The World of Water Birth:
This year has been a big one for me for me as far as consolidating my learning goes. I feel so blessed to be in the lucky position of being able to actively hunt out information that has the potential to be of great benefit to the birthing couples in my care. I love to do this, as it allows me to combine my two passions: traveling and a love of learning.
On the 19th October 2012 I attended a conference that was conducted by the Hawkesbury District Health Service. There were a number of great presentations. One, that I took particular interest in was “ Warm Water Immersion in Labour and Water birth: Promoting Normality” presented by a Midwife Jane Palmer.
Jane presented some new research on the effects of Water Birth on mothers and their babies. Put quite simply in a nutshell it is all good!
According to Jane, first time mothers in labour who use water immersion generally experience lower rates of intervention especially the use of epidurals.
Interestingly, there is no difference in infection rates or the ph levels of cord blood between babies that were birthed on land and babies that are birthed in water.
Jane also said, (the) “Cochrane Review has recognized that there is a significant reduction of the use of medical forms of pain relief used in labour and an overall reduction of time spent in the first stage of labour when a laboring woman has access to water immersion.”
Many mothers will be pleased to know that there is also a reduction in perineal trauma and a lower incidence of post partum hemorrhage associated with water births. Although it is not known why there is less perineal trauma associated with Water Births, it is hypothesized that the water may help in some way by providing some sort of counter pressure and support to the tissues of the perineum.
All and all I thought that Jane gave a great presentation. However, I thought that Jane’s presentation may have been enhanced by some of the studies by Dr Michelle Odent.
Michelle Odent was the first Obstetrician to introduce Birthing Pools into Birthing Rooms back in the 1970’s. Dr Odent says that the only contra indication to water birth is a labour that is progressing well on dry land.
In some situations however, birth pools can be very useful. Typically a labour can be quite challenging for the mother. Many mothers find the active phase of labour to be one of those challenges. In the active phase, the mother’s cervix has reached about 4 to 5 cm dilatation, the cadence of a labour is establishing, and the woman must move out of her normal outer thinking mind and into her hindbrain where all of the hormonal flows happen.
For some mothers, this is very difficult.When this challenge has reached a pathological level and the labour can progress no more.The mother’s natural production of oxytocin begins to decline and the labour will stall.
Immersion of the labouring woman in warm water at this time can be a very helpful means of increasing the oxytocin levels of the mother and interrupting the fear-tension-pain cycle. This immersion of the labouring woman’s body in water (that is at the temperature of the body) has an immediate analgesic effect for the mother. It decreases stress hormones for both the woman and baby and increases oxytocin levels. In fact in an aquatic birthing room even the anticipation of immersion in water for the mother can be enough to help the dilation of the cervix and the labour to progress!
According to Dr Odent water immersion helps a mother to release her inhibitions. When this happens the birthing woman and her caregivers, have to accept that a birth under water is a possibility.
A number of helpful things happen when a mother who is in good strong labour immerses herself in warm water. This can increase the effectiveness of the mother’s contractions for a limited time of about two hours only. The immersion of the labouring mother in warm water, results in a redistribution of her total blood volume as more of the blood returns to her core and less blood is needed in her extremities.
When this happens, special cells in the atrium of the heart that are sensitive to changes in blood volume respond by the release of a special peptide. This peptide modulates the posterior pituitary gland and this influences the production of oxytocin and vasopressin enhancing the mothers contractions and helping the labour to progress. In fact Dr Odent says “Even a fist time mother can get to full dilation with water immersion within two hours if she has the privacy she needs during the time she is in the bath”
So Dr Odent’s top 4 recommendations for the use of water in labour are:
1. Not to enter the bath too soon. Keep it as your trump card. Wait until the labour is starting to stall or the mother is around 5 cm of dilatation. At around this time, given dim lights and privacy even a first time mother can be ready to birth in about two hours.
2. The mother is to avoid “becoming a prisoner of her project” that is after the two hour time limit the labour will not progress any faster and may even be prolonged and at this time it may actually be more beneficial for the laboring woman to get out of the bath. After about two hours in the water the mother’s body will start to decrease her production of oxytocin as this system works via a negative feedback mechanism and prolonged immersion in water may then become detrimental to the laboring process.
3. Careful monitoring of the temperature of the water is required. The temperature must not go above 37 degrees Celsius as the babies temperature is always higher than the mothers and if the bath water is too hot in increases the oxygen demands of the baby and has the potential of distressing both the mother and her unborn baby.
4. Immersion in warm water in labour is a mechanism to treat difficult labour and not every one needs it or would benefit from it.
After many years of helping women use water Dr Odent says that one of the biggest changes is that the mother stops asking “When will you give me a pain killer?” and instead they ask for “How long will it take to fill up the bath?”
Odent, 1990 ‘Water in Sexuality’.