Water Bırth
What Is Water Birth?
Water birth is one of the natural birth methods in which part of labor, or the moment of the baby’s birth, takes place in a specially prepared birthing pool filled with warm water [1].
The aim of this method is to help the expectant mother experience the birth process in a calmer, more comfortable, and more controlled way. Thanks to the relaxing effect of warm water, the expectant mother may cope with contractions more comfortably, manage her movements more easily, and participate more actively in the birth process.
In recent years, water birth has increasingly attracted the attention of expectant mothers who want to have a natural birth experience. A Cochrane systematic review published in 2018 examined 15 clinical studies involving 3,663 women and showed that water birth may have potential benefits in terms of non-medicated pain management [2].
However, like every birth method, water birth should be evaluated individually. Not every expectant mother may be suitable for water birth. Therefore, the decision for water birth must be made by an obstetrician and gynecologist, taking into account the course of pregnancy and the health of both mother and baby [3].
What Are the Advantages of Water Birth?
One of the most important advantages of water birth is that the mother is in a more comfortable birth environment. Warm water may support physical relaxation while also helping the mother feel mentally calmer.
According to the Cochrane systematic review, being in water during the first stage of labor may reduce the need for epidural analgesia and support the mother’s active participation in the birth process [2]. The American College of Obstetricians and Gynecologists (ACOG) states that immersion in water during the first stage of labor may be considered for expectant mothers with uncomplicated singleton pregnancies between 37 and 42 weeks [3].
Possible advantages of water birth include:
- It may help labor pains be tolerated more easily.
- It may increase the expectant mother’s mobility.
- It may support muscle relaxation.
- It may reduce stress and tension during birth.
- It may provide the expectant mother with a more private and calm environment.
- It may support active participation in the birth process.
- In some expectant mothers, it may contribute to reducing the need for medicated interventions such as epidural analgesia [2].
Of course, these advantages may not apply to every expectant mother in the same way. The water birth experience may vary from person to person. Therefore, the most appropriate approach is to evaluate whether water birth is suitable for the expectant mother together with the doctor following the pregnancy.
How Is Water Birth Performed?
Water birth is performed in a sterile birthing pool specially prepared for birth and kept at an appropriate temperature. The expectant mother is usually taken into the pool during the active phase of labor. During this process, the expectant mother can choose the position in which she feels most comfortable in the water; she may sit, kneel, squat, or try different supported positions.
The buoyancy of water makes it easier for the mother to move. This may also make changing positions during labor more comfortable.
Water birth can be applied in two different ways:
- The expectant mother spends part of labor in water, while the birth takes place outside the water.
- Under suitable conditions, the baby may also be born in the water.
Which method is preferred is determined according to the mother’s condition, the baby’s heartbeat, the progress of labor, and the doctor’s evaluation. ACOG emphasizes that there is not yet sufficient data on the safety and benefits of staying in water during the second stage of labor, that is, during pushing and delivery, and therefore the practice should be approached carefully [3].
“ The purpose of water birth is not to eliminate pain completely, but to make the birth process more manageable, calm, and controlled for the expectant mother. ”
What Is the Purpose of Water Birth?
The main purpose of water birth is to make the birth process more comfortable and natural for the expectant mother. Warm water may help the muscles relax and may support the expectant mother in using her body more comfortably. This may contribute to labor pains feeling more manageable.
The purposes of water birth can be summarized as follows:
- To help the expectant mother relax
- To make coping with labor pains easier
- To create a calmer birth environment
- To increase freedom of movement
- To support the natural birth process
- To strengthen the mother’s active participation in birth
Water birth is not a method that completely eliminates pain. However, in some expectant mothers, it may help the birth process feel gentler and more controlled [2].
Is Water Birth Risky?
Water birth can be a safe option when planned under appropriate conditions. However, as with every birth method, there may be certain risks. ACOG defines possible risks related to water birth as follows: infection originating from the birthing pool, difficulty regulating the baby’s body temperature, umbilical cord damage, respiratory distress, and, in rare cases, asphyxia [3].
