By Anita Dobre –
Water birth as a natural pain management tool during Birth
The birth is most sacred, most powerful experience that can happen to a woman, it is sacred and holly, it is not to be known.
– Djapirri Mununggurritji
Water has always been a powerful inspiration for the imagination. In every land, every age, myths, tales and legends have testified that water has its healing power and beautiful romantic, even erotic power. 
 “Water, Birth and Sexuality” Michael Odent p22
What is water birth?
Water is a feminine symbol. Through the world water has always been associated with different kind art of healing – like spa, sauna, famous Russian bathes, sitz-bathes, thalassotherapy and more. Water has always been a symbol of the mother everywhere and at all times. Life began in the ocean; in amniotic fluid we recapture the history of life. The attraction of water during labour and dreams of aquatic births are not new.
Simply stated, water birth is when a mother labors and gives birth in water. Typically that means in a birthing tub at a birthing center, hospital, or at home. However, many women labour in the pool and get out when it’s time to push, or only get into the pool just before pushing. Water birth can happen in many different ways, and it’s best for mom to follow her own intuition during the childbirth process. There are no simple formulas for the use of water during labour. It is not a method that can be evaluated by “double blind” studies. The attraction to water during the labour varies considerably from one women to another. It can be neither measured nor forecast.
Childbirth at a turning point
Labour and birth is initiated and stimulated throughout by natural chemical messengers we call hormones. They are the conductor of the orchestra – physiological events that take place during the labor and birth. Understanding how this works can be the key to choosing and creating an environment that will make it easier for women to give birth to their babies naturally. It will reveal the best way to use help of water both during labour and perhaps for the birth of the baby in the water.
In order to have a baby, mammals are supposed to release a complex cocktail of “love” hormones, without this, birth is not possible. The key love hormone is oxytocin. It is hormone that causes muscular contraction involved in all phases of sexual/reproductive cycle including uterine contractions that open the womb, eject the baby at birth and then expel the placenta.
At the end of pregnancy the higher levels of oxytocin start to prepare the uterus for contractions by triggering the release of the female sex hormone oestrogen, while prostaglandin – a hormone produced in the tissue of the lower segment of the uterus – softens and ripens the cervix. When the baby’s lungs are fully mature and ready to breath, they produce hormone that reaches the mother’s bloodstream and sends a message to her brain that it’s time for labour to start. Levels of another important hormone, prostaglandin E2, also rise before labour with effect of inhibiting the baby’s breathing reflex before he or she comes into contact with the atmosphere.
Emotionally, the effect of the high level of hormones during labour is to make women draw deeply into herself, as she concentrates her energies on the overwhelming sensations she is experiencing. Her behavior becomes unthinking and instinctual. She dares to do what she would not do normally – to move and use unusual positions, to make a noise, shout or swear – being on another planet. Michael Odent stresses the importance of protecting the laboring woman from disturbances such as bright lights, talking and asking questions or giving her feeling of being observed with cameras, eyes, continuous electronic monitoring devices for the baby. Hormone secretion is very sensitive to intrusive environmental factors and can easily be inhibited.
When the mother is disturbed, feels anxious or is afraid, her body is likely to produce adrenaline, the “ fight and flight hormone”. This is kind of emergency hormone we release when there is a possible danger or in response to stimulation, fear and excitement. During labour adrenaline counteracts the release of oxytocine and can therefore slow or inhibit the labour. Our goal should be to keep the level of adrenaline as low as possible during labour.
When you analyze how a warm bath works – by protecting against too much sensory stimulation and anything that can set off a fight-and-flight response – a fundamental question is raised: what can disturb the involuntary process of birth?
In our society, pregnant women and breast feeding mothers, who need strong social support, are isolated. But laboring women at the time, when they need privacy, are observed by several people as well as, sometimes, a machine. In the cultures where the mother to be can isolate herself to give birth, childbirth has a reputation of being fast and easy. We have subtle and powerful ways to destroy the sense of privacy… establishing eye to eye contact when the mother to be is ready to “go to another planet” as if saying, “ stay with me; performing an internal examination at the wrong time; introducing a camera… We need to understand the need for the laboring woman’s privacy. All women need to feel secure in labour but we also have to know that, what is privacy for one women may be isolation for other.
