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  • Writer's picture Suzanne Fowler Evans

Water or Land for Birth - The choice is yours!

Lots of women and their partners are very keen to go down the least intervention route as possible and for many of them, when they are writing their birth

preference list, they will include using the birth pool. Approximately 9% of women give birth in water in the UK, which is still a relatively low number, but it has trebled from just 3% in the past 17 years. In my local Surrey maternity units, using the midwife led units and having access to a birth pool is a default now for low risk women. Unfortunately during the peak of the Covid 19 pandemic, the midwife led units were closed to the general public and reserved for women presenting with Covid symptoms, which will have led to a reduction in how many women could easily access the pool. At present all of our midwife led units are fully open to everyone which is fantastic news, but birth partners, please remember you might be asked to wear your face masks at all times!

Most of our maternity units nowadays have at least one pool for women to use in labour, this might be as part of a midwife led or home from home wing of the unit or on labour ward or you might be planning a home birth and considering hiring a pool. Whatever you have decided, unless your circumstances suggest that it really is not safe for you or your baby, using the pool for labour should be an option discussed with you at your 36 week check with your midwife or care team.

So lets look at the pros and cons of using water for labour and birth;

Size - the fab thing about a birth pool is its size - most pools are large enough for you to move around, use some gravity positions and sink right down so you benefit from the lovely warm water around you.

Privacy - using a birth pool offers you so much more privacy as you are in your own little watery world and you are less likely to have any unnecessary interventions, such as vaginal examinations or continuous monitoring in the pool.

Pain relief - using the pool can decrease the amount of discomfort you might feel during labour as the warm warm water relaxes the muscles and you are therefore less likely to want to use any more pharmaceutical pain management such as an epidural.

Oxytocin - you might find that as you are more relaxed in the pool, your body releases oxytocin and your labour progresses spontaneously, reducing the length of your labour.

Energy - because you are more relaxed and able to focus on your breathing you conserve your energy. This in itself can allow you to take more control over your care and the birth of your baby.

Protection - allowing the warm water to soften your vagina and perineum will help to prevent tearing or perineal trauma, it will also help avoid an episiotomy (cut in the perineum) whether you decide to stay in the pool or get out of the water to birth your baby.

Birth - as a rule, giving birth in the pool is an amazing and empowering experience, you can greet your baby and bring him or her to your chest for some lovely and essential skin to skin, your baby might even start to feed while you are still in the pool. When there is no rush to get out of the pool you and your baby will have that extra bit of skin to skin and bonding time.

Baby - how much nicer must it be for your baby to be born into a familiar environment to the womb, so their introduction to the outside world is gentle rather than potentially a bit harsh.

Whats not to love?

Well, in a bid to offer a balanced view here are a couple of things you might want to be aware of if you do decide to head towards the water in labour and suggestions as to what you can do or questions to ask.

You might find that, while for many women, labouring in the water makes their dilation more effective ie doesn't slow labour down for some, the opposite is true. So if your labour does start to slow down, what can you do? The answer could be you need more gravity, hop out of the pool for 20mins or so, wrap yourself up in a towel and have a little walk around, get onto all fours or try some supported squats - encouraging your baby to press down a bit more on your cervix can really help a slow labour - then when you feel things are hotting up, pop back into the pool.

Your midwife might want to monitor your baby's heart beat in the pool, she can generally do this quite easily using a waterproof hand held monitor, however if your baby needs more continuous monitoring you don't necessarily need to get out of the water. Talk to your midwife about using Telemetry to monitor your baby remotely.

While we recognise the benefits of using warm water to soften your vagina and perineum and you are less likely to tear, there is evidence that if you do tear, because the skin and muscle is saturated, there is a small risk that it could become more intense ie go from a first degree or surface tear to a third or fourth degree which can be internal and therefore may take longer to heal. So you need to weigh up the benefits and risks and decide what is right for you. In some maternity units your midwife might suggest or encourage you to get out of the pool just before you transition into the birth of your baby. The rationale being that this allows your perineum to dry out a bit before your baby is born, it could also be that once you are on dry land your midwife can see to guide you better while you are pushing.

So what can you do if using a birth pool is not an option for you?

Ask if there is a bath or shower available so you can still get the relaxing benefits of using warm water.

Take a hot water bottle from home and use it on your low back or anywhere that feels it needs a bit of TLC.

Take a flannel or small towel with you and ask your midwife to put it into some warm water and hold it against your vagina and perineum just before your baby is born to help soften everything up and lessen the risk of tearing or perineal trauma.

So for most of us a pool birth is a fantastic way to labour and give birth, if you are someone who loves a bath in the evening, maybe with candles and lovely smelling oils around you, the pool might be just the ticket to help you relax and enjoy your experience. However, it is not right for everyone and if you are more of a gym bunny or jogger you might find the pace of a pool labour frustrating. Labour and birth is an individual experience and what is right for one woman may not be for the next, so take some time before your birth day and think about how you relax and take that into the labour room with you. The great thing about our maternity units is that you have so much choice and having the space to use the pool, walk about, dance or bounce around on your birth ball - what ever works for you will be working for your baby. Remember, it is your choice as to how you give birth, and while it can be difficult to ask questions and make informed decisions when you are in the throws of full blown labour, you can always discuss your options when you have your antenatal appointments so everyone knows up front what your preferences are. In the event of you agreeing that getting out of he pool is the best option for you, you can still use your gravity positions, get on all fours and give birth in a position that is comfortable for you. Your midwife can work round you, not the other way round.

I hope this has given you some info and thoughts around using water for labour and birth. Please get in touch if you have any questions or would like to talk about your own circumstances, especially if you have been told that using the pool is not right for you and you would like to gently challenge that decision.

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