Possible risks of water birth include:
- Risk of infection
- Problems related to the baby’s breathing
- Stretching of the umbilical cord
- Need for emergency intervention during birth
- Overheating of the mother
- Difficulty with close monitoring of the baby
- Restricted movement when getting out of the pool
Because of these risks, it is important that water birth is performed in an appropriate healthcare facility and accompanied by an experienced team. The basic principle in water birth is to increase the mother’s comfort without compromising the safety of mother and baby [1].
What Are the Requirements for Water Birth?
The first and most important condition for water birth is that the mother and baby have undergone the necessary health checks. ACOG states that healthcare institutions offering water birth should establish comprehensive procedures for patient selection, pool hygiene, infection control, mother-baby monitoring, and emergency intervention protocols [3].
General eligibility criteria for water birth include:
- Singleton pregnancy and head-down presentation
- Being between the 37th and 42nd weeks of pregnancy
- Uncomplicated, low-risk pregnancy
- The baby’s heartbeat progressing normally
- No active infection or bleeding
- Approval of suitability based on the doctor’s overall evaluation
Who Cannot Have a Water Birth?
Water birth is not recommended for women with certain health problems or risk factors. According to ACOG and NHS guidelines, water birth is contraindicated in the following situations [3][4]:
- High-risk pregnancies such as preeclampsia, gestational diabetes, or serious heart disease
- Twin or multiple pregnancy
- Risk of preterm birth before the 37th week
- The baby being in breech or an abnormal position
- Signs of fetal distress or growth restriction
- Presence of active infection or contagious disease
- Risk of heavy bleeding
- A condition requiring oxytocin infusion
An evaluation is made by reviewing such preconditions. Alternative comfort methods such as showering, changing positions, and massage may be recommended for patients who are found unsuitable for water birth [4].
Water Birth in Istanbul
Water birth, which has recently become one of the prominent alternative birth methods, is also performed in Istanbul by expert teams under appropriate hospital conditions. The water birth method, which has become widespread in Europe over approximately the last 30 years, is also becoming increasingly known in our country.
Water birth is performed in specially designed and sterile birthing pools that allow the mother to move comfortably. One of its main benefits is that it helps the muscles relax by calming the mother. Every stage of the process proceeds under the supervision of a doctor and midwife.
How Many Hours Does Water Birth Take?
Just like traditional birth, the duration of water birth may vary depending on many factors. The first stage of labor, during which the cervix dilates, may last an average of 6-12 hours. The active phase, during which the baby exits the birth canal, usually varies between 20 minutes and 2 hours.
The muscle-relaxing effect of warm water may positively affect the birth process; however, because staying in the water for a long time may negatively affect the mother’s body temperature and the temperature of the water, it is generally recommended that time in the pool be limited to 1-2 hours [4].
What Is the Difference Between Water Birth and Vaginal Birth?
The most important difference between them is the environment in which the birth takes place. While vaginal births usually take place in a delivery room or hospital bed, in water birth the expectant mother receives support in a warm pool. The buoyancy of the water makes it easier to change positions, while warm water may contribute to muscle relaxation and pain relief [2].
In vaginal birth, medicated pain management options such as epidural analgesia may be used more commonly, while water birth stands out as an approach that supports non-medicated pain management. On the other hand, vaginal birth allows faster medical intervention; when complications develop, the team can intervene more effectively [3].
Does Water Birth Reduce the Possibility of Cesarean Delivery?
It would not be accurate to say that water birth definitively reduces the possibility of cesarean delivery. The Cochrane review shows that water birth does not create a significant difference in the rates of normal vaginal birth, cesarean delivery, or instrumental birth [2]. The need for cesarean delivery depends on many factors such as the baby’s position, heartbeat, the progress of labor, and the mother’s health condition. When a medical necessity arises, cesarean delivery may be the safest option.
What Is the Process Like After Water Birth?