There are hospitals where the importance to laboring women of privacy, darkness, silence, feminine environment, freedom of movement and able to be noisy, are all taken into consideration. But even in these hospitals modern women still find difficult to release all their inhabitations. In other words, they are unable to liberate their instincts. Water can be of help.  “Water, Birth and Sexuality” Michael Odent p -14, 15
Why water birth
Every birth is different, and every woman is an individual with her own needs, but the need for privacy and a calm, intimate atmosphere at the birth is universal and paramount to all mammals. The change in how a woman feels and behaves soon after entering a birth pool in a quite darkened room can be remarkable (Water birth book – Janet balaskas – p. 48). The need for privacy suggest that the immersion in a pool of water might provide the mother with opportunity for isolation and eliminate useless stimulation. This may also explain why shower in a small private room can be more efficient than the bath in a large busy one (Water, Birth and Sexuality” Michael Odent p -15).
There is a lot more of scientific research and anecdotal evidence supporting the benefits of water birth. For thousands of years women have been using water to ease labour and facilitate birth. Mums who choose natural birth knows that birth without pain medication isn’t birth without pain management. There are lots of ways to manage labor pain and water birth can be one of the best ways to manage pain during childbirth.
When a women in labour relaxes in a warm deep bath, free from gravity’s pull on her body, with sensory stimulation reduced, her body is less likely to secrete stress – related hormone. This allows her body to produce the pain inhibitors – endorphins – that complement labour. A labour women who is able to relax physically is able to relax mentally as well.
Immersion in warm water tends to reduce the level of adrenalin family hormones we secret at high rate when we are cold and frightening. Thouse are the hormones, that makes the dilation of the cervix take longer, it also becomes more difficult and more dangerous.
Many women report being better able to concentrate once they get into the water. Doctors and midwifes who attend water births find that mere sound of water pouring into the birth pool or bathtub helps some women to release whatever inhibitions were slowing the birth, at times so quickly that the birth occurs even before the birth pool is filled. Oftentimes women climb into birth pool to labour and the birth happens before they can get out.
Elasticity that water imparts to the tissue of the perineum, reducing the incident and severity of tearing and eliminating the need for episiotomies. The ease of the mother labours and gives birth in water is transferred to the child who is born in the water. The emotions the mother feels can also be felt by the child because the hormones her body secrets in response to her emotions are absorbed by the child. If the mother’s delivery is easy and smooth, so too, is the baby’s birth. The baby spends less time in the cramped birth canal and is free from fear, frustration, or other painful emotions a long and difficult labour might arouse in the mother. The mother is more emotionally available to immediately receive and attach to her child.
The baby emerges into the water has freedom of movement in familiar fluid surroundings. A baby’s limbs can also unfold with greater during those first moments when he leaves the mothers body and enters water. The water offers familiar comfort after the stress of the birth, reassuring the child and allowing his bodily systems time to organize. Water mitigates the shock and sensory overload that are so often an inextricable part of birth. Lights and sound are softer when perceived from under the water, and even the touch of his mother’s skin to his own tender skin is softened by presence of water (Gentle birth choices – Barbara Harper, R.N. p 149- 153).
Water allows women to go deeper in altered state, it’s actually chemical action in the brain that allows this happen. Women gets into water and the brain starts to pump up the hormone oxytocin, the hormone, that makes contraction and withit it makes endorphins to rise that makes birth more pleasurable. Wheater the baby is born in or out of water doesn’t actually matter as the effect that women receives by laboring in a water stays in the body for 24 h. If the women uses tub in early birth, it will help her even if she later will move to the hospital without tub. In chinesse medicine water is yin, yin is calm, relaxing, so if you have fear, anxiety, it heals you, it grounds you (Better Birth 360 – live interview with Barbara Harper).
Odent found that when woman’s contraction become more painful and less efficient, resting in a warm bath often provides relief, especially for women whose dilation has no progressed beyond five centimeters. In the pool, labour almost immediately becomes easier and more efficient. Warm water acts directly on the muscular system, so warm bath might have a direct relaxing effect. Bath, that is same temperature as the body, protects the mother to be against the fight and flight response (Water, Birth and Sexuality” Michael Odent p -15).
