families. I wish to acknowledge Joy Argent whose lecture on this subject has given me much of my information.

In case you’ve forgotten, before birth we all spent close to nine months totally surrounded by water. It is certainly no stranger to any of us: most of our body is simply water and the surface of our wonderful planet is mainly water. Water is essential for birth…..without it, we might die.

Pregnancy

A good diet of nutritious food and water is vitally important. Relaxation during pregnancy can often be enhanced by being in, or near water. Many women feel intuitively drawn to it. Exercise such as walking can be done near water, or some women prefer to actually swim…. I know many women who continue their routine laps well into advanced pregnancy. Water is also a great medium for just having fun! Especially with children.

Support groups also play an important role in pregnancy. They provide an opportunity for women to come together to socialise, chat, gain access to books and other material and share expectations. Support groups should be highly valued as long-term relationships can often be formed.

Labour

Regardless of preparation, often the intensity of contractions is a surprise. Warm water may enable a woman to relax and be glad that labour is underway at last. The water temp is usually around 37 degrees which is body temp, but some may prefer it cooler. The majority of labour, for some women, is spent actively, often walking. I have been with numerous women who choose to walk around inside a pool – the weightlessness is often a blessing. Sometimes pausing during contractions to lean over a handy person or object is useful.

It is important to keep up the intake of fluids throughout labour – whether plain water, juice or other preferred drink – this is particularly important if the woman spends a lot of time in hot water. So with drinking comes frequent trips to the loo! This is to be encouraged.

As contractions intensify, the benefits of hot water as pain relief are truly apparent.

Just think how good it feels to sink into a nice hot bath after a hard days’ work…Labour is also an ideal time for this. Water can allow women to seem almost normal between contractions (as in not in labour). Many women without access to a pool feel drawn to the shower – often remaining there until the hot water runs out. If there is back pain, hot water can be trickled or poured over the appropriate area if immersion isn’t comfortable or possible.

Hot nappies placed on the back after being dipped in hot water are extremely effective. Often women want the nappies to be ‘hotter’, and to wring them out, rubber gloves are necessary to protect the helpers’ hands. Hot nappies can also be used to relieve pain felt in the front, with the woman in any position she chooses. Small towels could also be used – but pregnant women usually have plenty of nappies available.

Cold water is also useful, not just for drinking, but for whipping face, neck, shoulders, etc…particularly if the women is in hot water. I even had one woman employ 2 pools of water – one hot and one cold. During her labour she would sit in the hot tub during the contraction, then, when it had finished, leap into the cold pool! She did this for hours! The strength of labouring women never ceases to amaze me! Most find the coolness of a cool towel gratifying, but couldn’t possibly get out of the warmth. Don’t forget their partners – if they’re in the water, often they feel the heat more.

Fetal heart monitoring is not usually a problem, even if a woman is using a pool.

She may choose to float to the surface if the care giver is using a Pinard’s stethoscope or many of the Doppler’s today are water proof, so the woman remains undisturbed. In the unlikely event that a vaginal examination is necessary, it can be done without the woman leaving the water – the midwife simply needs to be a little flexible (gymnast?) and be prepared to get a bit wet! (Occupational hazard with water).

The number of positions possible in a pool are endless. Changing positions is easily accomplished, with minimal effort from the woman. The woman may choose to ‘frog sit’, stand, lean over support person or thing, squatting, hands and knees or any other position she feels comfortable in. I took part in a labour position study recently. I was asked to write down each time a woman in labour changed her position. What I noticed was, that women tended to move every 4 seconds! Once in the water it was even more frequent, and in a more varied way.

Sometimes an anterior lip may be present, and it may mean some extra time is needed to relax and allow it to recede. Perhaps a short nap to regain energy and strength, or a time of reflection and letting go, in anticipation of the next important phase.

As with the first stage, the variety of positions possible for the second stage is enormous – limited only by your imagination.

Often this is when the hot nappies are relegated to the bucket. As the baby’s head stretches the perineum, being in hot water can increase the blood supply to help prevent tearing and reduce the sensation of pain. If woman are not in the water, then flannels or very small towels held against the perineum, after being dipped in hot water, are useful. Once again, this can be done in any position the woman chooses. As the baby is born, whether the flannel is dropped, or gets caught up in the proceedings, it is unimportant.

Normally the midwife stays out of the water, as I feel it is a very sacred space, but occasionally, bub requires a little extra assistance in leaving the birth canal, so I may ‘step in’. Partners often feel happier to catch the baby in water.

During the actual birth, a woman is still able to move around and change her position, if she wishes. Sometimes a woman may spend most of her labour in water, but if her baby isn’t meant to be born in water, it won’t be. Trust her to know what’s best, and support her in that. Being in the water gives the baby a beautiful, gentle transition into this world. It also makes it easy for the woman to lift her baby from her own body.

Page revised on 20th December 2021