Tuesday, April 19, 2011

Waterbirth: Evaluating benefits and risks

" Benefits of water birth have been studied by various practitioners such as midwives, doctors and researches around the world. Water birth was highly rated by women in a recent study of 1,300 water births.  In contrast, a minority of them found it ineffective (Balaskas, 2004; p48-49). Overall it was found there were common physical and emotional benefits for both mother and infant.  Unfortunately, no one can assure women that water births are safer than normal births, because they have not been studied broadly.  However, according to Gilbert (1999) (as cited in Balaskas, 2004:p22) a study has found a decrease in the perinatal mortality rate (1.2 per 1000 of water birth)."

I am very pleased to inroduce an article by Ms. Roa Altaweli : Waterbirth. I thank her for kind approval with posting summary of the article. You can read full version in her blog on women`s health and midwifery . Roa is highly qualified Midwife currently finishing her postgradual studies in Midwifery in UK.

Roa Altaweli, MSc (Midwifery), BSc (Nursing), RM, RGN
MPhil/PhD. student in Midwifery
City University London
United Kingdom

BENEFITS of waterbirth according to the article:
1. The comfort and mobility the water allows during delivery, as changing position under the water is easier than on the land especially in the case of overweight mothers or those carrying large babies.  It is almost certain that reduction of abdominal pressure causes efficient uterine contraction and better blood circulation therefore better oxygenation to uterine muscle and for the baby, which indicates less fetal distress.  As a result, changing position during labor is highly beneficial for mother and baby.  Balaskas and Gordon (1992; p34)

2. Warm water can be a wonderful aid to help mother relax during delivery and this is another benefit of water birth.  When the mother is relaxed, birth will have fewer complications, required less need for medical intervention and both mother and baby will be safe. 

3. Hydrotherapy in the role of pain management is a safer alternative treatment in contrast to anesthesia and narcotic drugs, especially back pain which is the most common women’s complaint.  Accordingly, muscle relaxation can be provided by warm water in order to reduce labor pain. " only 3 per cent of women who used water birth needed pethidine which is a sedative drug." Garland(2002) (as cited in Balaskas, 2002; p51)

4. An intact perineum.  Water can offer perineal muscle support by slowing down babies’ head descending (Garland, 2000).  As a result, the rate of tears and episiotomies are declined.  In the UK in 1998 (as cited in Balaskas,2004) a collaborative assessment of water birth at four birth units found that 57 per cent of first-time mothers complain of no perineal tears in comparison of 51 per cent on land.

5. Water birth is safe and non-traumatic experiences for babies because warm water promotes the transition from the uterus to the outside world along with softening the light, colour and noise.  Babies are extremely sensitive during birth.  Therefore, Balaskas and Gordon (1992;p125) stress the importance of water birth for the babies by mention the significant evidence by psychotherapies, that mother experience during birth can impacts on the baby strongly and originates emotion which can persist into adult life. 

RISKS of waterbirth:

1. Early labouring in water could slow contractions down. Hence, woman should not get in the tub, until her cervix has dilated around five centimetres and she is in active labour.

2. Infant aspiration of water is the main concern for most parents who are planning to have water birth. However, oxygen is transferred to the infant through the umbilical cord, unless it is cut or the placenta is removed.  Several physiological factors can prevent infant from aspiration of the water after delivery.  First of all, water temperature has the same body temperature of the infant between (35°-37°) therefore it helps in minimizing the stimulation to the infant’s lung.  Secondly, there is less possibility that water could enter the infant’s lung during delivery because the fetal lung is filled with fluid including amniotic fluid thus air pressure is needed to stimulate the lung to eject their fluid and after that allowing for oxygen and carbon dioxide exchange.  Finally, diving reflex, which is located in fetal larynx, allows the water to be swallowed rather than to be inhaled

3. Mothers should be familiar with the precautions including the water temperature, and planning for unexpected complications that may occur during water birth.  Water births appear to be more suitable for women with low risk pregnancies, and who need less medical intervention.

Final notes:

" Women still have many doubts deciding to have this new alternative method of delivery, because the lack of information regarding the process, benefits and the expected risk of water birth.  Therefore, antenatal classes are essential, to assist women during their pregnancy and to prepare them physiologically and psychologically.  Clearly a well managed and monitored water birth by experienced obstetrician or certified midwife results in a decrease of birth complications.  Additionally, water temperature should be monitored and maintained to the same degree of body temperature to prevent any expected problem.
In conclusion, water birth requires further research and studies by health practitioners, to reduce the need for drugs and medical intervention, to investigate more about the efficacy of water birth and to minimize any possible risk that could appear in the future.   Finally water birth is an effective method of giving birth.  However, further education, studies and research is required."

Balaskas, J. and Gordon, Y. (1992) Water Birth.  The concise guide to using water during pregnancy, birth and infancy, Thorsons,London
Balaskas, J. (2004) the Water Birth Book. Thorsons,London.
Garland, D. (2000) Waterbirth: an attitude to care. 2nd edn, Books for Midwives, Edinburgh


  1. Great to see this post on labour and birth in water. As you say, water is very beneficial to labouring women. The ability to move freely and relatively weightlessly is welcomed by women when they sink into that lovely warm pool. Having a pool deep enough to enable easy movement is important. Another big benefit is the privacy afforded by being in water in labour. I've noticed that women tend to move in ways that keeps them upright and their perineums out of direct vision and out of the way of direct access by the birth helpers - I'm sure that sense of privacy, plus the ability to move freely in response to pressure on those tissues, is one of the big contributors to the intact genital tract rate associated with water births.

  2. @Carolyn: Privacy and intact genital tract rate are really great advantages!

    I also think that upright possition may help to speed up the labour by taking full advantage of effect of gravity, so the head of baby places direct pressure on birth canal which can open more easily.

    I suppose that women during labour in water do not need amniotomy (artificial breaking of the water) and if water does not break spontaneously (on its own) baby can be born in caul (with intact sac). I think that labouring in water is much more gentle on mother and a baby.

    I also want to point out the difference in delivering positions. In waterlabour where actually crowning ( delivery of head of the baby) can happen in upright position in pool filled with water but alternatively also out of pool with choice of preffered position like all four, depens on wishes of women. During delivery on land, on bed in supine position (on back) woman is more likely to need more interventions, like
    -episiotomy (cutting of perineum-skin to enlarge the space)
    -obstetric maneuvers ( some manipulation of baby to speed the rotation and delivery of baby )
    -external pressure on womb to speed the labour
    -use of obstetric instruments like forceps
    These interventions may speed up the labour, but they might be painfull for mother and the baby. More, there is no evidence to support the benefits of such as practices when alternative already exits

  3. thanks a lot for this post, ive always wondered about water birth so happy to read about it here :)

  4. @May: Welcome! Did it cover all you wanted to know?

  5. is water birth still being practiced here in kuwait?