Labour and Birth In Water

1. Labour and Birth In Water Kate Saidi Coral Morby

2. Why choose a waterbirth? • Natural form of pain relief • Used for labour and / or birth • Birthing pools help you achieve a natural birth and reduce the need for drugs

3. Waterbirth Facilities in Leeds • Delivery suite at the LGI has two pools located in the home from home rooms. We have around 100 hospital waterbirths a year. • Can self-hire pools for home births. Cannot bring hired pools into hospital. • Most of midwives are trained in waterbirth • It is possible that rooms are in use and will have to wait • Inform staff when you ring up that you would like to use the pool and again on admission

5. Why does water help? • A long hot bath helps to sooth aching muscles • Women who labour in the pools often stay for the birth because of the natural pain relief effects • Relax and comfortable in the water • Reduces stress hormones • Promote the progress of labour

6. Beneficial effects of the pool • Buoyancy effect • Water increases support reducing muscular tension • This conserves energy and lowers pain • Easier mobility • Upright position and squatting position is easier • Women with SPD find alternative positions easier • Increase women’s feelings of control • The pool provides a private environment • You are free to move around in your own space • Calming effect benefits everyone

7. What the research says • No evidence to show that there are any significant risks to babies born underwater • Studies have shown that using water for labour and birth can: • Shorten the length of labour • Increase feelings of control and enjoyment • Reduce the use of pain relief and drugs to speed up labour • Increase the chances of a normal delivery

8. Hospital guidelines • One midwife provides one-to-one care during labour, and two present for the birth • When admitted – all observations recorded • If your waters go with no contractions – seen by a midwife and if everything well you may return home until labour starts • If your labour starts within 24 hours a waterbirth is still an option • If this does not occur induction will be required and a waterbirth is not possible

9. Who can use the hospital pool? • In general must be considered ‘low risk’ meeting the following criteria: • Maternal weight less than 100kgs/15 1/2 stone • Singleton pregnancy • Head down • No medical problems e.g. diabetes, epilepsy • No pregnancy problems e.g. high blood pressure • No previous caesarean • 37-42 weeks pregnant • Have gone into labour yourself and be in established labour • If waters have broken must be clear and not been broken longer than 24 hours • All observations (BP, temperature, baby’s heartbeat) normal

10. Admitted with contractions • Vaginal examination will be performed to determine the stage of labour • If you are not in labour you will be advised to return home to await further progress • This is important if you are planning a natural birth • When would you ring delivery suite to come in? • Latent phase of labour

11. Head Decent

12. Pain relief options before entering the pool (also to be used at home) • TENS (Transcutaneous Electrical Nerve Stimulation) • Shower • Massage • Hot towels on your lower back • Wheat pack • Hot water bottles

13. Established labour/first stage • Must be in established labour before entering the pool • Occurs when contracting approx every 2 minutes • And if this is your first baby you should be 5cm • If you have had one or more babies previously you should be 3cm • If you have not reached this stage you will be encouraged to mobilise • Do not get on the bed for prolonged periods, this will slow your labour

14. Once in the birthing pool • Monitoring – temperatures, baby’s heart rate with underwater sonicaid, vaginal examinations every four hours, can be done underwater

15. During the waterbirth • Pain relief- gas and air (entonox) • Encouraged to drink plenty, change position and go to the toilet • Water will be kept as clear as possible, a sieve may be used

16. Second stage of labour • Occurs when no cervix is left in front of the baby’s head • Your baby’s head will now descend and you should feel strong urges to push • The midwife will now monitor your baby’s heart rate more regular

17. The delivery • Water temperature increased to 37oC • No assistance is required; the midwife keeps her hands off until your baby is born • Once your baby’s head is visible you must keep your bottom under the water • The midwife will use a mirror to watch the delivery and encourage you to breathe at certain points • Your baby is delivered completely immersed under water, then lifted head first to the surface • Deliver in any position which feels comfortable

18. Reasons why you may be asked to leave the pool • Abnormal observations • Slow progress • Meconium • Bleeding • Murky water • Problems with your baby’s shoulders

19. Third stage • Delivery of the placenta • Asked to leave the pool about 10 minutes following delivery • The placenta is delivered on land • This can be done naturally or using a syntometrine injection • Skin to skin contact with your baby will be encouraged • If stitching is required this will be delayed for an hour to allow water to drain from the tissues

20. Common concerns • Infection – there is no evidence for this; we have strict standards of pool hygiene • Cord around neck – this is very common and not usually a problem • Drowning – babies born under water don’t get the stimulation to take their first breath. The baby instinctively recognises that it should not inhale water but that this can be swallowed. However if the baby has become distressed during labour this mechanism may be overridden.

21. Useful Advice • Don’t listen to the negative, think positive- most women have a normal birth and healthy babies. Have confidence in yourself and your ability to cope • Bring anything that makes you comfortable- pillows, birthing ball, wheat bag, drinks, snacks, massage oil, lip balm, music

22. waterbirthslgi@hotmail.co.uk

23. Useful Resources • Informed Choice Leaflets-11. ‘Do you want a waterbirth?’(women’s) Women’s Informed Choice Consumers pack (21 titles) £6.80 • www.infochoice.org 0800 581009 • The National Childbirth Trust - Using water in labour and birth, Straightforward birth, Home birth information sheet (50p each) • www.nctsales.co.uk 0870 112 1120 • Birth pool hire • www.birthpoolinabox.co.uk