Use of water in labour and birth

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This leaflet is to provide women and their partners with information about the use of water during labour as a form of pain relief.

The maternity unit at Milton Keynes University Hospital has two large deep pools which can contain enough water to allow freedom of movement. Healthy women with straightforward pregnancies over 37 weeks are offered the choice of using a birthing pool for labour and birth if they wish to do so.

Women report the soothing and relaxation effects that immersion in water during labour can provide. Water can help women feel relaxed and calm, as well as providing some relief from pain and the discomforts of pregnancy.

The advantages of using the pool are:
• The water in a birthing pool supports 75% of a labouring woman’s weight, allowing a feeling of buoyancy and comfort. This makes mobility easier which conserves a woman’s energy during her labour.
• The baby adopts a better position for birth in the pelvis
• Reduction in the need for other strong pain relief. The relaxing effect of warm water helps produce endorphins, promoting the body’s natural pain relief mechanism.
• A feeling of being more in control of your body.
• Less need for drugs that accelerate labour such as oxytocin.
• A calm unhurried birth of the baby aided by the counterpressure of the water.
• A relaxed warm baby guided straight into the arms of the mother.
• The water can help lower your blood pressure.

Risks of labouring in water
Research evidence shows that there is no increased risk to you or your baby if you labour and birth in water compared to ‘dry’ land. Although there are risks with all births we work hard to minimise any potential problems. For healthy women with an uncomplicated term pregnancy, complications appear rare provided guidelines for the use of water in labour are followed carefully. The midwife will aim to provide a positive birth experience for both you and your partner and will discuss any concerns that she may have during your labour with you. Your co-operation with any
advice will be for you and your baby’s safety. If an emergency arises you will be advised to leave the water as quickly as possible.

Who can use the pool?
You should be able to use the pool if you have had an uncomplicated pregnancy and are between 37 and 42 weeks pregnant and haven’t suffered from any serious medical conditions or complications during this or any previous, pregnancy. Unfortunately, it is only possible to use the pool if you are pregnant with one baby, and your baby is lying with its head down (cephalic presentation). You should also be physically able to get in and out of the pool, and have a Body Mass Index (BMI) of 35 or less. Your iron count needs to be at a good level, 100gL or more. In most cases, women can use the pool if a small intervention is needed. For example, if you need antibiotics for group B strep.

There may be circumstances when we suggest that you use the pool for labour but not for the birth. However, it is important to bear in mind that the use of water may not be available or may not be suitable for every woman. For example, if there are safety concerns. If you are unsure as to whether you are eligible to use the pool please speak to your midwife.

What happens if I am told I am unsuitable for a waterbirth but I still want to go ahead with one?
If you are told that you are not eligible to use water in labour, but you think that it is the right choice for you, discuss all your options with your midwife. Your midwife may refer you to your Consultant Obstetrician or Consultant Midwife to discuss the risks and benefits of waterbirth and carry out a risk assessment during your pregnancy and at the start of your labour with you.

It may not be possible to support your request for the use of water in labour, but your midwife will be able to discuss your options for labour and birth, including alternative methods of pain relief, including using the shower for pain relief and relaxing during your labour.

Do I need to book the pool?
As you do not know when your labour will start it would not be possible to book the pool in advance. However, if you are giving birth to your baby at home you can hire a pool for use at home. Discuss the possibility of a water birth at home with your community midwife. Please discuss with your midwife where you may wish to place the pool at home, particularly the following:
• Location of electrical sockets and equipment
• Whether the floor can bear the load of a full pool
• Providing adequate space around the pool
• Providing covering for the floor

Can I have a water birth at home?
If you are considering using water at home for either labour or birth please discuss with your community midwife who will make a plan with you. You are responsible for providing your own pool. Please ensure that the room you intend to use is suitable for a birthing pool. When you go into labour telephone the Labour Ward to inform the midwives that your labour has started and they will call the Home Birth Team.

Please do not enter the pool until your midwife has arrived and has checked that you and your baby are well.

What if the pool in hospital is already in use?
As you do not know exactly when your labour will start it would be impossible to book the pool in advance. There are two pools at Milton Keynes University Hospital and it is unusual for both to be in use at the same time. However, it can be helpful to have considered an alternative plan in case there is no pool available when you arrive. You may wish to use other strategies such as one of the showers to help you relax. Should a pool become free during your labour we will inform you as soon as possible and provided there are no complications with your labour we will do our best to
accommodate your preference.

How can my birth partner help?
The role of the birth partner is to support the mother in labour, physically and mentally helping her to feel relaxed and cared for. They can help by assisting you to change position, offering drinks frequently and using a facecloth rinsed in cool water to keep you cool. They can get into the pool if they wish wearing suitable clothing. If you have decided that you would like to use the pool, you and your partner may wish to complete a birth plan. This will ensure that your needs are fully understood.

