Choosing A Water Birth

Beverley A. Lawrence Beech

This is an excerpt from the AIMS booklet, "Choosing a Water Birth". You can order the full booklet for AIMS - see our Publications List for more details.

Into the Water

A woman's right to choose a water birth is now enshrined in Government policy:

"We recommend that all hospitals make it their policy to make full provision whenever possible for women to choose the position which they prefer for labour and birth with the option of birthing pool where this is practicable." [1]

The use of water to ease pain in childbirth has been known for centuries. Many midwives have been encouraging women to get into baths for pain relief. The idea of relaxing in a pool of warm water, in tranquil surroundings, is very appealing to many women, and increasingly, AIMS is approached by women who want to arrange the use of a pool.

According to Janet Balaskas, in her book Water Birth, there are legends of South Pacific islanders who gave birth in shallow sea water, and of Egyptian pharaohs born in water. At the First International Home Birth Conference at Wembley in 1988 a woman from Guyana, South America, described how the women in her home town go down to a favoured spot in the local river to give birth to their babies.

The current enthusiasm for the use of water in childbirth began when Frederick Leboyer promoted his ideas of a gentle birth and encouraged parents to bathe their babies immediately after birth. Not long afterwards Michel Odent, a French obstetrician, began to encourage women to use birth pools to ease the pain of labour at his maternity unit in Pithiviers, France.

Odent noticed that many women are attracted to water during their labours. While most get into the water for pain relief, and some leave the water just before giving birth; others choose to stay and give birth in the water, or find that the birth is so quick and easy that their baby is born in the pool unintentionally.

The Benefits of Water Birth

As the birth of her baby approaches, every woman will have her own, highly personal, reasons for being attracted to a certain scenario for the birth itself. When women are attracted to the idea of water labour or water birth they often see it as a simple way of helping themselves to cope without the use of strong drugs, and increasing their chances of giving birth naturally and normally with the minimum of interference or medical intervention.

"The atmosphere was magical, very hushed and peaceful. Here was a new life, praise be to God. Diena and I slowly and gently lifted my baby into my arms, where I gazed, devouring with my eyes. I lifted her to find out her sex, then put her back to my breast, where she lay happily, the water keeping us both warm." Oriole Melaniphy, 1989

Although only a few small studies in the UK have looked at outcomes for the baby as regards death and illness, so far there has been no evidence of increased risk when women have used water for labour or birth; although there are questions about the temperature of water and anecdotal stories of rare and isolated problems.

Doctors seem to have a much greater interest in reporting any adverse incident which may be connected with a water birth, even though it may not be a causal relationship. They are far less enthusiastic about reporting incidents relating to fetal scalp electrodes, prostaglandin inductions, oxytocin augmentation, epidurals, to name but a few medically recommended procedures and treatments. Anecdotal evidence in the medical literature is not unbiased reporting. It is filtered through the minds of doctors who do not wish to run the risk of causing criticism or litigation and it is also affected by the interests of drug companies and equipment manufacturers.

There seems to be a wealth of anecdotal evidence that labouring in water can reduce women's perceptions of pain so significantly that far fewer need to use drugs for pain relief. This has been borne out by a study that looked at a group of first-time mothers and researchers found that only 24% of those who laboured in water needed pain relieving drugs, compared to 50% of those who did not use water.[2]

A reduction in the use of pain relieving drugs not only benefits the mother (who will be more alert and responsive after the birth) but the baby will also benefit considerably. A study by Rosenblatt and colleagues has demonstrated how babies whose mothers had epidural anaesthesia were still showing adverse effects of the drug up to six weeks later. [3] Several studies by Jacobson and colleagues revealed that 25% of mothers giving birth to children who subsequently became addicts had been given opiates (morphine and pethidine), barbiturates, or both, in labour compared with only 16% for controls. The authors concluded that imprinting at birth could be the mechanism by which some young people are trapped into addiction after trying drugs, whereas others are not.[4]

It is difficult to know if mothers find it easier to cope with the pain of labour because immersion in deep, warm water, in itself, is an effective analgesic, or if labour becomes more manageable because of the way that women in water can move freely from one comfortable position to another, and relax so deeply between contractions while the mothers' bodyweight is completely supported, as well as an enhanced sense of privacy and security within the confines of the pool.

