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Waterbirth

Waterbirth

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The use of warm water as a natural form of pain relief in low-risk labour is a widely accepted practise, however labouring in the bath or delivering a baby fully submerged into water is not as common.

In this blog post, we will explore the commonly asked questions about water birth and discuss the benefits, current evidenced-based scientific research and also explain possible limitations to this research.

What we do know: The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) have stated: “To date, there is no evidence of increased maternal or fetal risk associated with water immersion, compared with labouring and giving birth on land”.

What we don’t know: When it comes to evidenced based research there are almost always limitations, and waterbirth is no exception. This is because there aren’t enough wide, all-inclusive and reliable studies into each of the rare complications that may occur during waterbirth – so it’s not yet possible to determine if these are related to the waterbirth or not.

Not enough evidence yet:

  • Little or no difference in the rates of vaginal delivery if labouring in the water or not
  • There is some evidence to suggest that waterbirth has been associated with a higher risk of umbilical cord breakage, however more research is required.
  • Insufficient evidence to determine if waterbirth decreases the chance of a 3rd or 4th degree perineal tears

 

Despite the need for continued research, there are some wonderful benefits to water birth and the use of warm water in labour.

Some of these benefits can include:

  • Empowering you during labour and birth
  • Increasing chances of a more satisfying birth experience
  • Providing a natural form of pain relief in labour
  • Possibly reducing your need for epidural
  • Easing your baby’s transition into the world

 

Risks or issues arising:

  • Preparation for emergencies – in the case of an emergency in labour, there may be the need to quickly move you from water to land
  • Facility capability – Not all hospitals or healthcare providers have the facilities or capability to support you having a waterbirth.
  • Your pregnancy, labour and baby’s health – Even if your birthing facility is able to care for you in the water you may not be able to have a waterbirth due to your obstetric health, position of baby or pain relief choices.

 

Some of the common reasons you may not be able to have a waterbirth are:

  • Premature labour
  • Expecting twins or triplets
  • Baby is in the breech position
  • You have been bleeding prior to or during labour
  • Your baby’s heartrate is irregular or concerning
  • You have an infection

 

In some cases, you may be able to labour in the water, but not deliver in the water. Or you may be advised to leave the water if your healthcare provider has concern for you or your baby’s wellbeing.

Can my baby drown?

One of the biggest concerns for parents when considering waterbirth is the risk of drowning. Babies in the womb are surrounded by water. Their lungs and circulatory system are significantly different to ours - right until the moment they take their first breath.

Science also discusses several possible protective physiological mechanisms and reflexes that will help prevent babies from gasping or inhaling when they are born into the water. There are ways to help prevent them inhaling water too, such as a hands-off approach during birth initially. Full education should be provided to all parents considering a waterbirth.

Can I have a waterbirth or labour in the water if I have Group B Streptococcus (GBS)?

Current evidence suggests that positive swabs for Group B Streptococcus (GBS) in pregnancy do not necessarily contraindicate water birth, so long as appropriate antibiotics are administered.

What about fetal monitoring?

Electronic fetal monitoring (listening to your baby’s heartbeat) is a crucial aspect of assessing baby wellbeing in labour. This can be done via a handheld doppler or via a cardiotocography (CTG) machine. In some circumstances of labour, continuous electronic fetal monitoring is required (for example, during an induction of labour or if concerned for baby wellbeing).

If you would like to labour (and/or deliver) in the water, your birthing facility will need to be able to supply waterproof, telemetry fetal monitoring equipment.

Obstetric emergencies

In the rare circumstances where an obstetric emergency occurs, it is critical that the mother and baby can be removed from the water as quickly and safely as possible.

There are many obstetric emergencies that cannot be managed safely if the mother is in still in the bath. Healthcare staff should be trained on methods to assist you to leave the bath safely in order to be cared for on land.

So, what are the recommendations?

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) lists the following recommendations with regards to water immersion and water birth:

  • Women should receive information in pregnancy about labour and birth in the water including the risks and benefits to enable them to make an informed choice.
  • Healthcare providers attending to women labouring or birthing in water must have appropriate training and demonstrated competence in waterbirth management. Their conduct must adhere to relevant practice guidelines.
  • Women requiring continuous electronic fetal monitoring may utilise water immersion provided that adequate telemetry equipment is available
  • Healthcare facility staff in attendance must have trained and practised in obstetric emergency management and be able to perform correct procedures under simulation to help women leave the water in case of an emergency.