The process after water birth is similar to the follow-up after vaginal birth. After the baby is born, the baby is quickly assessed; breathing, heartbeat, color, and general condition are checked. In suitable cases, skin-to-skin contact with the mother may be supported. For the mother, bleeding control is performed, separation of the placenta is monitored, and blood pressure, pulse, and general condition are evaluated. The first hours after birth are important for both mother and baby; therefore, medical follow-up continues after water birth as well [1].
Common Misconceptions About Water Birth
There are many misconceptions about water birth. The most common ones are:
"Water birth is completely painless."
No. Water birth does not completely eliminate pain, but it may make it easier to cope with contractions [2].
"Every expectant mother can have a water birth."
No. For water birth, the mother and baby must have suitable conditions [3].
"Water birth definitely prevents cesarean delivery."
No. If a medical necessity arises, cesarean delivery may be required [2].
"The baby breathes underwater."
The baby is brought to the surface of the water in a controlled way immediately after birth and takes the first breath when in contact with air.
"Water birth can easily be done at home."
Water birth requires expert follow-up, sterile conditions, and the possibility of emergency intervention [3][4].
“ The decision for water birth should be evaluated individually by a specialist physician in line with the expectant mother’s pregnancy course, health condition, and expectations. ”
Comments From Mothers Who Had Water Birth
Here are some comments about mothers’ experiences:
"It was an incredible experience for me. The water helped my body relax during birth and made the contractions feel lighter. Throughout the birth process, I felt stronger and more in control."
"It was the method I chose for the birth of my second child. Considering the difficulties I experienced in my first birth, its relaxing effect made a big difference for me. I recommend this experience to everyone."
"What I can say to those considering it is this: build a good support team for before and after birth. During the birth process, my spouse and midwife were a great help to me."
Frequently Asked Questions
Water birth is a natural birth method in which part of labor or the moment of the baby’s birth takes place in a special birthing pool.
The expectant mother is taken into a birthing pool at an appropriate temperature. The birth process proceeds under the supervision of a doctor and midwife. Under suitable conditions, the baby may be born in the water, or the birth may take place outside the water.
No. Water birth is not painless. However, warm water may help contractions be tolerated more comfortably [2].
It may be considered for expectant mothers who have a low-risk singleton pregnancy, whose baby is in a head-down position, who are between 37 and 42 weeks of pregnancy, and who are deemed suitable by their doctor [3].
Water birth may not be suitable in cases of multiple pregnancy, risk of preterm birth, fetal distress, active infection, heavy bleeding, or serious pregnancy risks such as preeclampsia or gestational diabetes [3].
Under appropriate monitoring, the baby is brought to the surface of the water in a controlled way after birth. The baby takes the first breath when in contact with air; therefore, drowning risk does not occur when the procedure is performed correctly.
Water birth is generally planned with non-medicated pain management. In most cases, it may not be appropriate for expectant mothers who have received an epidural to enter the water [4].
Yes. Pregnancy follow-up, doctor evaluation, choosing an appropriate center, and a birth plan are important.
Yes. Water birth is a form of normal vaginal birth supported in water.
References
- Royal College of Midwives (RCM). Evidence Based Guidelines for Midwifery-Led Care in Labour: Immersion in Water for Labour and Birth. (https://www.rcm.org.uk)
- Cluett ER, Burns E, Cuthbert A. Immersion in water during labour and birth. Cochrane Database of Systematic Reviews 2018, Issue 5. Art. No.: CD000111. (https://www.cochrane.org/CD000111/PREG_immersion-water-labour-and-birth)
- American College of Obstetricians and Gynecologists (ACOG). Committee Opinion No. 679: Immersion in Water During Labor and Delivery. Obstetrics & Gynecology, 2016. (https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2016/11/immersion-in-water-during-labor-and-delivery)
- NHS Scotland / Right Decisions. Use of Water for Labour and Birth – Gynaecology Guideline. (https://rightdecisions.scot.nhs.uk)