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If you’re preparing to have a baby, you’re likely looking into every option before finalizing your birth plan. Birthing situations outside of typical hospital births have become more common— in fact, birthing centers and home births saw a 20% increase in popularity between 2019 and 2020[1].
One of those birth plan options is a water birth. Some people might choose this type of birth in order to relieve pain during labor or have a more “natural” birth, but is a water birth safe, and what precautions should you take to ensure your baby will be healthy? Keep reading to understand more about the water birthing process.
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What Is Water Birth?
While some people might choose to be immersed in water during the labor process, a water birth occurs when the birthing person is submerged specifically during delivery, explains Michelle Owens, M.D., a board-certified OB-GYN and clinical director of Mae, which provides pregnancy and postpartum support to Black people through doula services.
The purpose of using water during labor or birth is to incorporate hydrotherapy: During labor, water immersion could result in pain relief and therefore, less epidural use and shorter labors, says Karen Jefferson, a certified midwife and the director of Midwifery Practice at the American College of Nurse-Midwives. “Those who remain in the water to have a water birth are more likely to have a shorter second stage of labor (i.e. time spent pushing) and have fewer or less severe perineal lacerations,” adds Jefferson, as being in water might result in less vaginal tearing.
It is important to note that any patient who has an epidural is not eligible for a water birth.
When the birthing person is in active labor, that’s the right time to enter the birthing pool, submerged from the waist down. The person is allowed to leave the tub periodically to walk around and use the restroom, and then return to the pool to deliver. A midwife, in order to keep the pool as sterile and safe as possible, stays outside the tub to support the person giving birth and make sure they have a safe method to get in and out for restroom use or for emergencies.
What Are the Benefits of Water Birth?
Small studies have shown that people who have given birth via water birth compared to more conventional birthing methods have had a more positive childbirth experience overall[2]. “Of note, in one study, waterbirthers reported a greater sense of autonomy and control,” says Jefferson[3].
Water birth seems to benefit the birthing parent’s comfort more than the baby’s, according to Dr. Owens. “Immersion in water during the first stage of labor (until the cervix is fully dilated) may be associated with shorter labor and decreased use of regional (spinal or epidural) anesthesia,” says Dr. Owens.
What Are the Risks of Water Birth?
There are not many studies on water birth, so there’s not much concrete evidence of risks to the birthing person, explains Nicole Rankins, M.D., board-certified OB-GYN and host of the All About Pregnancy & Birth podcast.
Meanwhile, rare risk factors for infants during water births include aspiration (difficulty breathing underwater due to water in the lungs) and infection due to inadequate disinfection of the tub. “There have also been reports of umbilical cord avulsion,” says Dr. Rankins, which is a tearing of the umbilical cord, making the placenta difficult to deliver.
It is important to note that continuous fetal monitoring cannot be accomplished with water births and complications such as dystocia (in which the baby is stuck in the birth canal and cannot come down) adds danger to water births. Water births should be reserved for only a completely normal labor.
The American College of Obstetricians and Gynecologists (ACOG) recommends against giving birth in water because there is a lack of research on the risks and benefits overall. And while you have the right to give birth in water, you should take into account any potential rare but serious complications for the baby, says Dr. Rankins. “A physician does not have to perform water birth if they believe, based on evidence, that it would be harmful to the mom or baby.”
Who Is a Good Candidate for Water Birth?
The only people who could be candidates for water birth are people who are full-term in their pregnancy and have no pregnancy-related complications, says Dr. Rankins. If there are no pre-existing complications, it should be safe.
Some of those pregnancy complications could include prematurity (delivering before 37 weeks of pregnancy), preeclampsia or diabetes, according to Dr. Owens. Pregnancy complications involving the baby could preclude you from choosing a water birth. That may include the baby in a breech position, which is feet facing forward in the uterus rather than the natural position of head facing forward, or if you are having multiples (twins or more), says Dr. Owens.
“If you are healthy with an uncomplicated pregnancy, this may be a reasonable option for you,” says Dr. Owens. Laboring in water may be a good alternative if you do have a higher-risk pregnancy and would not be a candidate for a water birth.
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How Can I Have a Safe Water Birth?
Because ACOG doesn’t recommend water births, some OB-GYNs do not practice them. But certified midwives and certified nurse-midwives are educated to support labor and birth and are well-qualified for water birth, says Jefferson.
That said, in many areas of the country, water birth is a relatively common practice among OB-GYNs. Just be sure to confirm your nurse midwife has appropriate experience in water births since each state has different requirements for certifying midwives.
Besides the provider, there are guidelines a water birth should abide by, including regulating water temperature (it should be between 95 and 99 degrees Fahrenheit, according to The American College of Nurse Midwives[4]) and following sanitation protocols for the tub to make sure it’s sterile and has a lower potential of causing infection, says Jefferson. There should be personal protective equipment for everyone involved in the water birth as well, says Dr. Owens.
Certified midwives and certified nurse-midwives also follow certain guidelines to keep the infant safe. “These include bringing the infant’s face to the surface immediately after water birth, and keeping the infant’s body submerged with their face above water to maintain thermoregulation,” Jefferson explains.
And finally, it’s important for there to be plans to monitor maternal and fetal vital signs to make sure everyone is healthy, as well as having a designated plan to exit the tub or pool if any birth complications take place, says Dr. Rankins.
What Do I Need for a Successful Water Birth?
First, you’ll need to plan where the birth will take place. “Immersion in water during labor can be an option at some hospitals, birthing centers, and/or may be used in a home birth,” says Dr. Owens. She recommends touring a facility or birthing center beforehand so it feels like a familiar space if you’re not going to have the birth in your home.
If you’re searching for a birthing center in your area, you might search “water birth near me.” And during this preparation process, Jefferson suggests taking birthing classes like Lamaze and Mindful Birthing to make sure you’re ready for labor.
You’ll also need the supplies: For a home birth, you can order or rent an inflatable birth tub online, says Jefferson. A hospital or birth center might use either an inflatable or built-in tub for water birth, she adds, and if you choose to just go through labor in a tub, you might then move to a bed for what’s called a “land birth.”
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