Why birthing pool

Physiological management no cord clamping, no oxytocic injection and placenta delivery by maternal effort , was used comparatively rarely. About a third of women overall received mixed management whereby no injection was given but the umbilical cord was clamped and cut before placental delivery. Eight women 0. For women who gave birth in water, of the nulliparae who had physiological third stage none had a PPH.

Of the 91 multiparae who had a physiological third stage two had a PPH, neither of which were classified as major. Neonatal outcomes are shown in Additional file 3 : Tables S3 a for all women and b restricted to waterbirths. Adverse outcomes were very rare; there were no stillbirths or neonatal deaths. The two cases of umbilical cord snap occurred during waterbirth. Neither baby required resuscitation, transfer to neonatal intensive care NICU or required a blood transfusion, and both had Apgar scores of at least seven at one, five and ten minutes.

One baby had Apgar scores of two at one minute and seven at five minutes following waterbirth, received facial oxygen and was admitted to NICU. One baby required resuscitation and had Apgar scores of six, eight and ten at one, five and ten minutes and did not require admission to NICU.

Three babies with pyrexia or suspected infection were admitted to NICU following waterbirth. None required any respiratory assistance, and no infections were subsequently diagnosed. Two babies were admitted to NICU with a congenital abnormality. Of the remaining five, one was born following shoulder dystocia, two babies were admitted to NICU with respiratory difficulties one following a birth out of water, the other following an emergency Caesarean section with a pneumonia which resolved by day three.

Two babies were admitted to NICU for a few hours of observation following waterbirth, one had an Apgar less than seven at five minutes, the birth weight of the other was 2, grammes. Maternal characteristics, intrapartum events and interventions, and maternal outcomes of birthing pool users and controls are shown in Additional file 4 : Table S4.

The proportion of nulliparas was significantly higher for the birthing pool than the controls 61 percent compared to 44 percent so the comparisons are shown stratified by parity. There was no evidence of a difference for maternal age, gestation, artificial rupture of membranes or augmentation. Irrespective of parity, women who used the birthing pool were more likely to adopt an upright semi-recumbent, squatting, kneeling, all-fours birth position, and have hands-off delivery technique perineum or fetal head not touched during the birth than controls.

As almost all women had a spontaneous vertex delivery SVD there was no evidence of a difference in mode of delivery between nulliparae and multiparae who used the pool and the controls. A significantly higher proportion of women who used the birthing pool had a physiological third stage compared with the control group who all had active management of the third stage.

Whilst nulliparas who used the birthing pool were significantly more likely to have a spontaneous second degree perineal tear, they were significantly less likely to have an episiotomy than nulliparous controls. There was no evidence of a difference for perineal outcomes for multiparas, and no woman sustained extensive perineal trauma.

The results of our prospective study of 2, women are reassuring: maternal outcomes were good, as would be expected in this low risk population and adverse neonatal outcomes were rare. The vast majority of women 94 percent of nulliparas and 99 percent of multiparas had a SVD and few had extensive perineal trauma or a PPH. We also found that significantly more women who laboured in water adopted an upright birth position and had hands off delivery technique.

Nulliparas who laboured in water had significantly fewer episiotomies compared with controls. We found very few women used pharmacological pain relief or complementary therapies such as aromatherapy or homeopathy. This is not an unusual finding for Italy where few obstetric units provide an epidural service for non-operative deliveries, and injected opioids or inhalational analgesia are not generally available.

It is thought that the progress of labour may be slowed if a woman enters the pool before her cervix has dilated to at least 4 cm [ 1 ]. We found no relation between cervical dilatation at pool entry and duration of labour in our sample of 2, women.

The subjectivity of assessing duration of labour may contribute to the difference in results between studies. Also, cervical dilatation is just one aspect indicating labour progress-cervical effacement and application of presenting part of the fetus to the cervix are equally important.

The higher proportion of nulliparas who laboured in water and sustained a perineal tear was offset by a significant reduction in episiotomy. This is consistent with other studies [ 17 , 24 , 25 ]. Having an episiotomy precludes having a first or second spontaneous perineal tear, therefore research reporting higher rates of first and second degree tears in women not having an episiotomy is not surprising [ 26 ].

Whilst episiotomies require suturing, this is not so for all spontaneous tears. The longer term consequences of these two different types of injury are currently under-researched. The vast majority of the literature focuses on morbidity of third or fourth degree perineal trauma. The incidence of extensive perineal tears was very low also 0. Other large prospective observational studies of women who used a birthing pool in the hospital setting report higher incidences of extensive perineal trauma, ranging from 0.

One potential explanation for the low incidence of extensive perineal trauma found in our study could be that only a small proportion of women had an operative vaginal delivery which is a known risk factor for extensive perineal trauma.

In our prospective study the potential for misclassification of perineal trauma was minimised as the midwife and attending obstetrician were both involved with defining the degree of trauma at the time of delivery, and it was graded according to International criteria [ 23 ].

A factor that might influence perineal outcome is maternal birth position. In this study, significantly more pool users adopted an upright birth position. A Cochrane review evaluating effects of birth position in women without an epidural reported an increase in second degree tears, Relative Risk RR 1.

