Depending on our preference, our health and that of the baby, some women may choose to deliver in the hospital, in a birthing center or at home. More and more women are choosing water birth as the way their babies come into the world.
During a water birth, the mother is submerged in water, usually in an inflatable bathtub, and will deliver the baby in the water. She may also choose to spend the contractions in the water and deliver outside. This can be a good option if we want the benefits of the hydrotherapy, along with the benefits of giving birth in a hospital.
What is water birth?
Some women report that the water eases contraction pains and the pain of labor itself. Unfortunately, if you get an epidural, it is not possible to give birth in water. This is due to the need to monitor the epidural site and keep it sterile and safe. Gas and air can be put in while we are in the water, but we will have to get out if we have an analgesic injection such as pethidine, which can cause sleepiness. You can go back in after a couple of hours, once the effects of the injection have worn off.
You may or may not be a good candidate for a water birth if you are carrying twins or higher order multiples. These pregnancies are at higher risk of preterm birth and other problems that may need closer monitoring during labor and delivery.
water birth in hospital
If we want to have a water birth at the hospital, there are some positives and some drawbacks. Hospitals have fully equipped delivery rooms and some women feel safer in a hospital environment as there is quick access to intervention should they need it.
If you are giving birth in a midwife-run unit or hospital, there will be dedicated rooms with a large specialized bathroom where you can give birth or go inside to help ease labor pains. These birthing pools have a special plumbing system. They often have ambient lighting in and around the birthing pools.
However, there may be situations in the hospital where there are not enough staff or pools available. Therefore, further restrictions may be placed on the woman to ensure that she does not enter the pool too soon before labor sets in. This is to prevent a woman who is not quite established in labor from blocking a swimming pool.
water birth at home
At home, a birthing pool is usually inflatable and it is the responsibility of the birthing couple to fill it, empty it, and clean it afterward. It is still possible to have a water birth at home by renting an inflatable pool. The midwife will take the temperature from time to time to ensure that the mother does not get too hot. You don't have to be in the water all the time. You can go in and out as you see fit. Even the couple can get into the pool if they want.
Labor often slows or stops when a woman feels nervous or unsure. This is something that can happen when a woman leaves her house to go to the hospital. While work at home is usually less subject to this effect since the woman is in her family environment. Couples and other family members can move freely and there is easier access to food and drinks. This will be the right decision for some women. Others may feel safer being in a hospital or birthing center.
Benefits
Water births have become more popular in recent decades. Expert gynecologists acknowledge certain benefits, but they don't recommend being in the water past the first stage of labor, when the cervix is fully dilated. They also do not recommend giving birth in water.
Immersion in water in the first stage of labor can help shorten the duration of labor. Labor in water may also decrease the need for epidurals or other spinal pain relief.
A small study revealed that women who give birth in water may also have a lower caesarean rate (13,2 percent vs. 32,9 percent). Not only that, but women who delivered in the water reported less stress incontinence 42 days after delivery than those who delivered on land. Larger-scale studies are needed to confirm these findings.
Women who give birth in water also report a greater satisfaction with childbirth. The warmth of the water and the weightlessness usually give space to give birth without disconnection.
Contraindications
In general, it is recommended that water labor be offered to women between 37 weeks and 41 weeks, 6 days gestation. There are other guidelines, including having a low-risk pregnancy, clear amniotic fluid, and the baby face down. Water births may not be recommended for women who are in preterm labor or who have had two or more previous cesarean deliveries.
Risk of infection
Water birth means sitting, pushing, and delivering in a bathtub, often including heces. A baby born in such an environment could possibly swallow the contaminated water, increasing its risk of infection. Depending on who we ask, the probability of an infection differs because the data is limited. However, there is no way to make the water free of contaminants. This is because the bathtub becomes contaminated with vaginal and rectal flora when the mother sits in the bathtub, even if the water is sterile.
A baby who swallows bath water is at risk of contracting an infection. Babies are genetically and physiologically programmed to take their first breaths of air, not water, within seconds of their heads being delivered. They have a "diving reflex" that instinctively closes their airways and prevents them from breathing water, but some scenarios can still cause them to inhale water:
However, it is important to know that even when infectious bacteria are expelled during delivery, nothing moves up or in. Therefore, the risk of infection occurs only if the baby breathes too soon (midwives and obstetricians are trained to minimize that risk) or if equipment is not properly sterilized.
Meconium aspiration risk
This medical term means that a baby has had its first bowel movement before birth and inhales the contaminated amniotic fluid, causing breathing problems.
Doctors and midwives can tell if this has happened when the water breaks because the meconium is usually green, sticky, thick and thick. Extra precautions should be taken when the first bowel movement occurs before delivery. A doctor or midwife needs immediate access to the baby in order to clear its airway, which often means delivering on its back.
risk of pneumonia
Although significant studies have yet to show the exact percentage of cases of water birth pneumonia, it is one of the risks. To prevent pneumonia, the water must remain warm, and the baby must surface immediately after delivery.
Pneumonia usually develops within the first 24 to 48 hours after birth and is caused by aspiration of meconium, fecal contamination, and bacteria from bathwater. There are also case reports of babies dying of postpartum pneumonia in water that was the direct result of ingesting fecally contaminated water. As most water births are done at home or in an independent birthing center, there is little 'research' done.
Risk of drowning
Where there is water, there is a risk of drowning. One study lists drowning and suffocation as fetal risks of water birth. Due to complications, the baby may stay underwater too long and her lungs may fill with water.
Medical professionals do their best to prevent this by placing the baby with its head above water so that it can get enough oxygen to breathe as soon as it is born.
Risk of umbilical cord breakage
Short umbilical cords can tether the fetus underwater or tear, leading to fetal blood loss. Maternal tears can be difficult to assess underwater, and mothers may bleed excessively. The good news is that a cable short enough to cause such an incident is rare.
During a water birth, the baby usually rises quickly to the surface, head first. This rapid movement will allow them to start breathing as soon as possible, but there is a risk that the umbilical cord may break. A broken umbilical cord can be life-threatening, as the fetus can bleed freely until it stops. It is usually easily treated by clamping the cord. It normally leads to neonatal anemia than anything else.
How much does it cost?
A hospital water birth can cost the same as a natural vaginal birth. In many cases, most or part of a hospital delivery is covered by health insurance or Social Security in Spain. Without insurance, a vaginal delivery can cost between $5.000 and $10.000, though costs vary by location and facility.
Prices for delivery in each can vary by location, but are generally lower than hospital costs (if not covered by public health). In the case of private insurance, most of the time home births are not covered. When choosing the team that will assist with your water birth, it is recommended to ask for a full breakdown of expected prices.
Some experts offer birthing tubs as part of their services. Otherwise, the price of renting or buying a birthing tub also varies depending on the location and the options we choose. A basic one with a lining can cost less than 300 euros, for example. Rental prices are around the same price. Other supplies will be needed as well, so plan accordingly.