Water birth is childbirth that occurs in water. During the 1970s Michel Odent in France and Igor Tcharkovsky in Russia pioneered the use of water in labour. Proponents believe water birth results in a more relaxed, less painful experience. It is best to enter the pool after the cervix has dilated to 5cm. Before this the relaxing effect of water may reduce the power of contractions. Critics argue that the safety of water birth has not been scientifically proven and that a wide range of adverse neonatal outcomes have been documented, including increased mother or child infections and the possibility of infant drowning. A 2009 Cochrane Review of water immersion during the first stage of labour found that it reduces the use of epidural/spinal analgesia and duration of the first stage of labour. There is limited information for other outcomes related to water use during the first and second stages of labour, due to intervention and outcome variability. There is no specific evidence of increased adverse effects to the baby or woman from labouring in water or water birth. (Elizabeth R Cluett, and Ethel Burns Cochrane Pregnancy and Childbirth Group 2009).
Baby doesn’t usually draw breath until there is contact with the cooler air above the water – the dive reflex. There is a small risk of inhaling water where there is foetal distress, so it is important for normal foetal monitoring of heart rate during labour.
It has been suggested that neonatal infection may occur due to cross-contamination from the water and pool, and from the woman. However, several comparative studies, report no increased risk of infection for the baby (Zanetti-Daellenbach RA, Tschudin S, Zhong XZ, Holzgreve W, Lapaire O, Hösli I. Maternal and neonatal infection and obstetrical outcome in water birth. European Journal of Obstetrics & Gynecology and Reproductive Biology 2007;134(1):37-43.). As with all maternity care it is necessary to adhere to cleaning protocols for labour and birthing pools, and employ usual precautions.
As with any labouring woman, it is important to avoid her becoming pyrexial. Therefore, the water temperature of a pool should not exceed the maternal body temperature, as immersing a woman in water above her natural core temperature will result in foetal hyperthermia and associated cardiovascular and metabolic disturbances. High temperatures have been identified as a safety issue by several authors as being associated with foetal mortality and morbidity, based on individual case studies. (Deans AC, Steer PH. Temperature of pool is important. BMJ 1995;311:390-1.).
References:
Reid-Campion M. Hydrotherapy: Principles and Practice. 2nd Edition. Oxford: Butterworth Heineman, 1997.
Jones L, Othman M, Dowswell T, Alfirevic Z, Gates S, Newburn M, et al. Pain management for women in labour: an overview of systematic reviews. Cochrane Database of Systematic Reviews 2011, Issue 7
Mammas IN, Thiagarajan P. Water aspiration syndrome at birth – report of two cases. Journal of Maternal-Fetal and Neonatal Medicine 2009;22(4):365-7.
Department of Health. Changing Childbirth. HMSO, 1993.
Thoeni A, Zech N, Moroder L, Ploner F. Review of 600 water births. Does water birth increase the risk of neonatal infection?. Journal of Maternal-Fetal and Neonatal Medicine 2005;17(5):357-61.