As homebirth midwives, we encounter waterbirth in our everyday work. Women who are new to planning a homebirth or want to use water during labor for pain relief understandably have a lot of questions about the logistics of waterbirth and how they might be able to imagine themselves in the water.
The method of using water as a therapeutic coping tool in labor is called hydrotherapy. Hydrotherapy is one of the most effective tools for managing the intensity of labor and birth. Check out all these rad benefits:
Increases pain relief
Decreases blood pressure
Provides privacy and space
Can shorten the length of labor
Higher rates of intact perineum
Greater comfort during contractions
Lower rates of interventions
Higher satisfaction with birth experience
A more relaxing third stage (placenta birth)
Creates intimacy and privacy during bonding
Our favorite benefit is the privacy and space that it gives mom- to find her grounding, her breath, be present with the sensations and move her body in an intuitive way. It's what homebirth is all about- an experience of a normal life event with just the right amount of freedom and support to make you as comfortable as possible.
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1. Do I have to give birth in the water at home?
No, you do not have to give birth in the water. Although the images we see on social media and in birth photography of homebirth often depict a mom in a blow-up birth pool, many women plan a homebirth without the use of a tub. We jokingly call it "earth birth" which is a perfectly adequate way to birth a baby at home. Some women get in the birth tub for relief in labor, and get out for some reason (change of scenery, stretch legs, work on progressing the labor, use the bathroom etc) and they don't return to the tub again, but have their baby in some other space in their home. Statistics from one year in our practice revealed that only 20% of our clients actually had their baby in the water, with the rest embracing the "earth birth" way.
2. Do I have to use a blow up pool or can I use my own bathtub?
Yes! Bathtubs are always an option. They make especially great options if they are larger or deeper, soaking or jacuzzi type tubs. Moms get the most relief if they can submerge their whole lower half and change positions (kneeling, squatting, hands and knees) as needed. The benefits of using your own tub at home are:
You'll collect less equipment in your supply preparation
Bathtubs take less time to fill with water, which means you can get in faster
Bathtubs are easier to keep at the ideal water temperature
Bathtubs are easier to clean up
3. Where do I get a birth tub to use for labor?
There are a couple options for having a birth tub available at your birth:
Borrow one from a friend or someone you know. Families that purchase tubs for their own births are usually happy to allow other moms to borrow them in between their own needs, as long as they use a birth tub liner. A local homebirth family group or natural mom forum is a great place to ask.
Rent one from a local supplier. A birth worker in your community may offer this service. For example, a doula in San Diego provides a tub and all the necessary equipment, along with drop off and pick up of the supplies. Easy and affordable!
Buy a birth tub from an online store or Amazon. Earthside Birth Pools is a beautiful, affordable and super functional option. Grab all the other supplies you need (air pump, hose, thermometer etc) on our master Waterbirth Supplies List.
4. Can the baby take a breath under water after they are born?
No, it's so extremely rare that we do not consider it a risk for waterbirth. Babies respond to the feeling of air hitting their face before they have the reflex to breath in for the first time. When a baby is born under water, this reflex is delayed until they are brought up into the air. We are careful to be sure that babies are born totally submerged so that they do not have any opportunity to initiate that first breath until their heads are completely out of the water. This means that mom's bottom needs to be completely under water for the birth of the head. Alternatively, we may ask her to stand up out of the water all the way as he baby is being born.
5. Does waterbirth help with pain management?
Yes! Speak with almost any woman who has slipped into the water mid-labor and she will tell you the relief was immediate. High quality research also shows us that women who used labor tubs in medical environments were less likely to use pain medications and report greater satisfaction with their coping tools and pain relief compared to land birth.
6. Can you still listen to the baby's heart rate while mom is in the birth tub?
We can! We use a handheld doppler with a waterproof probe so we can find heart tones on baby in almost any position mom is in and monitor the heart rate intermittently throughout the labor. Very rarely do we need to ask mom to change positions or get out of the water for a better listen.
