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Are you interested in giving birth in a tub or birth pool? Often, in order to use a birthing tub you have to sign a consent form. Many of my clients have more questions than answers after they read over the risks and benefits, so let's break it down.
What is Waterbirth?
Water is an amazing tool for comfort during labor. In fact, it has it's own name as a comfort measure: hydrotherapy. A hot shower beating on your back can help with back labor. Submerging in water helps to relax muscles, soften perineal tissue to reduce tearing, and allows you to float giving your tired joints a break. Even just the sound of water may speed up the length of labor!
Of all the ways we use water in labor, fully submerging in a nice deep labor tub is by far the most helpful. We call it "the midwife's epidural" because it gives the most possible pain relief without using medication. Most commonly, people are using birthing tubs at homebirths and in birth centers, though some hospitals do offer tubs for labor.
A waterbirth in a step beyond just hydrotherapy or water immersion. You are not just using the water for pain relief, you are intentionally staying in the tub during the pushing stage of labor and giving birth to your baby in the tub. Your baby is born into water. Note that while some places allow for waterbirth, others ask you to get out of the water before your begin pushing. Some people don't getting out, while others experience a big disruption of their flow.
Is Waterbirth Safe?
The safety of water immersion during labor is well established and undisputed, which is why you will be able to find many facilities that allow for immersion in water during labor but not during pushing and birth.
Giving birth in the water tends to be a little more controversial thanks to a study in the 2000s put out by the American Academy of Pediatrics (AAP) that claimed that waterbirth had not been studied and posed nothing but risks to the newborn. Luckily, we have resources like Evidence Based Birth that are able to round up the MANY studies that have been done on waterbirth all around the world. Here are some of the benefits noted from the largest studies:
Lower use of pain medication (epidural)
Higher rate of satisfaction with birth
Lower rate of postpartum hemorrhage
Lower rate of parental infection
Less use of Pitocin to speed up labor
Given all of the case reports and data there are some things we can do to mitigate the biggest risks of waterbirth. The first big concern in that bacteria may grow in wet and warm environments, especially in places that are not being properly cleaned and disinfected. Bacteria can grow in plastic tubing or in complex pipe systems, so to mitigate risk:
Use a brand new hose to fill the birth tub OR regularly disinfect hoses in a permanent facility
Use disposable birth tub liners OR regularly culture and disinfect tubs in a permanent facility
Another concern is that babies might accidentally breathe in water directly after they emerge from the birth canal. Healthy babies do not take their first breath until they are out of the water because they have a dive reflex. In addition, a newborn's lungs are already filled with amniotic fluid that is thick and viscous so no other fluid can get in.
To ensure that they do not breathe water in, families should be educated on keeping the baby above the water once they have emerged. In other words, do not re-submerge babies that have been born in water.
Finally, there is a study that indicates that babies born into water might be at higher risk of umbilical cord avulsion (cord snapping).
Providers should slowly and gently untangle the baby's umbilical cord before pulling the baby up and out of the water.
When Should I get in the Water?
If you are interested in water immersion, you can use it at any time. That said, there are some assumptions that providers may have about submerging in water: some say that getting in early can help people progress quickly due to the reduction in stress hormones and increased relaxation. Others say the opposite! That getting in water early can slow labor down.
I usually suggest that you get into the water early especially if labor is starting at night because then if it does slow labor down, it gives you time to rest and sleep during the night. Once labor is rocking and rolling, I usually suggest the shower first because it gives slightly less pain relief so that we are saving water immersion for when you really need it: at the most intense moments of labor.
All that said, you know yourself and your body best. You should feel free to get into the water whenever you think it might be helpful for you.
Where Can I Have A Waterbirth in Chicago?
Unfortunately, there are varying degrees of understanding of waterbirth in the Chicago landscape, and many barriers to use of hydrotherapy in labor. Due to the AAP's continued opinion and current statements condemning and discouraging waterbirth, many facilities continue to be have unofficial bans on waterbirth. In some facilities, you must meet certain BMI requirements or risk-related thresholds. You are most likely to get a waterbirth in a homebirth or birth center scenario because if you are low-enough risk to qualify for out-of-hospital birth, you almost always qualify for waterbirth.
Locations that allow and encourage water immersion in labor and delivery:
Homebirth
Gentle Birth Care
Birth Roots Midwifery
Burr Ridge Birth Center
Locations that allow and encourage water immersion in labor ONLY:
Evanston Midwives
Elmhurst Midwives
Locations that advertise water immersion availability:
Prentice Midwives
UChicago
Ultimately, if you want an unmedicated labor, you will want to prioritize a practice that encourages water immersion in labor and delivery since it is a powerful tool for achieving an unmedicated labor. If you are too high risk for a homebirth or birth center birth, looking for midwifery care that is enthusiastic about waterbirth is the next best thing! Beware of a classic bait and switch: birth tubs are advertised to encourage people to sign up to give birth at a certain facility but then the tubs are not actually available or used in practice. Note that the landscape is always changing and your best bet for getting the most up to date information is to talk to an active, full-time doula.
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