What is "hydrotherapy for labor and birth"?
"Hydrotherapy" is the use of a heated water bath or pool by a laboring woman during labor and birth. Many women in labor find that being in water helps them relax and helps relieve pain. Some women prefer to stay in water at the time of birth and deliver their baby in the tub or pool. Others stay in water only part of the time during the labor and choose to birth their babies in a bed. This article will describe some basic information about the use of a warm water bath for labor and/or birth.
How did water birth first get started?
The first recorded water birth was in 1803 in France. According to the story, a woman who had been in labor for 48 hours climbed into a tub of hot water to relax and her baby was born shortly afterward. Not much is mentioned again about the technique until the 1960's when a Russian scientist, Igor Charcovsky, began experimenting with the use of warm water immersion for women in labor to see how it affected their labor, the birth, and newborn behavior.
Then in the late 1970's through the 1980's various obstetric practitioners began using warm water baths for laboring and birthing women. Dr. Michel Odent in France and Dr. Michael Rosenthal in California collected information about its effects and women who had experienced it told their stories. Interest in the idea gradually spread around the world.
What are the benefits of water during labor and/or birth?
Soaking or floating in a pool of warm water seems to help the body relax more easily because water creates a sense of weightlessness. The muscles don't have to work so hard to support a laboring woman and there is no pressure on the body to cause local discomfort. This can lead to more relaxation and a sense of reduced pain with the contractions.
Some researchers feel that being in water improves blood flow to all parts of the body, especially the uterus. They have observed that a laboring woman's blood pressure may be lower if she soaks in a tub of warm water. They also feel that improved blood flow may protect the baby against fetal stress. Because being more relaxed and more comfortable lowers stress hormones caused by labor pain, some researchers have found that labor may be somewhat shorter if warm water immersion is used. Other researchers have not found any great difference in the length of labor.
Being in a tub of water that is heated to normal body temperature can help the laboring woman maintain her own body temperature at a stable level. She may be less likely to become chilled or overheated. Because the warm water relaxes muscles in the pelvis and vagina, there may be less need for an episiotomy and less incidence of tears. While research suggests that fewer episiotomies are performed in women who use warm water baths for birth, it is not certain that there really are fewer tears compared with delivering in a bed.
Most women who have used warm water baths for labor or birth report very positive feelings about it. They report less pain, a greater sense of relaxation, and a greater sense of control.
Are there any problems associated with laboring or birthing in water and how can they be prevented?
Some researchers have noted that if a laboring woman gets into a warm bath too early in labor, it will slow down her labor and space out the contractions. Because of this, many people recommend that a laboring woman wait until her labor is well established and her cervix is at least 4 centimeters dilated before using the tub. Others have noticed that labor goes faster if the woman is 4 centimeters or more dilated and she gets in the water, but then labor will slow down if the woman stays in the tub continuously for more than one or two hours. There is no good research on this yet. If labor slows, the logical thing to do is to walk around for a half-hour or so and then get back in the tub. Many people who have participated in water births report that the pushing stage is easier and shorter, but, again, the research on this is still new.
If the temperature of the water is either too hot or too cool it can cause undue stress for the baby. The temperature is maintained close to 98 degrees and laboring women are encouraged to stay hydrated and comfortable. The baby's heart rate may go up if the baby is overheated. A rapid heart rate could also indicate infection or distress so it must be evaluated carefully.
Another concern for the baby is what happens if the baby is born underwater and then tries to take a breath. We know that a healthy baby who is not in distress will begin to breathe only when it feels cool air on its mouth or nose. Thus, if a mother is giving birth in a tub, she must have her bottom and hips completely under water to prevent the baby from taking a breath. If her pelvis is partly in and partly out of the water during the actual birth, air could touch the baby's mouth and it could inhale before the whole birth is completed. Once the baby is born, it is raised gently to the surface and cradled in the mother's arms with its face out of the water. Then the baby will start breathing safely.
Babies can lose body heat very rapidly. It is important to make sure the water in which the baby is born is at least body temperature so that the baby will not get chilled. A cold baby uses more oxygen and can be slow to breathe and nurse.
Infection can occur from two sources. One source is germs the laboring woman might carry in or on her body and the other source is germs that might be present in the pool or water. Because birth always involves the release of body fluids, researchers have looked at the potential for infection. During birth, a laboring mother will lose fluid from the bag of waters, pass urine, blood, and sometimes stool. Fluid from the bag of waters and urine are usually sterile, that is, there are normally no germs in those body fluids. Blood can carry both bacteria and viruses. Stool usually carries bacteria and other types of organisms. Current research indicates that most germs cannot live very long in warm, chlorinated water. Since city water has chlorine in it to kill germs, and city water is what goes into our tubs, the chance of infection due to water contamination is remote. Also, if there are bacteria or viruses in body products or fluids, the amounts are thinned out with exposure to a large tub of water and that makes the germs less able to cause infection.
