Pros and Cons of Water Birth

What Are the Pros and Cons of Water Birth?

Far too many mothers know firsthand the frequent pitfalls of giving birth in a regular hospital, on a bed. The pain can be excruciating, often prompting women to use hospital-administered drugs. The baby can take many hours to come. An episiotomy may be performed. The obstetrician may rupture the amniotic sac with a stick in an attempt to speed up a slow labor; but tearing the amniotic membrane can lead to other complications.

Alert to the problems that so often occur in conventional hospital settings, many women opt for more natural ways to give birth. One of them is giving birth in the water: a “water birth.”

What Is a Water Birth?

A water birth is when 1, 2 or all three stages of birth* occur when the mother is inside a birthing tub or regular bathtub filled with warm water. A water birth can be done in a hospital that offers the option of water birth, at a birthing center or in your home. A medical professional experienced in childbirth, such as an obstetrician, a family practitioner, a nurse or a certified midwife must be present during labor and birth, to assist the mother through the process.

(*The three stages of birth are: labor, birth and delivery of the placenta.)

Benefits of Water Birth

Water births have gained popularity in recent years among mothers looking for more natural and less complicated ways to give birth. Many mothers who have had a water birth rave about the benefits.

These are some of the advantages, according to mothers and experienced midwives:

• A much greater feeling of relaxation, which can decrease or even eliminate most of the pain that usually accompanies giving birth
• Many moms who have had conventional births on dry land and then have a water birth find that they have better control of their bodies in the water; they can re-position themselves with ease, rather than struggle to find a comfortable position. They can also choose to kneel on the tub’s bottom, to assist the baby in coming out; this would be much harder to do on a hospital bed
• The water puts gentle, even pressure on the woman’s abdomen, which can help her body to safely push the baby out; labor may thus be shortened
• You are much less likely to have unnecessary interventions by medical staff, such as an ARM or AROM — “artificial rupture of membranes.” This is done when doctors think your labor is taking too long, so they rupture the amniotic sac with a thin stick, which drains the amniotic fluid and in turn puts pressure on the infant from the collapsing uterine walls. It can also alarm the baby and speed up its heart. The added pressure and scare may cause the baby to pass its first stool (meconium) while still inside, which introduces dangers of infection and obstruction of the baby’s breathing after the umbilical cord is cut, if bits of stool are inhaled
• Mom is able to hold and cuddle her baby immediately after she or he comes out. Some women giving birth in water tubs have even gone so far as to cradle their babies right after birth while the infant is still attached to the placenta, with the placenta still inside the mom. The mother simply waits for the placenta to come out on its own (without anyone pulling on the cord); it usually comes out within about 10 minutes to an hour (or slightly longer) after the baby is born. Note: if you do not wish to wait for the placenta to come out on its own, you will probably be asked to leave the tub to deliver it; that’s because if the placenta is pulled out by the health professional assisting you, there is a chance that you may bleed heavily. To better monitor how much blood you’re losing, your doctor or nurse would want you out of the water for the delivery of the placenta
• A big advantage of waiting for the placenta to come out naturally is that mother and baby get some immediate skin-to-skin contact, all by themselves, with no disruptions. This will help colonize the baby’s skin with the mother’s bacteria, the right bacteria for the infant. That is much less likely to be allowed in a conventional hospital setting, where personnel are so anxious to get through the customary procedures, which include cutting the cord immediately after birth, cleaning the infant and wrapping him or her in a sheet
• The perineum, the skin between the vagina and the anus, may be less likely to tear, as the water softens the mother’s tissues that surround the baby’s head as the infant comes out
• When done at home or in a birthing center, the mother can be surrounded by her partner, the nurse or midwife who is assisting her, and anyone else she may wish to be present; in contrast, in a typical hospital setting, there are likely to be strangers bouncing in and out of the room as she goes through labor
• Use gravity to your advantage: when giving birth on a bed, a mother is usually lying down horizontally; on the other hand, when she is in a tub, she is more likely to be in an upright position, which may promote an easier, faster delivery
• Less traumatic experience for the baby: having been surrounded by amniotic fluid before birth, it may be less stressful for your baby to come out into warm water rather than cool air. When in a birthing center or at home, the mother can also adjust the lighting, having dimmer lighting to make the atmosphere more soothing. This is in stark contrast to all the bright lights that will flood your baby’s eyes upon birth in most hospital settings

All that said, there are also possible risks connected to water births, which a woman considering the pros and cons of this method should be made aware of.

Possible Risks of Water Birth

• Infection: although only one fatality has been documented in the United States, there is a risk that your baby could become infected with foreign bacteria or viruses in the birthing pool; these could be present in the water inlets or outlets, especially if a whirlpool-type tub with circulating water is used, as these are difficult to clean. To prevent the risk of your baby getting an infection, experts recommend that plain tubs be used, without water-circulating fixtures. Further, mom should make completely certain that the tub has been thoroughly sanitized. Tub should not be filled with water until after contractions have begun, as standing water encourages germ growth
• Baby may breathe in water before cord is cut: there is a small chance that your little one may inhale water before the cord is cut, and before baby is brought out of the water. To reduce this possibility, the midwife will quickly, gently bring the infant to the surface as soon as she or he is out, and hand the baby to mom, who will place newborn on her chest
• Greater risk of tearing in perineum: while some experts believe there is a lower risk of perineal tear in water births than in land births, there are doctors who say the risk of the thin membrane tearing is greater in the water. You will have to talk to your provider about this and make your own decision

Other Things to Keep in Mind

• In the event of an emergency, it may take a few minutes to get you out of the water
• Your contractions may still be painful even in the water
• Water should be no more than 100 degrees Fahrenheit; hotter water may pose a danger of overheating for the infant
• If labor takes a long time, you will need to come out of the water periodically to re-heat it
• Getting into the tub too early in your labor may actually slow labor
• Drink water during labor, to stay hydrated
• Not all health care providers assist with water births; you will need to talk to your provider to learn whether he or she performs water births; if s/he doesn’t and you are set on a water birth, you can try calling local hospitals to see if they offer the service; you can also look up birthing centers and nurse midwives in your area. If you select a birthing center, you will also be able to get your pre-natal and post-partum care there
• If you have your baby in a birthing center or at home, you should have an emergency plan in case you need to be transported to a local hospital
• For some moms, it works out best to find a hospital that offers water births, so that if something does go wrong, the mom or baby can quickly be tended to

In addition, not all women will be considered for a water birth; if you have risk factors hat would increase the likelihood of complications in your delivery, you may not be given the option to give birth to your baby in the water. Some of these factors are:

• High blood pressure, diabetes, cardiovascular disease, pre-eclampsia, active (weeping) genital herpes — the herpes virus can be more easily transmitted to the baby in water
• There were problems with your baby during the pregnancy, such as the infant not growing well
• Bleeding in the last weeks of pregnancy
• Your labor was induced
• You had a caesarean section in the past
• You took strong drugs for the pain

You will probably also not be able to give birth in a tub if you are having more than one baby, if your baby is premature, if s/he is in the breech position (feet or bottom first) or if the pushing stage is taking too long.

You will also be asked to leave the tub if fetal heart monitoring indicates a problem with the infant or if you start bleeding during labor.

Where you deliver your baby is an important decision for you and your partner to make; once you have located possible hospitals, birthing centers and medical staff who would be able to assist you, by all means ask questions of them and even go visit the places in person, to get a better sense of the atmosphere and standard of care that you may expect.

By Cynthia Sanchez. A graduate of the University of Washington, Cynthia has extensive experience writing about health and wellness topics for different media.