The pool has to bee sufficiently deep so that, if she is kneeling, the water is just below the breasts, making skin to skin contact and eye to eye contact as easy as possible. Immersion in a small pool reduces the gravity. Ideally, the pool should be large enough to allow woman to adopt position and deep enough to allow woman to make complete immersion possible. If its overly too large, too much time is requested to fill and empty it, and once full, the atmosphere of privacy is reduced. A similar problem can arise if the pool is constructed in a transparent material. The prevailing colours should be considered. Light blue reinforces an aquatic atmosphere. The water must be constantly regulated and kept at body temperature.
Recommended water temperature ranges are: 32-36 degrees during labour, 36 – 37 degrees for delivery as baby temperature mostly are half or one degree higher. Here most importantly is that mother feels comfortably warm and is not looking flushed or overheated. Since women vary a lot in what t feels right for them, this is the main guide. An important factor is to ensure that the mother is encouraged to drink plenty of water while in the pool to avoid dehydration. Maternal temperature should be recorded regularly. Maternal hyperthermia at water labour was a concern some years ago and this has largely been addressed by adherence to the above guidelines.
If a mother-to-be goes to the bath before the onset of hard labour, the contraction may stop. On the other hand, the cervix might dilate several centimeters quite rapidly. However, this will not necessary prevent the protraction of the later stages of labour. Alternatively, if mother-to-be gets into the water only when hard labour is established and when dilation of the cervix is well advanced (for example, at least 5 cm), the end of the first stage can be very fast: in the region of one hour for the first baby. However, a degree of flexibility is required and each women should be reviewed individually. Some women having intense labour may benefit from entering the pool earlier.
On the entering the pool, the mother-to-be often gives a great sigh, expressing relief and even well–being after that, rapid dilation is often accompanied be what might called a deep regression. She cuts herself off from our world, forgetting what she learned, what she has read, all her received ideas. She dares to shout out. Well – intentioned attendants should become less intrusive, as her inner feeling takes her deeper and deeper. It is as if a water were protecting her from useless stimuli. If the midwife is familiar with birthing an atmosphere of intimacy and spontaneity, she has no need to disturb the birth process with vaginal examinations. She can access the stage of labour by observing woman and her breath patterns – how deeply and how noisy is breathing. The midwife can also sense when labour has stopped and when the contractions are no longer efficient. It often means that baby is not far away. When you add to darkness and silence, sensory stimulations is reduced even further. When woman lies back in the pool so that her ears are under the water, the outside world is cut off completely.
If the contractions suddenly stop being efficient, the mother also feels it. If she trusts what she feels, if she is not prisoner of a project in terms of giving birth under water, she does not hesitate to leave the bath right before. Leaving the warm water and returning to a cooler atmosphere often triggers off one, two or three irresistible contractions – and the baby is born (Water, Birth and Sexuality” Michael Odent p. 2-3).
Summary of benefits of laboring or giving birth in water
Common findings are that using birth pool:
- Increases privacy
- Provides significant pain relief
- Reduces the need for drugs and interventions
- Encourages a woman’s sense of control in labour
- Facilitates mobility and enables the women to adopt optimal positions for an active birth
- Speeds up labour
- Promotes relaxation and conserves energy
- Helps to reduce tears
- Is rated highly by mothers and midwifes
- Encourages an easier birth for the mother and a more gentle welcome for the baby 
 Water birth book” Janet Balaskas p55 – 73
The reason why kneeling or immersion in water during labour is so helpful is mysterious. What is clear is that water is often way to reduce inhibitions… We observe that during such immersion in warm water, semi – darkness is the best way to reach a high level of relaxation. Water may be a good way to reduce adrenergic secretion. Immersion in warm water with semi- darkness may also be a way to reach alpha brainwave rhythms. Water may be a symbol of mother, of comfort, regression to childlike needs and behavior. Whatever way we want to talk about the effect of water during labour, one thing is sure. The contractions become more efficient and less painful at the same time, so that sometimes the labour is very quick. Many women do not want to leave the pool because it is so comfortable. As a result sometimes the baby comes while the mother is in the pool.
But as every labour is unique, no two women will use a birhing pool in quite the same way. Moreover, a minority of women who try the pool do not find it helpful. Many women, however, are very keen to get into the pool at the earliest possible moment (although we will see it later that is is not wise to get in too early) and some are comfortable that they want to stay in the water for whole of the remaining birth and birth. Others find the pool helpful for pain relief during labour, but feel the need to be on dry land for the birth itself. In a long slow labor episodes in the pool can be useful for resting. The message is that water can be of benefit in a variety of ways (Water birth book – Janet Balaskas p. 48 – 49).
