If youâre pregnant and trawling instagram for inspiration, you canât have escaped the photos of the beaming woman in the birth pool, her partner behind her, their newborn in their arms, the fairy lights twinkling in the background. Even celebrities are getting in on the act, most recently, Hilary Duff shared this beautiful image of her second home water birth.
Waterbirth safety has at times been called into question, but a large retrospective cohort study of over 46, ooo women published on 26th March 2021 in the BMC concluded:
- No association between water birth & specific adverse outcomes for mother or baby.
- White women from higher socioeconomic backgrounds more likely to be recorded as giving birth in water.
- Maternity services need to focus on equitable access
Another recent study published in the BMJ found that women choosing water immersion for labour or birth were no more likely to experience adverse birth outcomes than women receiving standard care and rated their birth experiences more highly.
Positive birth experiences and waterbirth seem to go hand in hand. But why is this? And what exactly happens in a waterbirth? Most importantly, how do you know if itâs the birth for you?
While some may think that birth in a pool is only for home birthers and hippy-types, this couldnât be further from the truth. Many birth centres and even obstetric units have birth pools now, and just under 10% of UK babies have a âwaterbirthâ, which officially means they are born underwater. Around twice that figure spend time during labour in the shower, bath or pool, but itâs not classed as a waterbirth unless you actually deliver in the water.Â
The thought of birth underwater can make some people worried, but itâs important to note that babies donât take their first breath until they meet the air, due to something called the âdive reflexâ. Until this first breath, they are still getting all the oxygen they need from the placenta, just as they have throughout your pregnancy while âunderwaterâ in the amniotic fluid of your womb. This is why itâs important that the pool water is at least 18 inches deep, so that your baby cannot âsurfaceâ before their whole body is born, and be stimulated to breathe.
So can you have a waterbirth in the bath? You can â but you donât get the same effect. Birth pools are much bigger and deeper than baths and you therefore experience the weightless feeling and increased mobility that you might be familiar with from pregnant trips to the swimming pool. Many women report that this freedom of movement, along with the soothing feeling of the warm water, makes labour feel much more manageable. In fact, several studies have shown that women who choose waterbirth are less likely to want other forms of pain relief and more likely to report a positive experience of childbirth.
As someone who has given birth in water twice, Iâd say itâs hard to explain just why it feels so great â but thereâs definitely more to it than just heat and weightlessness. Thereâs something about being in your own private space, less exposed, and out of easy reach, that I think also makes you feel safer and more protected in waterbirth. However, if the magic of the pool doesnât work for you, you can of course just try something different. If you opt to stay in the water you can have gas and air, or if you feel like a change you can get out and try labouring on dry land, perhaps with different pain relief such as epidural or opioids (you canât have these in the pool).
Apart from the increased comfort the water brings, there are other established advantages to water birth. Research has shown that being in the pool can reduce the length of the â1st stageâ of labour (thatâs the part when your cervix is dilating) by an average of 32 minutes. Added to this, other trials have found birth in water to be associated with lower rates of tearing and episiotomy, higher rates of normal vaginal birth, and better âApgarâ scores for the baby (the way a babyâs condition at birth is measured). In fact, many people who have their baby in water are surprised by how peaceful their baby is â many water born babies donât cry but just calmly lock eyes with their mother. Itâs an incredible moment.
And are there disadvantages? Itâs hard to find any! Some people donât like being in the pool, but this is very rare, and of course, easy to remedy by simply getting out again. Over the years there have been alarmist headlines about waterbirth safety, but as well as the new evidence cited above, a 2018 Cochrane review (a very well regarded source of evidence), found no increased risk to either mother or baby. There are basic rules to follow for waterbirth safety: your midwife can advise you and you can learn more about pool hygiene, water temperature and more from your pool supplier. But put simply, you need to remember:
- Water should be 96 to 98 degrees, but if the water feels too hot or cold for mum then listen to her as your best guide.
- Get in when you feel drawn to do so, but the best timing is felt to be when contractions are 3 or 4 every ten minutes and labour is established.
- Use fresh water, a new hose pipe, a new tap connecter and a new pool liner to ensure the water is clean and hygienic.
If you decide you want to try waterbirth, the best way to maximise your chances of this happening is to have a home birth. At home, you can hire, borrow, or buy your own inflatable birth pool, get it set up in advance and get yourself and your partner up to speed on how long it takes to fill with your particular water system. You can even use the pool for relaxation in your final days or weeks of pregnancy! If you donât want a home birth, you need to speak to your care providers about accessing a pool in your local area. If there isnât a pool available, you may even be able to negotiate bringing your own to the hospital â itâs always worth asking.
As well as practical issues of pool access, you might find that you are told that you are not eligible for a waterbirth because of being âhigh riskâ. For example, you may be expecting twins, have a high BMI, or be having an induction or a VBAC (Vaginal Birth After Caesarean). However, itâs worth remembering that women in all of these circumstances and more have had waterbirths, and that it is always worth talking to your care providers and asking them to consider your individual case rather than be limited by blanket policies. Indeed, new guidelines from NICE, for example, suggest that women having a VBAC should have access to a pool. Emma Ashworth, from the organisation Association for Improvement in Maternity Services told me, âWomen classed as high risk can and do give birth in water. AIMS frequently supports women to get the birth they want even if they have been initially told itâs not possible.â
Women who have had waterbirths tend to be evangelical about them, and I have to say, Iâm one of them: waterbirth for me was blissful and if I had another baby, I would never do it any other way! Having a baby in water may seem a strange idea at first, but itâs really not complicated â you just get a pool, fill it with water and get in. If you have a baby before you get out, congratulations, youâve had a waterbirth!
Milli Hill is the author of The Positive Birth Book and Give Birth like a Feminist. Her 2nd and 3rd babies were born at home in water. Find her on twitter @millihill and instagram @milli.hill