The tubs go through a thorough cleaning process with special cleaning products that kill germs after each use and tests are done periodically to make sure no bacteria that cause infection remain. To prevent cross-infection between the laboring woman and health care providers, the health care personnel wear special gloves and gowns during examinations and the birth.
Labor is stressful for both the mother and the baby. Nature has equipped healthy babies and mothers to handle that stress. Fetal distress occurs when the baby's ability to cope with labor is compromised in some way. A problem can show up in labor and be recognized by changes in the baby's heartbeat or it might show up shortly after birth. Sometimes a stressed baby will have a bowel movement in the amniotic fluid before it is born causing the leaking water to appear green or yellow tinged. Checking on how babies are handling labor is managed the same way for all babies regardless of whether or not the mother labors or births in water. All babies are monitored electronically for 20 minutes or so when the woman first arrives in the hospital. In active labor the heartbeat of every baby is monitored with a special stethoscope every 15 minutes. If there are indications that the baby is experiencing a problem, the mother will be asked to leave the tub and the electronic heart rate monitor will be put on.
Safety for the Laboring Woman
The same principles about infection described above apply to the laboring woman. Research shows that water does not enter the birth canal and travel upward during labor and there is no increased incidence of infections of the birth canal or uterus because of a water birth. Bleeding
It is very hard to estimate the amount of blood a woman passes after she delivers the placenta (afterbirth). This is true whether the woman is delivering in a bed or in a tub. There is some research that suggests a slightly greater amount of blood loss after a water birth. The nurse or midwife will check the uterus frequently to make sure there is no excessive bleeding. If there is a concern, the woman may be asked to exit the tub for an examination and/or treatment.
The combination of hard, physical work (labor) and immersion in a warm tub of water can lead to loss of body fluids through sweating. Dehydration (not having enough liquid in the body) can cause an increase in the mother's heart rate and a low-grade fever. The laboring mother will be asked to drink at least 8 ounces of clear fluids every hour to prevent dehydration.
What kind of equipment do hospitals and birth centers have for water use in labor or for birth?
Some hospitals and birthing centers have birthing rooms equipped with a Jacuzzi bathtub and shower. A woman in labor can use either one. The Jacuzzi is not very deep and is not big enough for doing a birth.
Some have large portable spas available to patients who have requested this option. The spa has jets and can accommodate the laboring woman and her partner comfortably.
What happens if there really is a problem?
We assume that the health and safety of the laboring woman and her baby are the primary factors that influence decisions about your care. A problem for you or the baby will be handled in the same manner whether you are planning a water birth or a birth in the bed. All maternity patients have access to monitors, medication, obstetric specialists, pediatric specialists and surgical procedures as needed.
Certain kinds of problems would not permit the use of the water tub. If a particular concern arises when you are already in the tub, you may be asked to move back to the bed. In general, your pregnancy must be normal with no sign of high blood pressure or fetal compromise. Medical or fetal problems that put the woman or her baby at high risk and require continuous electronic fetal monitoring would preclude birth in the tub.
Laboring and giving birth in water is becoming more widely available to expectant mothers.
1. Read everything you can on laboring in water and water birth.
2. Discuss your concerns and preferences with your nurse midwife or doctor.
3. Partners who wish to be in the tub with the mother need to bring a bathing suit. Laboring women can use a sports bra or tank top if they choose.
For more information about waterbirth, check out these links:
Global Maternal/Child Health Association
The organization, Water Birth International, was formed to encourage research, distribute accurate information, and to help people who were interested in the concept successfully implement the use of water baths for labor and birth. Water Birth International changed its name in 1992 to the Global Maternal/Child Health Association and has sponsored several international conferences on water birth. They are a great resource for books and videos.
Monadnock Community Hospital's Birthing Center
Monadnock Community Hospital's Birthing Center has long been known for its family-centered birthing philosophy and underwater birth is just another extension of that.
This pioneering site is dedicated to the belief that every mother has the right to have the birth experience she wants, and to educate expectant parents and birthcare professionals about the extraordinary value of water labor and waterbirth to everyone concerned.
Birthwaves of Toronto
Birthwaves, a Toronto based business, is the first store of its kind in Canada, providing essential items for midwives and home births. This website provides numerous resources for parents planning a waterbirth. They also provided some of the graphics for this story.
Waterbirth Info/Midwife Archives at Gentlebirth.org
The Midwife Archives is a collection of
excerpts from messages that have appeared on birth-related distribution lists or
newsgroups. Not all of the opinions here are those of midwives - some are from
labor assistants, childbirth educators, or parents.
Special thanks to the nurse midwives of OHSU for their assistance in researching this article. I originally wrote this article at suite101.com, where you can find many links and articles on pregnancy and birth. Links and images used with permission of the website owners.
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