7. What is the best position to give birth in when you are inside the birth tub?
Truly, whatever position is the most comfortable for her. At home, moms have the freedom to move into whatever position they would like. Frequent positional changes during labor help the birth to progress normally. Moms who are free to move into positions instinctually are able to maximize this benefit in their labor. Most of our clients birth reclined (resting their back against the side), squatting (and holding the edge), or on hands and knees inside the birth tub. We discuss with our clients ahead of time who would like to catch the baby. The mother, the father, or both, are always welcome to receive their baby themselves at the birth. If the midwife is preferred, or the circumstances are indicative, the midwife can easily reach into the birth tub to assist the birth of the baby as needed.
8. I tried the birth pool with my last labor and hated being in the water, is that common?
It sure is more common than it is talked about. A small percentage of women get into the tub and get right back out, never to try submersion in labor again. Most of these moms report not being able to get comfortable, either due to the "bounciness" of the blow up birth pool that doesn't help them feel firmly grounded, or the softer sides that prevent her from finding really firm grip on the birth tub wall. Many birth tubs have handles to help with this. Some moms do not like the water touching them in labor, or find the temperature uncomfortable. One way of getting a heads up on this possibility before birth is considering in pregnancy if the thought of water submersion is a comfort, or if water is a normal part of how you cope with illness or stress. If the answer is "no", you may not enjoy water submersion in labor either. For moms who are unsure, they can always have the option available and utilize it if needed. Our clients who "know" ahead of time that they would not prefer water in labor do not end up regretting not having it available. It's just one tool that can work for some women, while many other options for coping exist.
9. How does the birth tub get cleaned up after the birth?
Some of our clients get out of the birth tub after they give birth to their baby or wait until after they give birth to the placenta. Once they are warm and dry in bed and snuggled up with their baby, one of the attendants will clean up the birth pool. This includes draining the water (with a sump pump), sanitizing the birth tub (with spray or wipes), deflating the birth pool (with an air pump), and folding everything away into their respective packages for storage. Birth tubs are often set up on tarps or painter's plastic to protect the floor from random water drips. There is usually a laundry load of towels that need to be washed as well.
10. How do I know if I have room for a birth tub in my home?
The average birth tub will fit almost anywhere. Earthside and Oasis are 2 brands that are deep enough for comfort but do not take up an unnecessary amount of space. Most families prefer to set up their birth tubs in their master bedrooms because of the comfort and privacy they already feel in that space. It's also common to set one up in the living area. Any place that a hose can reach from a hot water source will work- we have set up birth tubs in studio apartments and fifth wheels. Many families move furniture around a little to make room. Some couples have to slide their bed to one side of the room, remove an armchair etc.
11. Do moms tear less when they give birth in the water?
The research is mixed on this. Some studies show that tearing increases without an attendant's hand readily available to help preserve tissue integrity at the time of crowning. Some studies show that the intuitive positions of the mother, warmth of the water to the perineal tissue and absence of provider's hand meddling actually improve tearing outcomes for women. Whether on land or water, we discuss our client's preferences for perineal support with them ahead of time and remain watchful during pushing. In our homebirth practice we see tearing rates below average and tend to provide a more "hands-off" approach during second stage.
12. How do you keep the water in the tub at the right temperature during the labor?
We closely monitor the temperature of the water in the tub with a thermometer. Many women imagine the labor tub will be at the temperature that a hot bath is but we work to keep the water as close to body temperature as possible (98-99 degrees). Any cooler and it puts the baby at risk for heat loss when they are born. Any warmer and it can make the mom uncomfortable and put her at risk for increased blood loss. We are careful to not set up the tub until closer to the end of labor for this reason. We can usually add hot water pretty easily, but sometimes have to bail the tub as we add more water. For our clients planning water birth we advise them to turn their water heater all the way up in early labor. If we run out of hot water you can find us boiling the biggest pots we can find on the stove!
