Moms who choose a natural birth know: birth without pain medication isn’t birth without pain management. There are lots of ways to manage labor pain!
And a water birth can be one of the best ways to manage pain during childbirth.
But it doesn’t stop there—water birth has so many other benefits for a laboring mom and baby, many of which are backed by science.
What is a water birth?
Simply stated, a water birth is when a mother labors and gives birth in water. Typically that means in a birthing tub at a birthing center, hospital, or at home. However, many women labor in the tub and get out when it’s time to push, or only get into the tub just before pushing. Water birth can happen in many different ways, and it’s best for mom to follow her intuition during the childbirth process.
Moms and midwives rave about the benefits of water birth:
I had both of mine in the birth center and loved the calm environment, but the difference was still huge between my son’s water birth and my daughter’s “land” birth. If I were going to have any more, a home birth would be amazing to experience, but I’m still glad that I got to experience the magic that is a water birth! – Kaylin B.
My 4th babe was a water birth. It was so calm and peaceful, and labor surges were so much easier to handle. I wish I could go back and have a do-over with my first 3 births! My baby was also very calm, and her cry was so different from the startled first cries of the first 3. – Kris B.
There is a reason that you save the tub for the last part of labor, because it is SO good. – Kristen W.
Benefits of water birth
There is a lot of scientific research and anecdotal evidence supporting the benefits of water birth.
- Comfort and mobility—buoyancy helps mom feel lighter, and makes it easier for her to change positions
- Reduces stress and promotes relaxation
- Reduces blood pressure
- Provides a sense of privacy to facilitate the feeling of safety
- Helps mom to conserve her energy
- Helps relax the pelvic floor
- Reduces cesarean-section rates
- Reduces the need for drugs and interventions
- May lead to shorter labor
- Reduces the distraction of outside stimuli
- And of course, provides a drug-free form of pain management!
How does a water birth help manage pain?
Warm water has been used for centuries to relieve general pain, from sprains and muscle pain, to cramps and stiffness. Used in this way, warm water can help reduce labor pain by relaxing muscles and improving circulation.
The buoyancy of the water helps mom move around easier, finding the best position for birthing her baby, which helps alleviate pain. The water also reduces the feeling of pressure, and helps her to feel more weightless and relaxed.
But the most important aspect of pain management from water birthing is that the benefits listed above work together to help facilitate the cascade of birth hormones. During labor, natural oxytocin is released, which stimulates contractions. Endorphins—which are often better than morphine at pain reduction—then start flowing. When mom is relaxed, feels safe, and can focus on mentally getting into her birthing mindset, her oxytocin flows much easier, triggering those feel-good endorphins.
Studies have found that when using water for labor and/or birth, there is a statistically significant reduction in use of pain medication and a statistically significant reduction in the amount of pain reported.
Risks of water birth: Is it safe?
Midwives and doctors agree that laboring in water is perfectly safe and is not associated with any increased risks. However, there is conflicting opinions on whether giving birth in water is safe. Some doctors say that there just isn’t enough evidence to support giving birth in water, while midwives say there is plenty of evidence to support the practice.
A Cochrane Review found that water birth was beneficial and safe for both baby and mom, but it also said that more information is needed. In the UK, physicians and midwives agree, based on this review, that “complications are seemingly rare,” and that good practice guidelines like properly cleaning the tub before use will help reduce these rare complications.
A new study performed by Oregon State researchers shows that water birth is just as safe as land birth. The study found that babies born in water were no more likely to need transfer or admission to the hospital than those who were born on land, and neither were the moms. However, the researchers did find an 11% increase in perineal tearing among mothers who gave birth in water. This could be because women who are birthing in water are less likely to get episiotomies.
Who can have a water birth?
There is very little evidence to support the idea that any woman should be excluded from water birth. However, most studies suggest that a woman should be at least 37 weeks gestation, with a head-down singleton infant, and have no medical complications or risks.
Other contraindications that rule out a woman from a water birth include:
- Excessive vaginal bleeding
- Maternal fever greater than 100.4, or suspected maternal infection
- Any condition that requires continuous fetal heart rate monitoring
- Untreated blood or skin infection
- Sedation or epidural
- Fearful Attendant
While nearly all healthcare providers abide by the above, some contraindications may vary depending on the attendant.
If meconium (baby’s first bowel movement) is present in the amniotic fluid, mom may be asked to leave the water, since meconium may indicate a stressed baby who may be more likely to gasp underwater. Some midwives will only ask mom to leave the water if the meconium staining looks fresh (black and goopy, not green).
✔ Multiples and breech babies
Multiples and breech births are typically excluded from studies, so there is no evidence to support whether it’s safe or not. But many moms decide (along with their midwife) that a home water birth is still the best choice for their twins or breech baby—and sometimes breech births and multiples are surprises. Here are some other great water birth videos too.
✔ Shoulder dystocia
Gestational diabetes is thought to increase the risk of shoulder dystocia (when the shoulders get stuck). However, some midwives are comfortable working with mom to get her into a better position in the tub to release the shoulders.
✔ Bottom line
Talk with your healthcare provider about whether you are a candidate for water birth. OB’s tend to be more conservative, but some midwives are skilled and comfortable with non-standard water births and find that the benefits outweigh the risks.
Is water birth sanitary?
Some physicians are concerned about potential infection due to water birth, however, the research shows that there is not an increased risk for infection for mom or baby during a water birth—as long as precautions are taken such as:
- Properly cleaning the tub with non-toxic cleaners
- Using clean water, preferably filtered, especially if you have chlorinated water
- Changing the water if it’s contaminated with excessive feces
- Being careful to leave the vernix intact after baby is born
Likewise, blood often drops to the bottom of the tub and congeals, and feces can be scooped out, so there really isn’t as much mess as you might think.
