Warm water immersion in labor can diminish stress hormones (called catecholamines), which increase pain and slow labor; it also directly reduces pain by increasing the body's production of natural pain relievers (endorphins), can ease involuntary muscular tension, and enhance relaxation during and between contractions. It can also lower blood pressure within minutes and decrease edema (swelling), and the buoyancy can promote better circulation and increase efficiency of uterine contractions. In addition, use of a large tub increases mobility so that it is easier to change positions to aid the progress of labor, especially when a woman is becoming tired. Birth into water can reduce the incidence and severity of perineal tearing; the water encourages relaxation of the pelvic floor and provides natural support to the perineum.

Waterbirth may have benefits for the baby as well, and often provides a gentler transition to life outside the womb. Many pregnant women are drawn to water, especially during labor, and women all over the world give birth in labor tubs, tide pools, or natural springs.

The advantage of tubs specifically designed for birth is that they are portable, heated, and large enough to accommodate movement and a variety of labor positions. Rented tubs can be used in the hospital or at home, and might be just what you need for a more comfortable labor. Some women choosing hospital birth use rented labor tubs at home, often with the services of a doula, to help them stay home longer. This enables them to enter the hospital when labor is well-established, which can help them avoid unwanted interventions. A bathtub or shower can also provide pain relief and relaxation, and should be available wherever you choose to give birth.

There are some practical considerations to using water as a comfort measure. If a mother is using it for pain relief or reduction of blood pressure and edema, it is important to have enough depth to be fully immersed- her whole body should be under the surface. Less water than this will still be helpful, but not as effective. Be sure to use water that is close to body temperature, 98-100 degrees Fahrenheit. If it is too cold, she could become chilled or waste energy shivering- energy better used for labor! For this reason, have plenty of towels and blankets handy, since many women will be in and out of the tub several times during labor. If the water is too warm, she may become overheated, flushed, or dizzy; if this happens, she can simply leave the tub for awhile and have someone add cold water. In any labor it is important to keep drinking liquids, but especially while in the tub, to avoid dehydration. Have a non-slip surface (bath mat or similar item) nearby for when the mother gets out, and a person or two ready to assist if necessary. A woman can use the pool whenever she wants; however, if a mother chooses to get into the water in early labor, before her contractions are strong and close together, the water may relax her enough to slow or stop the labor altogether. That is why some care providers limit the use of the pool until labor is established and the dilation of the cervix is at least 5 centimeters (the tub is ideal to have at home for women who experience lots of preparatory or "false" labor, since it can sometimes help her get some rest). But. some women have found that entering the pool helps them relax enough to really get labor going! It can sometimes be helpful to wait until active labor so the mother has something to reserve for when labor becomes more difficult. According to Barbara Harper, Author of Gentle Birth Choices and founder of Waterbirth International, the first hour of relaxation in the pool is usually best and can sometimes help a woman achieve complete dilation even in a short amount of time.

For most women, the question of safety needs to be addressed. There are no known hazards to laboring in water, whether or not the bag of waters has broken. Waterbirth is completely safe as well, as long as some precautions are followed. First, there are several factors that prevent the baby from beginning to breathe underwater after birth. The water temperature is close to that of the amniotic fluid in the womb, so there is no shock of a temperature change. The baby is also receiving oxygen from the umbilical cord, just as it has for the previous nine months. In addition, the baby has an autonomic reflex, called the dive reflex, which prevents it from inhaling any substance that is in the throat and causes it instead to swallow (this reflex disappears after about six months). There is a complex chain reaction of hormones and chemicals that cause the breathing process to begin; just know that it is impossible for a newborn to breathe until up in the air. However, the baby should not be left under water for an extended period of time (longer than half a minute). There are several waterbirth films that show babies under water longer than this, and the babies do fine because the placenta is still supplying oxygen, but it can't be predicted when the placenta will begin to separate and stop the flow of oxygen. The safest approach is to remove the baby unhurriedly, face down so water drains from the nose and mouth.

A note about waterbirth: the use of water during labor always works best when there is no expectation that the birth will happen in the tub. Although the water can be a valuable tool, some women need more assistance from gravity and find that contractions slow down in the tub. The best approach is to be flexible. Michael Odent, French waterbirth expert and author of Birth Reborn, says that "the baby can be born underwater when there are suddenly irresistible powerful contractions and the mother does not feel like getting out of the pool: it should not be the objective. Often women need to get out of the pool for the very last contractions, at a phase when paradoxically a short rush of adrenaline can help. Women who are prisoners of the project of giving birth under water may be tempted to stay too long in the bath."

There are several ways to use pools during labor. Many homebirth midwives are experienced with and enthusiastic about waterbirth. Tubs can be rented for home use, whether the birth will happen there or in the hospital; some hospitals are also receptive to allowing use of rented tubs, but this changes all of the time, so ask your health care provider. The emphasis on technology and monitoring in hospitals and the treatment of pregnancy as an illness sometimes makes this a controversial request, but be persistent- in this setting, the reintroduction of natural elements such as water can be a real lifesaver.

Labor/birth tubs can be rented through Beautiful Birth Doula Services, including delivery at (920) 219-2223.

As this option becomes well known and more women request it, expect more hospitals to offer water immersion for labor and birth.