13. Does the baby still get good vaginal bacteria from mom if birthed in water?
Yes. The small amount of research we have on this topic shows that there is no difference in microbiome diversity for newborns born vaginally in water or on land. Learn more about those details in this article.
14. Can I put anything in the birth tub water, like bath salts?
No, we do not recommend adding anything to the water. The water should be as clean and pure as possible for the birth of the baby. It's one of the reasons we recommend using a water potable/ drinking hose only for filling the birth tub.
15. What is the next best option for hydrotherapy if tubs are not available to me in my birth location?
Using the shower in labor offers near-identical perceived pain relief as compared to using a bath. The shower is especially helpful for back pain and has the benefit of both privacy and soothing water sounds. Women can plan to labor at home in a tub or shower for as long as possible before heading into another place of birth. Showers are available at most birthing centers and hospitals. Women who are low risk and do not require continuous monitoring should always have the option of utilizing the shower for pain relief. This post shares some other great tools for managing pain in labor.
16. Does laboring in the water help you have a quicker labor?
It definitely can. Many study findings report water birth shortening labors by 70-90 minutes compared to land birth. This may not be directly caused by the water itself, but the impact these types of care and options have on women's support and comfort. Water birth is associated with birth locations that honor the physiological process which can impact how labor unfolds. Water birth is also associated with increased relaxation and privacy which can be an important aspect in "surrendering" to the work a woman's body is doing in labor, which can help the birth unfold smoothly as well.
17. Is it true that you shouldn't get in the birth tub in early labor because it can slow labor down?
Yes, although this is not a universal truth. Many things can slow down early labor but not much can slow down true active labor. The relaxing benefits of water submersion can space or pause contractions. A warm bath is actually one of the tools we use for prodromal labor since it can calm things down well. If this is the case in a labor it's easy enough to get mom out of the water to labor on land longer. We advise our own clients not to get into the birth tub until their labor is active- or if they have been experiencing contractions that are 3-4 minutes apart for the last couple hours. There are exceptions to this advice, of course.
18. Is there an increased risk of infection when giving birth in the tub?
No, in fact, some research even shows that the rate of antibiotic need for newborns is less in the water birth group- even when the water is contaminated with bacteria at the time of birth.
19. Can I still get in the birth tub if my water breaks?
Yes. Applying common sense to the research referenced above makes water submersion safe for women who's water has broken. Risk factors go up for infection for women whose water have been released for 24 hours. Vaginal hygiene is an important part of lowering that risk, including reduced vaginal exams and frequent sanitary pad changes. Clean water in a birth tub that is not utilized until the active stage of labor should not increase infection risk for women. Likewise, the vagina is a self-cleansing organ that protects itself by draining out and away from the body.
20. Can I use the birth tub if I am GBS positive?
Yes, you can. A study done specifically on the outcome of Group Beta Strep positive moms who gave birth in the water showed no difference in GBS colonization of the their newborn compared to GBS positive moms who had a land birth. There is even a theory that the water has a dilution effect that protects the newborn from these types of infection (see the link in question 18).
21. Where can I learn more about waterbirth?
If all this info is making you more curious about waterbirth, we have done our job as homebirth midwives that endeavor to educate about natural birth options. Here are some additional resources for learning more about your water options for labor and birth:
Waterbirth International : Waterbirth benefits and education
Evidence Based Birth : Education and conversation surrounding waterbirth research
Barefoot Midwife : Instagram account of a homebirth midwife we love, Lisa Marie, who posts waterbirth videos
Gentle Birth Choices: A childbirth book by Barbara Harper about practical options for natural birth, including waterbirth
Embrace the concept of waterbirth with confidence, knowing that it's a safe, empowering and useful tool for a more comfortable and enjoyable labor experience!
Although we are licensed midwives by profession, we are not YOUR midwives. All content and information on this website is for informational and educational purposes only, and does not constitute medical advice. Although we strive to provide accurate general information, the information presented here is not a substitute for any kind of professional advice. For more information, click here.
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