Ina May Gaskin: Don’t hold contraction rather let them be, let them come as fast as they want, just go with it. Let the gravity do it thing. Breath out and let the birthing happen as best as it can be. Surrendering over and over and letting go (Guide to childbirth – Ina May Gaskin).
Is a water birth for you? When water birth may not be the right option
While it is clear that water can offer hugely valuable support for most women in labour, it is not the right choice for everyone. Some women, for example, are very certain from outset that they want an epidural and/or other form of medical pain relief. This being said, there is instances of women who have been encouraged to use a birthing pool for temporary relief while waiting for anesthetist to arrive; they have found that water so surprisingly soothing and supportive that they have forgotten about the epidural and gone on to have their babies without drugs of any kind. The message is that it is impossible to know what you want until you get there, though you may have a strong idea of your preferences for now. Therefore you should inform yourself of the pros and cons of a wide variety of options and choices for your labour, including the complementary therapies as well as a variety of medical interventions.
The UK’s Royal College of Midwifes position paper on water births (October 2000) outlines the following criteria for the use of water during labour:
- This must be the woman’s informed choice
- The pregnancy should be of normal full term at 37+ weeks
- There must be a singleton foetus (only one baby) with cephalic (head down) presentation
- No systematic sedation (tranquillizers or other drugs)
- Spontaneous rupture of membranes less than 24 h (i.e. if more than 24 h have passed since membranes ruptured and labour has not yet started, a water labour may not be recommended)
These criteria refer mainly to labour. Whether or not the baby is born in water depends very much on how things progress, how your baby is coping with labour and how you feel at the time (Water Birth Book” Janet Balaskas p 77 – 80).
Keeping and open mind… Labour or giving birth in water is an option open to women who have a healthy pregnancy and are generally defined as “low risk”. However, what will actually happen at the time is unknown. It’s important to keep open mind when you are considering using a birth pool, coupled with strong intention as to how you would ideally like to give birth to your baby. You need a strong vision and intention to realize the dreams, but equally you need the flexibility to accept a complete change of agenda and adapt to the unexpected if it arises, keeping the most important priorities in view.
Yoga in the pool
There are many ways to integrate yoga in the pool. First of course is the breath. The same breath that can be use in non-water birth can be used also during labour and birth in the pool. Ujjayi breath (Ocean breath) by inhaling through the nose and exhaling through a wider open mouth is great as the partner can follow mums expressions and see if she is relaxed in her face and jaw. She can also add sound, which also works great to follow mum and check she is not tensed, which will cause a change of the sound. In addition, using sound helps to bring attention away from the intensive feelings around the pelvic area. By creating a low pitch sound we are sending energy down and helping the baby to move deeper in the pelvis and through the birth canal. Sound A – O – U – Um are great to release the muscles around the jaw and the pelvic area.
You can be in labour and give birth underwater in a variety of positions – moving and changing them spontaneously. You can kneel in an all-fours position over the edge with the baby emerging from behind. Alternatively you could squat in the water, holding onto the sides for support or on your partner if he/she is well set at the wall (by having support at the back for him/herself). It is much easier to squat unsupported in the water than on the land. Your partner could enter the pool by sitting on a low stool or a beanbag. You might even choose a semi sitting position facing forward.
Especially, asymmetrical movements from an all-fours position are great to use in the pool. The midwife may decide to enter the pool with mum. Some midwifes prefer to put on a bathing suit and enter the water, others suggest wearing cotton trousers and the top usually worn in an operating theater and standing in the pool only if necessary. Most midwifes prefer not to enter the pool as it is usually not necessary and quite easy to observe what is happening from the outside.
Open pelvis positions
Slow micro movements are very effective in open pelvis positions as they help ensure good blood flow and lymph flow and promote good neurological functioning in this important area.
- Author: Anita Dobre, prenatal & postnatal doula & yogateacher.
- “Water, Birth and Sexuality” Michael Odent
- “ Water birth book” Janet balaskas
- “Gentle birth choices” Barbara Harper
- “Guide to childbirth” – Ina May Gaskin
- “Blue Mind” – Wallace J.Nichols
- “Better Birth 360″ – live interview with Barbara Harper
- “Face of Birth” Movie