Water Births - Like a Natural Epidural?
Updated: Jan 18, 2019
I can still feel the prickling warmth of the water, as I entered the pool after transition, for the birth of my second baby girl. “Why the heck wasn’t I in here earlier?” I thought to myself. 20 minutes later, after some damn intense surges, me breathing my baby down, I could feel my baby’s head. She’s here. A smile broke across my face. She popped out a couple of surges later. No perineal trauma. And I felt frigging ecstatic. (Insert awesome birth pic from my friend and birth photographer Jes from Jessica Jackson Itty Bitty Photography, right here). Next day, I was literally up cooking my family’s breakfast and the following day we were walking around Freedom with our baby and 3yo buying an entertainment unit haha.
Now, 9 months later, I’m sitting here writing this (with my double shot latte, with beans as strong as I can find, as I am the very unwilling participant of a no sleep experiment, courtesy of my 9 month old”), as water has been high on my agenda lately, as I want all the mothers in my area, of Hobart, Tasmania, to have access to water to labour or birth in, providing there are no medical issues. I recently put together a water immersion and water birth petition for the women of Hobart and little ol’ me was interviewed by Radio National the other day. You can listen to the storyhere and you can also here my little cherub chatting at the start of the interview. Swwwwooon.
A birth pool is like nature’s epidural, except without all the side effects and risks. I am by no means anti epidural, I get it. I really do. My pain threshold is terrible, or at least it used to be. I used to be the one who howls in pain when I have the slightest scratch or stub my toe. And. I don’t. Do. Waxing. Erk. Ouch. No thanks. However, I have done two drug free labours. But you have to have tools, support and many options (water is super duper awesome) to help you cope.
Don’t get me wrong, water doesn’t numb you from the waist down. You can still feel the labour, except you have control, a sense of relaxation and the heat. Oh the heat. So comforting at a time of the most intense physical and emotional journey of your life.
So, Why Get in the Water During Labour?
Increases relaxation, by reducing stress hormones
Reduces need for pain relief, such as an epidural or opiates
Mums report their pain to be lower than women who labour on land
Potentially shorter duration of first stage of labour (although studies vary)
What the Benefits of a Water Birth?
Lower chance of an episiotomy
Higher rates of vaginal births
Better chance of birthing with no major perineal trauma
Used less pain medications compared to women who had land births
Women who had waterbirths had average pain ratings that were lower than all the women who had land births—even lower than the women with epidurals
A calm entry earth side for baby, as baby goes from a warm amniotic sac to the warmth of the water.
Mum’s calm hormones give calm hormones to the baby (this is known in the research, that the mother’s hormones are the same as the baby’s hormones)
A sense of empowerment and elation from mother. A confident start to parenting. (I’m sorry but you’re gonna need the best Goddamn start to parenting that you can muster, as the parenting gig is pretty dang tough)
Um excuse me?! What Mumma doesn’t want that?
Risks/Drawbacks of Water Immersion/Water Birth:
Some women don’t like the sense of loss of gravity, maybe Mum prefers to be on land
Have to keep adding warm water
Extremely rare risk (reported only by case reports, not large scale studies) of baby swallowing water (that under appropriate conditions, right temperature, mother and baby appropriately monitored, shouldn’t happen) during a water birth
Again, extremely rare risk of infection (but shouldn’t happen if appropriate protocols take place) during a water birth
One of the big issues in working out the risk, is that there isn’t great research available about water births, as it’s a very difficult thing to measure. As, for a reasonable analysis, you need 1000 women who birthed in water and 1000 women who birthed on land. You can’t randomly assign women to each group, as they’re obviously going to know which group they are in. Also, very often, women may not even end up birthing in the pool, for a variety of reasons. Sorry if you’re losing the will to live, while reading about research and a very vague entry into statistical analysis (I could go on about this, but only a handful of people would enjoy it).
Ill get to the point soon.
Now, researchers have published multiple case reports about adverse events that were related to (or possibly related to) waterbirth. This a poor type of evidence to draw a conclusion on. Any researcher would know this. Conclusions should be drawn from large, randomised samples, not individual cases, of some random woman who birthed down the road, with no medical support and had many risk factors during the pregnancy.
What do the Doctors and Midwives Say?
In the US and Australia, obstetricians totally agree with water immersion, but are mixed on the safety of water births. They base that on the risk of the baby swallowing water (this basically doesn’t happen for a variety of reasons and it’s an incredibly rare anomaly if it ever does, please see Evidence Based Birth review) when it is born and risk of infection (also rare and obviously, you would take typical precautions). The national obstetrician’s organisations have drawn conclusions about this, based on some very rare, individual case reports (see Review from Evidence Based Birth if you want the analysis).
