What you REALLY need to know about Water Birth

I speak to so many pregnant women who love the idea of a water birth, but so few people actually have them in the end.

I had two water births myself, so I don't have a frame of reference for a land birth, but I have witnessed many waters births at home, and a handful at hospital, and I can genuinely say that water immersion during labour is a fantastic tool for pain relief, relaxation and mobility.  

So what the heck is going on and why are we restricting the use of a nice warm bath when anyone can rock up to a maternity unit and be administered strong opioid pain relief, which arguably carries a much greater risk to both parent and baby?!

Let’s get into all of it..... Here are my five BIG things you should know about Water Birth.....

ONE – Water birth is very effective.  

A recent meta analysis and systematic review (Burns et al 2022) states:

“Water immersion significantly reduced use of epidural, injected opioids, episiotomy, maternal pain and postpartum haemorrhage. There was an increase in maternal satisfaction and odds of an intact perineum with water immersion.’’  

TWO - Despite all this good evidence...water immersion is VERY underused.  

But why?! Why are so many women denied access to a pool despite so much evidence that it works well and is a very low risk pain relief option.  

Well, the answer is complicated. So many women are ‘risked out’ of a water birth, often for risks that have no bearing whatsoever on the safety of water immersion during labour. Simply being labelled ‘high risk’ for whatever reason (in reality most women are slapped with this label by the end of pregnancy) often puts a barrier between you and some nice safe warm water. These reasons are often nonsensical and not evidence based, and often with some good advocacy, support and talking to the right people, you can side step this recommendation and be admitted into the pool.  

Fear of medical litigation has led hospitals to be very keen on continuous monitoring, (even though it doesn’t improve outcomes but does increase the risk of the baby being born via surgery) which again makes it harder to get in a pool. Yes, they have the wireless ones, but they often slip around and constantly loose the trace...so in general they would rather you are on land and pretty still to keep a good trace on the CTG.  

Lots of hospital midwives are also not very confident with supporting water birth. It is a much more hands off skill, and for a labour ward midwife who is very much used to being hands ON and medically managing birth, sitting on their hands can be very difficult. Often even if you do manage to get in, after a while they conjure a reason to try and get you out.  

3. If you want a water birth, here's how to go about it...

• Plan a home birth. You are far and away more likley to sooth those labour pains in a nice deep tub of water at home, than you are at hospital  

Don't leave it until you are in labour to have this conversation. During pregnancy if you are told NO you can’t have a water birth, ask....  

• Why not?  

• What are the risks to me/my baby in my individual circumstance? 

• Is this just a policy? What is the up to date evidence behind it? 

• Can I speak to a professional midwifery advocate or a consultant midwife to make an ‘out of guidance care plan’  

• What alternative pain relief can you offer me that carries as few risks for myself and my baby? 

If you are in labour and being denied access to the pool for a reason you deem illogical, OR your care provider is gatekeeping the pool saying you need to have vaginal examination before you can get in.... consider using these phrases... 

“Can you explain to me what would be unsafe about me having a warm bath right now? What extra risks would this warm water carry?” 

Or in the case of the gatekeeping VE:  

“Are you saying I need to accept a vaginal examination against my consent in order to benefit from clinically proven pain relief?”  

This is where having a doula comes in incredibly handy! We can ask all those questions, taking the pressure of you and your partner, meaning you can focus on labour and we can handle the rest of it!  

4. The pros and cons of water birth

Pros-  

• Mobility 

• Relaxation  

• Pain relief 

• Privacy (you are in your own little protected bubble)  

Cons... 

• You might not like it, it might not provide the relief you had hoped for

  
  

• People are often told YOU CAN’T GET IN THE POOL YET IT WILL SLOW THINGS DOWN... 

  
  

Well what if it does? Maybe you can get a well needed break. Maybe you get back out and it speeds back up again? Maybe it doesn’t really matter?! Sometimes getting in the pool does seem to slow things down a bit, but probably not as often as you might think. And there is a very simple solution so it seems a daft reason to deny someone the pain relief of a nice warm bath.  

5. Birth partner water birth tips

Having a jug handy can be really useful for water massage. This is basically pouring a nice big slow slosh of warm water down your partners back during a contraction. This can be really excellent pain relief/ help with relaxation. If you are in hospital and don’t have access to a jug, I often find one of those sick bowl things (or two layered up) does the trick!  

Find out more about Doula Support

If you have are planning a home water birth, check that you have well-fitting tap adapters to connect the hose. I’ve had a few sketchy situations where I’ve had to rig a gaffatape situation, and you just don’t want to be doing that and potentially flooding your house, while your partner is in labour.  

Don’t overfill your pool. In fact, when your first fill it... underfill it! This will mean if you need to top it up there will be space and you wont have to faff around with a bucket. And on that note – a bucket is also a non-negotiable item for a home water birth, along with way more towels than you think you will need. 

As a doula and antenatal teacher, I really do love a water birth. 

If you want more birth tips and info from a working doula...  

I offer power hours, antenatal courses and doula support (the first two can even be done online!) so get in touch if you’d like to chat.