However, the interaction between birth position and delivering in water in terms of effects on the perineum is not clear and requires further research. A concern about waterbirth is that it may predispose women to have a PPH as typically waterbirth involves physiological management of the third stage of labour.

We found a low overall incidence of PPH which was in keeping with our sample of women with an uncomplicated pregnancy. However, irrespective of land or water birth, determining whether a woman has had a PPH is based on estimation of blood loss which is inevitably an imprecise measurement.

Whilst PPH is defined by estimated blood loss, it is only one of the factors taken into account in deciding whether a woman requires a blood transfusion or not. The majority of the women who gave birth in water had either active or mixed management. This was unexpected as waterbirth is usually associated with physiological management, and may reflect the influence of the predominantly medical care model in Italy. This is in contrast with a Cochrane review of seven RCTs and 8, women that showed that active management reduced the risk of major PPH compared with physiological management [ 21 ].

However, the women in the trials were at mixed risk of excessive bleeding. Two of the RCTs were restricted to women at low risk of childbirth complications [ 30 ]. It is worth noting that the components of physiological management are not always well defined and vary between studies, which may influence results.

This involves immediate and uninterrupted skin-to-skin contact between mother and baby following birth, encouraging her to focus on the baby, self-attachment breastfeeding, and the placenta being delivered by maternal effort and gravity without interventions.

It is not clear to what extent this was practised in the units taking part in this study. In our sample there were no serious adverse neonatal outcomes. All 10 babies admitted to NICU were discharged home with their mothers. In Italy paediatricians routinely attend childbirth, consequently there may be a lower threshold for intervention than in countries where the paediatrician is not routinely present. There were two cases of umbilical snap in this study sample.

This unintended effect has been previously reported for babies born in water [ 14 , 16 ]. Therefore, until such data are available, it is the recommendation of the American College of Obstetricians and Gynecologists that birth occur on land, not in water," according to a November Commitee Opinion by ACOG. However, professional organizations like the Royal College of Obstetricians and Gynaecologists and the American College of Nurse—Midwives support water births in certain situations.

This process includes ongoing maternal and fetal assessment as labor progresses". What's more, a December study from the University of Michigan compared water births with land births. It found that the birthing practices were equally safe, "and that women in the water group sustain fewer first and second-degree tears," according to the statement. Land births and water births also had comparable postpartum hemorrhage rates and neonatal intensive care admissions.

Contrary to lingering misconceptions, water birth is not just a fad among celebrities. Increasingly, more and more people are noting the benefits of water birth. Many mothers claim that unmedicated water births lessen the pain of labor and delivery , thanks to the buoyancy of the water. Barbara Harper, R. When women get into the deep water of a birth pool, not just a shallow bathtub, there is a chemical and hormonal response that adjusts the level of the hormone oxytocin, which pumps from the brain and helps regulate the intensity of the contractions.

So, as the body becomes buoyant in the deep water and more oxytocin is released, more pain-inhibiting endorphins flood the mother's brain, putting her more quickly into an altered state of consciousness and allowing her body to do the work that it needs to do. What's more, Harper and Collins say, water causes the perineum to become more relaxed, which can reduce the severity of vaginal tearing.

Even though steps are taken to avoid serious outcomes, and advocates state that home water birth is safe, Patrick Weix, M. Water births themselves are not significantly more dangerous than birth out of water , but when they take place at home—and most of them do—there is an increased risk.

That's because there's no immediate medical help with home water births. Here are some important water birth risks to know. Water birth means sitting, pushing, and delivering in a tub—which often includes feces in the tub. A baby born in that environment could possibly swallow the contaminated water, increasing their risk of infection. Depending on whom you ask, the likelihood of an infection differs because data is limited. However, "there is no way to make the water contaminant free,"says Dr.

That's because the tub becomes contaminated with vaginal and rectal flora the minute a mom sits in the tub, even if the water is sterile. A baby that swallows tub water is at risk for infection. You might find attending one of our Early Days groups helpful as they give you the opportunity to explore different approaches to important parenting issues with a qualified group leader and other new parents in your area. Dekker R. Public Health England. Redshaw M, Henderson J.

Winterton N. When it comes to content, our aim is simple: every parent should have access to information they can trust. All of our articles have been thoroughly researched and are based on the latest evidence from reputable and robust sources. We create our articles with NCT antenatal teachers, postnatal leaders and breastfeeding counsellors, as well as academics and representatives from relevant organisations and charities.

Read more about our editorial review process. How to labour in water or have a water birth. Read time 6 minutes. Email Post Tweet Post. Here we answer your questions… When should I get in the pool? How can my birth partner help? What will my midwife do? Water births are becoming increasingly popular among women who want to try for a natural birth or use very little pain medication during the birthing process.

But what is a water birth exactly? What are the benefits and the risks of a water birth? Do you need to plan a water birth in advance? Below we answer these questions and more to help you decide if a water birth may be a fit, so you can talk with your doctor or midwife. They can let you know what steps you can take to finalize your birth plan. There are several studies that have been done on the potential benefits of water births.

Some women have found giving birth in water to be soothing, helping to ease stress and even calm their newborn baby. Some of the benefits women have reported include:. Warm baths are already an everyday way to relax.