"As waves built up, I started to use my voice in deep toning and as I had my head on my arms on the side of the pool the reverberations coming off the water were amazing. In between waves I'd sit back leaning on the side relaxing, then flip over onto my feet to squat during waves. It was so easy to move around in the water. We had a hexagonal pool with wooden sides and rails. I found the flow of water very soothing and the temperature control was perfect, I didn't have to shift it at all."
Diane Bhumi, Wiltshire

Using water has also been shown to reduce episiotomy rates. One study reported that of 541 women using a water pool during 1994/96 there were three episiotomies performed on primigravida and two episiotomies on multigravida women (during 1996 there were no episiotomies). Just under half the women had intact perineums, and 53 women had first degree tears, 83 had second degree tears and two women suffered a third degree tear. [5]

If you decide to book a water birth, you do not have to make a firm decision about whether or not to give birth in water. Be flexible and follow your instincts. If near the end of your labour you decide to get out of water that is fine - in fact many women feel the need to have their feet firmly on the ground to harness gravity to give birth.

Arranging a Water Birth at Home

Arranging a water birth at home can be difficult for some parents unless they have a sympathetic midwife. Fortunately, since the First International Water Birth Conference many more professionals are better informed, more confident, and better prepared to assist parents with this option. If you are faced with a midwife who is uncertain, and a health authority or Trust that is unwilling, you should make sure all your contact is in writing. It is not unknown for officials to make statements which they would not be willing to put on paper because what they have told the woman is misleading or sometimes completely untrue.

"If we can't find a midwife who can deliver you in water you won't be able to have your baby in water." Julia Boulger, Redhill

The Trust has a duty to provide a midwife, and if you are wishing to have a water birth they have a responsibility to ensure that she is adequately skilled and trained. When challenged about such misinformation the defence is often "Mrs X must have misunderstood."

Many women are told that they have to seek the approval of their GP or obstetrician, or that there are circumstances where a home water birth will not be "allowed."

Unfortunately, there are many staff who are not aware that it is not in their, or anyone else's, power to "allow" anything. They may recommend, or advise, but they have no authority to "allow" as the decision is entirely the woman's. All women have the right to give birth in water in their own homes if they choose, and an appropriately skilled midwife must be provided.

Sample Letter

If your GP is interested in supporting a water birth (few of them are), and undertakes a lot of home births, you can approach him/her and ask if s/he would be prepared to provide cover. If he is not willing to be involved, or you do not wish to approach him, you can contact the Supervisor of Midwives at your local maternity unit and book a water birth through her. Your letter could be along the following lines:

Dear ,

I am expecting a baby sometime in (state month) and I intend to use a water pool for labour and birth at home. I would be grateful if you would allocate a midwife who has experience of, or an interest in, this kind of birth.

We have decided not to approach my own, or any other, GP for support. If, however, you consider that GP support is needed, please feel free to make the necessary arrangements. I shall not involve myself with this issue.

I accept full responsibility for my decision to give birth at home and in water and I feel confident that you will be able to provide me with a competent midwife, fully backed up by such facilities as are necessary to make the birth as safe as possible.

Yours sincerely,

Always keep copies of any letter you write. In addition you should send copies to:

We suggest you send copies to each of the above mentioned people, so that the Health Authority or Trust is fully aware of requests for water birth. Women are often told that there is no demand. What the authority really means is no-one has informed them of this kind of request before, and no-one keeps records of how often this service is requested and turned down.

Arranging a Water Birth in Hospital

AIMS is frequently contacted by women who are trying to organise a water birth in hospital. Although many hospitals advertise, or apparently offer water births, they can never be guaranteed. The pool may be genuinely out of order or "in use by another woman", but we suspect very often this is an excuse. The best way of finding out is to get the statistics for your local unit as to how many women laboured in water and how many women gave birth in water last year. In 1996 the British Journal of Midwifery published a study which the National Perinatal Epidemiology Unit at Oxford carried out in 1993-4 to look into pool use [7]. It confirmed our suspicions. Nearly half the 219 hospitals in England and Wales with pools virtually never used them. Only 4 had 100 or more water births, 17 had 50 or more, 179 had fewer than 20, and 93 units had fewer than 4 births over two years.

Meeting Professional Opposition

Hospitals that are uncertain about birth in water give a range of excuses to justify why a woman cannot get into the pool:

If your local hospital does not have a pool, all is not lost. Bring your own, or encourage the hospital to provide one. It is not necessary for you to book into the hospital by booking with a particular consultant obstetrician. You can book directly with the midwives. Some parents have found that the midwives were enthusiastic about a water birth but the obstetricians were not. If you decide to book with the midwives, write to the Director of Midwifery Services at the hospital concerned and ask her to make the necessary arrangements.

If you want to book your water birth in a GP unit, you do not have to get the permission of the GP or the obstetrician. You can write directly to the Director of Midwifery Services at the unit.

If you find yourself arguing with the medical or midwifery staff you can bypass them and write to the Chief Executive and seek his/her help. They are often very sympathetic.

