The benefits of using water in labour.

Extract from “Water Birth” by Janet BalaskasHow water can help you in labour“The water looked very inviting and I was delighted with it when I got in. I had a fire burning and the room was candle lit, with soft music and lavender oil in a burner.”

The change in how a woman feels and behaves soon after entering a birth pool in a quiet darkened room can be remarkable. It seems to alter her state of consciousness and her concentration – sometimes dramatically – so that she very soon relaxes and sinks more deeply into herself and is able to let herself surrender to the involuntary rhythms of her labour. It’s as if she becomes sleepy, even dreaming.

In the ‘Birth and the Family Journal (Vol 8)’ Michel Odent writes: ‘The reason why kneeling or immersion in water during labour is so helpful is mysterious. What is clear is that water is often the way to reduce inhibitions… we observe that during such immersion in warm water, semidarkness is the best way to reach a high level of relaxation. Water may be a good way to reduce adrenergic secretion. Immersion in warm water with semidarkness may also be a way to reach alpha brain wave rhythms.

Water may be a symbol of mother, of comfort, regression to childlike needs and behaviour. Whatever way we want to talk about the effect of water during labour, one thing is sure.

The contractions become more efficient and less painful at the same time, so that sometimes the labour is very quick. Many women do not want to leave the pool because it is so comfortable. As a result sometimes the baby comes while the mother is in the pool.’

The benefits of water immersion, or hydrotherapy, in labour have been studied and assessed by many experienced midwives, researchers and doctors all over the world.

It is clear from common findings that including a pool of warm water in the birthing room adds a whole new dimension to the experience of childbirth. A recent study of 1,300 water births found that the use of a birth pool is rated very highly by women, whether having their first or subsequent baby and their enthusiasm is shared by midwives.

This echoes the findings of thousands of women and their midwives all over the world. There are some women who have had several water labours or births and have had such satisfactory experiences that they cannot imagine giving birth in any other way.

But just as every labour is unique, no two women will use a birthing pool in quite the same way. Moreover, a minority of women who try the pool do not find it helpful.

Many women however, are very keen to get into the pool at the earliest possible moment (although we will see later that it is not wise to get in too early) and some are so comfortable that they want to stay in the water for the whole of the remaining labour and birth.

Others find the pool helpful for pain relief during labour, but feel the need to be on dry land for the birth itself. A further group may labour and give birth on land but use the pool for relaxation after the birth.

In a long slow labour, episodes in the pool can be useful for resting. The message is that water can be of benefit in a variety of ways.

“My labour was very short and intense. Near the end I wanted to get my head down to slow the pain down When I went into the pool I found that I couldn't get my head down lower than my hips as I had been doing out of the water, so I felt the contractions more strongly than ever. I got out because I missed the presence of my husband to cling to and overall felt very isolated in the pool.”


Privacy and non-intervention

One of the benefits of labouring in a pool is the sense of privacy that most women who use it experience. Enclosed in her private space, protected by the gentle barrier of the water, a woman can feel secure from unwanted contact and more in control of her body. She is free to turn her attention inwards and focus on the rhythms of her labour and what she needs to do to ride the powerful sensation of the contractions.

Although it is essential that regular fetal monitoring is carried out periodically while the mother remains in the pool, in practice there are fewer internal examinations and other procedures than in most labours on land.

And, significantly, this ‘hands-off’ approach seems to have no adverse effect on mother or baby as was noted in a study of 2,000 women in a hospital in Switzerland where water birth is offered as an option to every woman.

“I was glad not to need any stronger pain relief (I had an epidural for the birth of my first baby) and to give birth naturally feeling in total control in the pool and in my own home. I liked the fact that being in the pool meant that the midwives keep a hands-off approach and leave it up to you with no internal examinations and no breaking of the waters. It was so different from my first experience.”

Midwives who attend water births often have to develop different ways of assessing progress in labour. Instead of routine vaginal examinations to check dilation, the midwife relies on more subtle indicators, such as the woman’s breathing, vocalisations and movements.

In fact, many midwives feel that attending labours and births in water has added an extra dimension to their midwifery skills, including an extra sensitivity to changes in the mother without the need for manual confirmation.


Pain relief through water

“The pool helped the labour to progress rapidly… I was very eager to get in the water and found it a huge relief when I entered… the pool was very useful in coping with the pain, helping to focus me so I could concentrate on making the pain useful and positive.”

One of the main reasons that women choose to use water during their labour is for the relief of pain. There is no doubt among midwives experienced in its use, that immersion in water can provide dramatic relief of discomfort for a high proportion of women.

Various studies have confirmed this finding. For example a clinical audit of water births carried out in five birthing units in England, ‘supported the proposition that water birth is effective as a method of pain relief.’

In hospital birthing units that have a long-standing commitment to the provision of pool facilities and support from birth attendants who feel at ease with using water in this way, there has been a dramatic reduction in the use of analgesic drugs such as pethidine (meperidine in the US).

The study cited above found that only 3 per cent of women who used water in labour used pethidine as well, compared to 60 per cent of women who laboured on land. A reduction in the use of such narcotic drugs is welcomed by all concerned, as its is now widely recognised that they can have a depressive effect on both mother and baby’s central nervous system, especially in repeated or large doses

A systematic review of three randomised control trials exploring immersion in water in labour only (not birth) found that there was a significant decrease in the use of medical pain relief in the women who used a birth pool in labour – indicating that for some women the use of a birth pool provides an effective alternative route to epidural anaesthesia.

Epidurals have become very sophisticated and generally provide effective relief from pain and can be used very positively in some circumstances. You need to be aware that using a birth pool will not eradicate the pain in the same way as an epidural – but works indirectly by helping significantly through the benefits listed below, to make it easier for you to tolerate and manage the pain yourself.


Summary of benefits of labouring or giving birth in water

Increases privacy
Provides significant pain relief
Reduces the need for drugs and interventions
Encourages a woman’s sense of control in labour
Facilitates mobility and enables the woman to adopt optimal positions for an active birth
Speeds up labour
Promotes relaxation and conserves energy
Helps to reduce tears
Is rated highly by mothers and midwives
Encourages an easier birth for the mother and a gentler welcome for the baby