What do I wear in the pool?
You can either be naked as if going for a bath, or wear a T-shirt or swimwear. It is important that you feel comfortable and the choice is yours. You may also like to bring 2-3 large bath towels and a towelling dressing gown for when you leave the pool.

How warm is the water?
The water temperature is usually between 34-37ºC during the first stage of labour and you can regulate it to suit you throughout this stage. For your baby’s birth, the water needs to be about 37ºC. The midwife will monitor the water temperature hourly to ensure that you are comfortable and are not becoming too hot. The temperature of the water should not be above 37.5°C.

What if I need additional pain relief?
You may like to consider using aromatherapy oils or Entonox (gas and air) to help in addition to the water. If this does not provide enough pain relief for you the midwife may advise you to leave the pool for other pain relief such as Pethidine or an epidural.

How will my baby’s heart rate be monitored?
The midwife will use a hand held battery operated heart rate monitor which can be safely used while you are in the water. The midwife will listen every fifteen minutes to assess the wellbeing of your baby. If it has been identified that continuous monitoring of your baby’s heart rate is required, in certain situations the midwife can use a wireless telemetry monitor which enables this to happen.

What if the midwife is concerned about the labour? Would I ever be asked to leave the pool?
We would only ask you to leave the water if we were concerned about the condition of either you or your baby and we needed to monitor either of you more closely. Your midwife will discuss her concerns with you, and you will be kept fully informed so you understand the reasons why. Once either yours or your baby’s condition has been examined more closely you may be able to get back in to the water.

Can I change my mind about giving birth in the pool?
Yes, you can change your mind about giving birth in the pool. Some women prefer to use the pool for pain relief during the first stage of labour and then leave the pool for the birth of their baby.
Although most women enjoy using the pool, being in the water does not suit everybody and if you find that in labour that this no longer your preference you are able to change your mind about using the pool.

Can I still use the pool if my waters are broken?
Yes, but only if the baby has not had its bowels open (passed meconium) and all is well with the labour. If the baby does have its bowels open it may mean that it is not coping with the stress of labour and will require closer monitoring out of the pool. Also, if your waters have been broken for more than 24 hours we recommend that you do not use the pool.

Is there any risk of infection?
Evidence shows that the risk of getting an infection by using water for pain relief is minimal.

What happens if I need an episiotomy (cut)?
If an episiotomy is needed you will be asked to leave the pool. If you require stitches following the birth of your baby this will be carried out at least one hour after the birth as the skin tissues will be waterlogged.

Will the baby breathe while it is under the water and how long does the baby remain under the water after birth?
A concern for some people is that the baby will breathe whilst still under the water – this is highly unlikely as there are many mechanisms that prevent this from happening, one of which is the change in temperature that normally occurs when a baby is born. The water temperature is carefully monitored throughout labour to prevent this occurring. Ensuring the baby’s head is totally submerged during birth also prevents the breathing reflex from starting until the head is clear of the water.

How is the placenta (afterbirth) delivered?
• If you have had a normal labour and birth you can stay in the water to deliver your placenta without the assistance of drugs.
• If you would prefer you can have an oxytocic drug via an injection to help your placenta deliver, but you need to get out of the pool after your baby is born for this.
• You can choose to leave the pool to deliver your placenta, your midwife will help you out of the pool and you can deliver either on a bed or mat on the floor. This can be done with or without the aid of an injection of an oxytocic drug.

When labour has started:
Telephone the labour ward to let them know you are coming in and that you would like to use the pool if it is available. The number is on the back of this leaflet. When you arrive the midwife that will care for you will ask you some questions and look at your notes. She will examine your tummy to feel the position of your baby, and she may do an internal examination to help you decide when to get into the pool.

If your pregnancy is straightforward and no problems have been identified when you arrive, then the pool can be used. The pool will take approximately 20-30 minutes to fill. When it is ready you may enter whenever you wish. You may like to try different positions to maintain your comfort and get in and out of the water as you desire.

If it is not possible for you to use the pool as planned then the midwife will explain the reasons why it is not recommended to you.

Useful telephone numbers
Labour Ward 01908 996471
Community Midwives Office (answerphone, 7 days a week) 01908 996484

• Birthplace in England Collaborative Group, Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: The Birthplace in England national prospective cohort study, BMJ 2011;343: d7400 (2011)
• Care Quality Commission, Women’s experiences of maternity care in England: Key findings from the 2013 NHS trust survey (2013)
• Cluett ER, Burns E, Cuthbert A. Immersion in water during labour and birth, Cochrane Pregnancy and Childbirth Group (2018).
• Royal College of Midwives (2012) Evidence Based Guidelines for Midwifery Led Care in Labour. Immersion in Water for Labour and Birth
• National Collaborating Centre for Women’s and Children’s Health, Intrapartum care: care of healthy women and their babies during childbirth. NICE Clinical Guideline 190, London: National Institute for Health and Clinical Excellence (2014)
• RCOG & RCM (2006) Immersion in water during labour and birth. Joint statement. London.