Midwives in the US and Australia typically support water immersion and water births, based on large amounts of research. The American College Nurse Midwives (Midwives, 2014) released preliminary data from nearly 4,000 waterbirths that occurred in birth centres all over the U.S., supporting water birth as safe for mothers and infants. Midwives, generally come to the conclusion, that for labouring women who are not presenting with any risks and providing they are informed of the benefits and risks. Water births are available in a few different states in Australia, depending on the policies of hospitals and birth centres. In Tasmania, water births are available in Launceston (the second largest city in Tasmania), but not in Hobart (the capital city, where little old me lives). Further, in countries like England and New Zealand, who have a more woman focussed approach to maternity care, water births are extensively available.
Basically, midwives generally support water births and midwives are the experts in normal birth. Obstetricians are the experts in high risk birth and often don’t support water births. Ill let you ponder that.
What really baffles me…
Is why there is so much talk about a couple of EXTREMELY RARE and POSSIBLY NOT EVEN RELATED RISKS OF WATER BIRTHS, among doctors. When there are an ABSOLUTE MYRIAD of risks associated with medical pain relief. I am absolutely not saying that all these risks will happen, or to make anyone feel guilty or judgy wudged. But, as with any birth intervention, the benefits and risks should be made clear, so women can make an empowered choice.
Let’s Talk About the Benefits and Risks of an Epidural:
Um, duh. No pain. Nuff said.
A break, time to recuperate. You may be able to get some sleep
Relaxation, it may even help a stalled labour, as fear of the pain can stop progress. Once the pain is removed, some women’s labour can then progress
May reduce overall fear of childbirth
Significantly interferes with birth hormones
Lowers oxytocin, you need loads of this for birth to progress and to establish breastfeeding)
Reduces beta – endorphins, your own pain relief and gives you a euphoric feeling
Production of Adrenalin and Noradrenalin at the end of birth to push your baby out is impaired and makes Mum fully excited and alert to meet baby
Increased need for instrumental delivery (ie. Forceps, vacuum), due to a laying down position and absence/reduced levels of adrenalin.
Can slow labour due to interference with natural hormones
Potential need to help the birth along with synthetic oxytocin
Differing reviews of an increased caesarean rate – some say no increase, some say a 50% increase
Drop in blood pressure
Inability to urinate (so catheter required for 2/3 women)
Itching, shivering, sedation, nausea, vomiting, fever, unexpected maternal breathing issues, postpartum hemorrhage,
Inadequate pain relief for 10-15%
Rare side effect of severe headache for 6 weeks
Very rare – speech slurring, convulsions, life threatening reactions for 1 in 4000 women
Changes in hormones for baby, the same as for the mother
Changes in temperature for baby
Sometimes drug levels in the baby higher than in the mother
Newborn toxicity, jaundice
Change in fetal heart rate – very often stabilises, but can contribute to an emergency caesarean
I could go on, but I think that’ll do! Are you even still with me?? Head along to www.sarahbuckley.com if you want to know more anyway.
Again, not saying not to use medical pain relief or trying to guilt anyone. But the point I am making, why focus on the INCREDIBLY RARE IF THEY EVEN HAPPEN AT ALL risks with water births? When the risks of an epidural are well documented, but rarely, openly discussed. I’d love you to comment below if your caregiver discussed with you the benefits and risks of an epidural.
The reality is, when childbirth is concerned:
There is always a risk, a very small risk it may be, but you can never eliminate risk, no matter what you do or don’t do.
Why refuse a women’s right and childbearing right to have all pain relief options? Particularly when there are so many physical and emotional benefits for the mother and for the baby, from a water birth.
So, no matter where you are, look at your options for water immersion/water births/home births/birth centres and maybe you can even bring an inflatable birth pool to a hospital (like one of my Hypnobirthing couples did, at the Hobart Private Hospital, as they only have one large bath down the hall)! See her cool birth space she created below.
The bottom line is, let women make an informed choice based on ALL the natural and medical options. And Mums, keep in mind, your body, your baby, your choice.
I am a Clinical Psychologist, a Hypnobirthing Practitioner in Hobart, Tasmania and a mother of two precious young girls. I am passionate about helping mothers have positive birth experiences. I hope that women will inform themselves and learn strategies to help them through their births, regardless of whether they want to have a caesarean, epidural, natural birth or home birth. No one would run a marathon without some training and birth is harder than that, so childbirth definitely needs some preparation too. Birth can be an empowering and joyful experience and this gives you and your baby the best start to the rest of your baby’s life. Contact me now to book a Hypnobirthing class in Hobart, Tasmania, a one on one Skype Session, or enrol for Hypnobubs Online, if you’re not in Tasmania (you can upgrade this to a Skype session with me too).