Immersion in water during labour was popularised as a formal method of pain relief in the 1970s. Since then it has blossomed in popularity as people have become more interested in the benefits of natural pain relief for labouring women.
King's College Hospital Dubai is one of the few hospitals in the UAE that is able to offer women the use of water to both labour and give birth in, and there is a designated birthing pool in the Labour and Delivery Department.
We met with Dr Samina M Dornan, FRCOG, Consultant ObGyn and Sub Specialist in maternal fetal medicine at King's College Hospital Dubai, to find out more about this popular method of pain relief and delivery:
HOW DOES WATER HELP WOMEN IN LABOUR?
Both the Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives say that, “All healthy women with uncomplicated pregnancies at term should have the option of water for pain relief available to them and should be able to proceed to a waterbirth if they wish”. Lying in water gives a sense of relaxation and reduces the need for other forms of pain relief.
WHO IS BEST SUITED FOR A WATER BIRTH?
If you are considering water birth your obstetrician will discuss with you the criteria required to ensure you are a good candidate for a safe and relaxing water birth experience. You will need to meet the following criteria:
- Uncomplicated pregnancy of 37 plus weeks
- Baby is positioned head down
- No pre existing medical problems
- Expecting only one baby
- If your waters (membranes) have ruptured they must be clear in colour and have occurred less than 24 hours previously
- Your baby has a normal heart rate
Your Doctor/Midwife will go through a series of questions to ascertain if water birth is a suitable option for you.
BENEFITS OF USING WATER
- The buoyancy in water enables a woman to move more easily than on land. You can create a quiet space around yourself, helping you to feel private and keep interventions to a minimum
- Women have reported less pain during water birth, resulting in a reduced need for alternative methods of pain relief and epidural/spinals
- Water immersion during labour is associated with no difference in labour duration, type of birth, five-minute APGAR scores, neonatal infection and admission to neonatal units
- Women’s experiences of water for labour and birth are generally positive in terms of feeling relaxed, involvement in decision making and feeling more in control
ARE THERE ANY RISKS ASSOCIATED WITH THE USE OF WATER IN LABOUR?
There is no evidence of increased adverse effects to the baby or woman from labouring in water or delivering in water. There are some precautions that need to be taken to ensure the wellbeing of you and baby, which include:
- Your midwife will check the water temperature regularly
- King's College Hospital Dubai must maintain standards of pool hygiene
- If your baby is born under the water, it will be lifted into the air so that breathing can start.
These precautions are taken to minimise the small risk of overheating the baby and the risk of infection to both mum and baby.
WHAT DO I WEAR?
You can wear whatever you feel comfortable in; a bath robe and towels will be provided for when you leave the pool as you can get cold very quickly.
CAN MY HUSBAND OR BIRTH PARTNER BE IN THE POOL WITH ME?
Yes, this is not a general problem. We would ask that they shower before entering the pool.
WHAT HAPPENS IN LABOUR?
- The water temperature should be maintained within a range of 35-37 degrees centigrade during the first stage of labour
- Your baby’s heartbeat will be listened to every 15 minutes
- Entonox (gas and air) is the only other form of pain relief you can use in the pool
- The water is kept to a level of above your uterus
- It is advisable that you drink plenty of water to prevent dehydration
WHAT HAPPENS AT THE BIRTH OF YOUR BABY?
- When your baby is being born, the water temperature is elevated to 37 degrees
- Your baby should be born completely under water, with no air contact, and then be raised head first to the surface.
WHAT HAPPENS AT THE DELIVERY OF THE PLACENTA (AFTERBIRTH)?
- At the third/final stage of labour, the placenta is delivered by itself, and there is no evidence that delivery of the placenta in water is harmful to you.
- You should leave the pool if active management of the third stage of labour is required. For example you have consented to the use of drugs to assist you in labour.
- When you have left the pool the midwife will examine you to see if you need any stitches.
Sometimes you may be asked to leave the pool during labour. Reasons for this may be:
- Abnormal changes in the baby’s heart rate
- Meconium staining in your waters (baby has opened his/her bowels)
- Bleeding from your vagina during labour or any other complications. If your labour slows down, you may be advised to leave the pool for a while, but you may be able to get in again later.
WHAT HAPPENS IF I AM TOLD I AM UNSUITABLE FOR A WATERBIRTH, BUT I STILL WANT TO GO AHEAD WITH ONE?
If you are told that you are not eligible to use water in labour, but you think that it is the right choice for you, discuss all your options with your Doctor.
WHAT ARE THE ALTERNATIVES?
You may be able to use water for pain relief in the first stage of labour even if you do not actually deliver your baby in the water. Alternatively, there are other methods of pain relief which are available that your Doctor/midwife will discuss with you.