Will the water wash away my baby’s beneficial bacteria?
Some moms are afraid that giving birth in the water will wash away some of the beneficial bacteria that baby receives from the mom’s vagina and skin. Keep in mind that babies don’t have a sterile gut as once thought. Additionally, babies swallow fluids as they come down the birth canal, which helps to further support their microbiome before they even exit mom. So a good portion of their additional bacteria transfer is internal and can’t be “washed” off.
Furthermore, babies are covered in a thick white substance called vernix that protects their skin from water and seals in beneficial properties for the baby. Vernix also contains some good bacteria, so don’t wash it off—instead, rub it in after birth. Also, practicing skin-to-skin after birth and breastfeeding are truly superstars when it comes to good bacterial boosts for baby.
Finally, if you think about it from a historical perspective, women are instinctively drawn to water during birth, and many have given birth in water for thousands of years. We’ve made it this far birthing that way, so I wouldn’t worry too much. Just be sure to use clean, filtered water for your tub. Most hospitals don’t have filters, but you can purchase portable ones that are easy to use in the spur of the moment. Assign this task to your doula or partner so you don’t have to think about it during labor.
Do babies inhale water during a water birth?
No. There are four main reasons that babies don’t aspirate water during a water birth. Keep in mind that you will never keep a baby submerged, and should bring her to the surface immediately.
- Prostoglandin E2, the hormone that starts labor, restricts the baby’s ability to breathe directly after birth.
- Babies are born with mild hypoxia (lack of oxygen), which suspends breathing.
- Fetal lungs are already filled with amniotic fluid, which protects the lungs, similarly to the way meconium protects the colon. It’s highly unlikely that fluid from the birth tub could displace the thick fluid in the lungs.
- The Dive Reflex protects babies from drowning. Infants (up to 6 months old) automatically hold their breath when submerged in water.
Planning a water birth
If you think you want a water birth, there are a few things to consider.
✔ Who is your attendant?
Though many hospitals are jumping on the birthing tub bandwagon for labor (and for good reason!), it’s difficult to find an OB or in-hospital midwife who will actually let you deliver your baby in the water. However, laboring in the tub is the most beneficial aspect of water birth, and some women choose to get out of the tub when they feel the need to push anyway. So, if a hospital is your only option, you can still have a natural hospital birth with help from the tub.
If you are set on having the option of water delivery, then you’ll probably need to go the home birth or birth center route. Most out-of-hospital midwives will support a water labor and delivery. If you already have an attendant, ask her if she is comfortable with water birth (including delivery). If you’re still looking for a midwife to attend your water birth, try a Google search for midwives or birth centers in your area. You can also go the old school route and ask around for midwife recommendations. Other places to look are sites like Mothers Naturally, ACNM, and Our Moment of Truth.
✔ Do I have to know beforehand if I want a water birth?
Home birth midwives can usually bring the birthing tub to your home whether you think you’ll use it or not. If you’re going to a birth center or hospital that has a tub, you’ll have access to the tub when and if you want to use it. Birth is unpredictable, and the best thing to do is surround yourself with many different tools that may help—but don’t try to force anything. Sometimes women are so set on birthing in the tub, or not delivering in the tub, that they interrupt their birthing flow for their delivery. Commit wholeheartedly to natural birth, but be flexible in when, where, and how it unfolds.
✔ When to fill the tub 🛁
For first-time moms, begin filling the pool when contractions are 3–4 minutes apart for an hour. (Some midwives won’t want you to get into tub until transition because sometimes water can stall contractions.) For experienced moms, you can fill the tub when contractions are about 5 minutes apart. When you need to start focusing during contractions and can’t talk through them, begin filling the tub.
If your hot water heater is small, then start filling it as soon as contractions start. If labor goes a little slower, you can stop filling and cover the pool to retain the heat. A hose is the easiest way to fill the pool. Choose a drinking water hose, as garden hoses are often made with PVC and may leach lead.
It takes anywhere from 1/2 hour to 2 hours to fill a birth tub, and it all relies on your water pressure and whether you have a hose or are using buckets. So keep those factors in mind when deciding when to start preparing the tub.
✔ Temperature of the water ♨️
The temperature of the water should be as close to body temperature as possible, but not over 100 degrees. You can get a bath thermometer to monitor the temperature.
✔ When to get in the tub
Midwives often caution moms to not get into the tub until they are 5–6 centimeters dilated. One reason is that the water may slow or stop labor. (This happened to me!) If that happens, you can get out for an hour or two to get things going again. Another reason midwives caution against jumping in too early is that the relief from the water is so strong that going in too early may not provide the same pain relief as waiting until later, closer to transition. It’s better to let your body get some endorphins flowing before using the pool.
Preparing for water birth
The best way to prepare for birth is to see other mamas doing it! Luckily, we have access to tons of water birth videos via the internet. Watch some videos of how other moms did water birth and think about whether it might be right for you.
✔ Water birth supplies
If you’re choosing a home water birth, you’ll likely need some supplies. Even if you’re choosing a birth center, you may need to bring some of these supplies with you.
- Birth pool if your midwife doesn’t have one
- Drinking water hose
- Water filter (where to buy)
- Soft towels and washcloths
- Bowl for cold water or a fan (to cool mom)
- 1–2 large stockpots for boiling water (if needed)
- Chux pads (in case you want to deliver on land)
Water birth, another great option for natural mamas
Water birth is a safe choice for most moms, and can be phenomenal for pain relief. If you think you might want to try it, do your research, get prepared, be flexible, and let your birth experience unravel as it was meant to!
How about YOU?
Did you have a water birth? How was your experience? Share with us in the comments below!