If you find yourself in the middle of an argument:

Meeting Resistance

If you find that despite all your efforts, the hospital persists in refusing to book you in for a water birth, or refuses to confirm that you will have an experienced midwife attend a water birth at home, you can take a number of actions:

Some parents have expressed their concern about taking such action because they do not wish to antagonise the hospital staff. It is our experience that such actions often result in the staff bending over backwards to show that they are trying to respond to the parents' needs. In those isolated cases where the parents have been met with hostility we have advised them firmly to state that they will not tolerate such attitudes and if the person concerned does not amend his/her behaviour immediately they will refuse to be attended by them. This action has always resulted in modified behaviour.

Conclusion

It was clear from the speakers and delegates at the First International Water Birth Conference that many thousands of women are labouring and giving birth in water around the UK and abroad each year and find it a positive and empowering experience:

"I did not have any form of pain relief, I just used the pool. I felt great and felt much less pain in the pool!" Yvonne Williams, Isle of Man, 1994

As water birth grows in popularity and becomes more widespread, the majority of women will have no problems arranging one. Increasing numbers of midwives are growing more confident and supportive and there are many hospitals which enthusiastically promote and encourage water birth - and have seen their drugs bill plunge dramatically as a result.

This booklet has been written in order to help those who may experience difficulties in getting what they want. For many readers it will provide an interesting insight into the kind of problems which can occur. For others, who find themselves in difficulty, we hope that this booklet will arm them with information and some strategies, as well as the confidence, to persist in obtaining the best possible care for themselves and their babies. When women do what they know is right for them, the outcome is more likely to be a positive one.

Beverley A. Lawrence Beech
1998

AIMS makes information and articles freely available on its website as a public service. We also provide advice and support to individual parents and professionals at no charge. We receive no government or charitable funding, and rely solely on donations, membership subscriptions and the efforts of our volunteers. If AIMS has helped you, please help us to help others by joining or making a donation.

References

[1] Winterton, N, House of Commons Health Committee, Second Report - Maternity Services. 23 February 1992, ISBN 0 10 283092 4

[2] Burns, F, Greenish, K, Pooling Information, Nursing Times, 1993; 89 (8):47-9

[3] Rosenblatt DB, et al, The influence of maternal analgesia on neonatal behaviour: II Epidural bupivicaine, Br J Ob Gyn, 1981; 88:407-13

[4]Jacobson B, at al, Opiate addiction in adult offspring through possible imprinting after obstetric treatment, BMJ, 1990; 301: 1067-70.
See also Jacobson B, et al, Obstetric pain medication and eventual adult amphetamine addiction in offspring, Acta Ob Gyn Scand, 1988; 67:677-82; and Jacobson B, et al, Perinatal origin of adult self-destructive behavior, Acta Psychiatr Scand, 1987; 76:364-371

[5] Brown, L, The tide has turned: audit of water birth, Br J Midwifery, 1998; 6 (4), 236-43

[6] For the full proceedings from this conference see Beech, B, Waterbirth Unplugged, Books for Midwives, 1996.

[7] Marchant S, et al, Labour and birth in water: national variations in practice, Br J Midwifery, 1996; 4 (8): 408-412; 429-430.

Birth Pool Hire Companies

Active Birth Centre - (www.activebirthcentre.com)
Nationwide delivery.

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Middlesex - Tel 020 8422 9308

Birthworks - (www.birthworks.co.uk)
Nationwide pool hire via agents or direct delivery.

Alice Charlwood Birth Pool Hire - Wiltshire
Tel. 01672 520957

Aquabirths - Bradford
Ruth and David Weston, Tel. 01274 781358 Email: aquabirths@sharplesweston.freeserve.co.uk

Birth Rites - East Sussex, S. London
Tel. 01342 826581

Blue Lagoon - Lancashire
Tel. 01695 556642

Elsie Inglis Birth Pool - Edinburgh
(administered by AIMS Edinburgh on a voluntary basis, to keep costs low)
Tel. Caroline Weddell on 01506 824620 or Nadine Edwards on 0131 2296259

Naissance Naturelle - Solihull, West Midlands
Tel 0121 7054598

Waterbabies - Bury, Lancs
Tel 0161 764 2616

About This Document

Original version (c) AIMS 1996

This fully revised edition (c) AIMS 1998

Published by AIMS on behalf of the British Maternity Trust

ISBN 1 874413 09 6

AIMS makes information and articles freely available on its website as a public service. We also provide advice and support to parents and professionals at no charge. We receive no government or charitable funding, and rely solely on donations, membership subscriptions and the efforts of our volunteers. Please help AIMS to help others by joining AIMS or making a donation.

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