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Waterbirth by Megan MacInnes, CNM, MS

Why have a waterbirth? Is waterbirth for me?

You may have heard about waterbirth in the media.  Is it intriguing to you? Ask your midwife about it during a visit.  To get you started, I will briefly describe waterbirth at Mt. Auburn Hospital.

We began offering waterbirths at Mt. Auburn a few years ago as clients started to request it.  At the present time, only the nurse-midwives and one OB-GYN attend waterbirths. Women come to us from all over seeking waterbirth in a hospital setting. We’re one of only a few hospitals in eastern Massachusetts to offer this option.

Why waterbirth?  Some practitioners and clients believe that water makes for a calmer, more peaceful birth.  Water immersion in labor often helps one cope better with the pain; waterbirth started when women laboring in a tub decided they just didn’t want to get out for the birth!  Sometimes a woman can relax so well in the pool that her stalled labor begins to progress again. Your partner can join you in the pool and help receive the baby as it emerges. (Partners, please wear a swimsuit!)

If you are a first-time parent taking a childbirth preparation class, the instructor may show a video of a waterbirth to stimulate a discussion of the benefits and drawbacks.   Some second time mothers eagerly pursue waterbirth to help resolve issues remaining from a less than satisfying first labor and birth, or simply out of a genuine desire for a different experience.



What do I need to do to prepare for a waterbirth?

 ->  Work at staying healthy by eating sensibly and exercising throughout your pregnancy.

->  Attend a natural childbirth or HypnoBirthing class to help you prepare for an unmedicated birth.

->  If complications arise during your pregnancy, discuss with your midwife how they may affect your plan for a waterbirth.

->  Ask your midwife about additional blood tests that are required at 36 weeks of pregnancy, in order to be eligible for a waterbirth; these include HIV, hepatitis B and C.



What might prevent me from having the waterbirth I’ve planned for?

It’s important to remember that waterbirth is just another option.   Try not to make it the be-all and end-all of birth.  Birth often surprises us.  It’s good to seek the experience you want, but be flexible; sometimes in the end water turns out to be NOT what you want, and sometimes circumstances change in your labor and more intervention is needed.

Conditions that preclude a waterbirth include, but aren’t limited to, meconium-stained amniotic fluid, need for continuous fetal monitoring, nonreassuring fetal heart rate tracing, anticipated shoulder dystocia, multiple gestation, breech presentation, maternal infection, hepatitis B or C, HIV, genital herpes and labor occurring before 37 weeks.



Is there a downside?

Potential risks of waterbirth are:

->  infection or exposure to infectious organisms such as Legionella, which has been found in the Cambridge water supply

->  water aspiration if the baby is not immediately brought out of the water.  To prevent this, we do “rapid emergence “ of the newborn, getting it out of the water before it takes its first breath.

->  accidental rupture of the umbilical cord if it is short; we try to prevent this by making sure the water is not too deep, so there isn’t far to go to get the baby out of the water.

->  overheating the mom; water temperature should be maintained between 95-99^o .  We also encourage more fluid intake to prevent dehydration.  If maternal temperature rises above normal, the mother must get out of the pool until her temperature returns to normal.

-> inability to move quickly out of the pool in an emergency situation is a safety consideration.   The mom needs to be able to move quickly out of the tub if there is any difficulty during the birth, and her partner/husband must be able to help her out if needed. 

-> transient tachypnea (rapid transitional breathing requiring oxygen, level 2 nursery support and more intensive observation of the newborn) has occurred after some waterbirths.  This condition can also occur after land births.  It is believed to be caused by slow absorption of the fluid from the baby’s lungs during the transition to air breathing after birth.



In summary

Waterbirth is available to you at Mt. Auburn, given a little planning, a healthy pregnancy, and a fetus doing well in labor.   Laboring and birthing in a variety of positions, including in water, helps to keep the birthing process normal, a concept that MAMA midwives wholeheartedly support, no matter where the birth ultimately takes place.

 References for additional information:
England, Pam.  Birthing from Within.
Kitzinger, Sheila.  The Complete Guide to Pregnancy and Childbirth

www.waterbirth.org