The choice of a water birth (or gentle birth) can be a good solution for pain relief.
Being immersed in warm water during labour has a relaxing effect on the mother-to-be's body and helps her to feel less pain, which reduces the need for further anaesthesia. In addition, this mode reduces the duration of labour itself, but studies show no decrease in the duration of the expulsive phase.
What are the advantages of water birth?
- the use of water is a non-pharmacological method of pain control;
- water helps to relax: it promotes the production and release of endorphins (natural pain inhibitors);
- shortens the time of labour and gives the mother a greater feeling of control over her body;
- saves the mother-to-be precious energy;
- reduces the need for analgesic drugs and the epidural;
- softens the tissues and thus reduces the possibility of perineal lacerations;
- reduces the need for synthetic oxytocin supplementation;
- immersion facilitates freedom of movement. The pelvis is thus more mobile, which can help correct any foetal malpositions and facilitate the descent of the foetus into the birth canal;
- immersion provides the woman with greater intimacy, reduces inhibitions and fears, and protects her from external interference.
Advantages and positive effects on the baby as well:
- foetal circulation improves in water;
- birth in water represents a more gradual transition from intrauterine to extrauterine life;
- the first respiratory efforts are facilitated by the humidity of the water environment;
- warm water helps to maintain the temperature of the newborn baby and prevent hypothermia.
Who can access the water birth?
Women who want to have access to this possibility must meet certain criteria:
- the pregnancy must be physiological (i.e. not at risk);
- not pregnant of twins;
- the pregnancy must be full-term (37-41 weeks);
- the baby must have the correct cephalic presentation (not breech or transverse);
- serological tests (such as HIV) must be negative for the protection of the operators;
- there must be no ongoing skin infections and fever;
- labour must be well underway.
It is, however, impossible to choose this modality if the following cases occur:
- pre-term pregnancy;
- previous post-partum haemorrhage;
- maternal hyperpyrexia (fever);
- need for continuous cardiac-fetal monitoring if no underwater fetal monitor is present;
- vaginal bleeding;
- birth-analgesia;
- amniotic fluid stained with meconium;
- breech presentation.
How is the water birth organised?
- the tub into which the woman enters is about 70 centimetres high and filled with warm water;
- during labour the temperature of the water is maintained at around 36°C, while as we approach expulsion it rises to around 37°C;
- during labour the mother-to-be is free to move around inside the tub, as she pleases: she can squat, she can float, she can get up, she can get out of the tub and get back in if she wants to, as often as she feels the need;
- the mother-to-be can, indeed is often invited, to drink and get out of the tub to pee.
Facilities that offer this service must guarantee accurate hygiene standards for the tubs.
It will be necessary to get out of the water (both during labour and delivery):
- at the express request of the birthing mother;
- when communication with the mother is difficult;
- in case of doubtful cardiotocographic signs;
- if amniotic fluid is tinged with meconium;
- there is marked slowing of labour;
- in the presence of vaginal bleeding;
- hyperpyrexia (very high fever (over 40 °C);
- difficulty in disengaging the shoulders;
- the appearance of any abnormalities.
Are there any risks for the baby?
The foetus receives the mother's antibodies and is therefore adapted to the mother's microorganisms. So being born in a tub of water containing the same micro-organisms (between mother and baby) poses no risk.
The infant's adaptation to the aquatic environment is possible thanks to the diving reflex (or dive response), a physiological defensive reflex that is activated when water comes into contact with the skin receptors on the face: this causes apnoea in the expiratory position with closure of the larynx. The reflex is at its most effective at birth, and then disappears around 4-5 months of age; it is inhibited by contact with air and reduced or absent under conditions of foetal acidosis. The first breath occurs as soon as the baby's face comes out of the water.
What about fathers-to-be?
Find out from the facility where you will be giving birth whether fathers-to-be can also get into the tub ... provided that the mother is happy with this and feels comfortable.