Written by Keryn Thompson, RM & IBCLC (L-301766)

References

Allen, J., Gao, Y., Dahlen, H., Reynolds, M., Beckmann, M., Cooper, C., & Kildea, S. (2022). Is a randomized controlled trial of waterbirth possible? An Australian feasibility study. Birth. https://doi.org/10.1111/birt.12635

Aughey, H., Jardine, J., Moitt, N., Fearon, K., Hawdon, J., Pasupathy, D., Urganci, I., & Harris, T. (2021). Waterbirth: a national retrospective cohort study of factors associated with its use among women in England. BMC Pregnancy and Childbirth, 21(1). https://doi.org/10.1186/s12884-021-03724-6

Carlsson, T., & Ulfsdottir, H. (2020). Waterbirth in low‐risk pregnancy: An exploration of women’s experiences. Journal of Advanced Nursing, 76(5), 1221–1231. https://doi.org/10.1111/jan.14336

Clews, C., Church, S., & Ekberg, M. (2020). Women and waterbirth: A systematic meta-synthesis of qualitative studies. Women and Birth, 33(6), 566–573. https://doi.org/10.1016/j.wombi.2019.11.007

Davies, R., Davis, D., Pearce, M., & Wong, N. (2015). The effect of waterbirth on neonatal mortality and morbidity: a systematic review and meta-analysis. JBI Database of Systematic Reviews and Implementation Reports, 13(10), 180–231. https://doi.org/10.11124/jbisrir-2015-2105

Feeley, C., Cooper, M., & Burns, E. (2021). A systematic meta‐thematic synthesis to examine the views and experiences of women following water immersion during labour and waterbirth. Journal of Advanced Nursing, 77(7), 2942–2956. https://doi.org/10.1111/jan.14720

Lewis, L., Hauck, Y. L., Crichton, C., Barnes, C., Poletti, C., Overing, H., Keyes, L., & Thomson, B. (2018). The perceptions and experiences of women who achieved and did not achieve a waterbirth. BMC Pregnancy and Childbirth, 18(1). https://doi.org/10.1186/s12884-017-1637-5

Menakaya, U., Albayati, S., Vella, E., Fenwick, J., & Angstetra, D. (2013). A retrospective comparison of water birth and conventional vaginal birth among women deemed to be low risk in a secondary level hospital in Australia. Women and Birth, 26(2), 114–118. https://doi.org/10.1016/j.wombi.2012.10.002

Nutter, E., Meyer, S., Shaw-Battista, J., & Marowitz, A. (2014). Waterbirth: An Integrative Analysis of Peer-Reviewed Literature. Journal of Midwifery & Women's Health, 59(3), 286–319. https://doi.org/10.1111/jmwh.12194

Schafer, R. (2014). Umbilical Cord Avulsion in Waterbirth. Journal of Midwifery & Women's Health, 59(1), 91–94. https://doi.org/10.1111/jmwh.12157

Ulfsdottir, H., Saltvedt, S., & Georgsson, S. (2018). Waterbirth in Sweden - a comparative study. Acta Obstetricia et Gynecologica Scandinavica, 97(3), 341–348. https://doi.org/10.1111/aogs.13286

Ulfsdottir, H., Saltvedt, S., & Georgsson, S. (2019). Women's experiences of waterbirth compared with conventional uncomplicated births. Midwifery, 79, 102547. https://doi.org/10.1016/j.midw.2019.102547

Vidiri, A., Zaami, S., Straface, G., Gullo, G., Turrini, I., Matarrese, D., Signore, F., Franca Cavaliere, A., Perelli, F., & Marchi, L. (2022). Waterbirth: current knowledge and medico-legal issues. Acta BioMed.

Weaver, M. H. (2014). Water Birth in the Hospital Setting. Nursing for Women's Health, 18(5), 365–369. https://doi.org/10.1111/1751-486x.12144

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