33-year-old Anastasia is one of the mums I looked after in the postnatal period who gave birth to her first son in water. This has stayed vividly in my memory because water births are not very common. The national average is around 2%, although individual hospitals may have higher rates. The rate for water births at leading hospitals here is up to 26%. For out-of-hospital outpatient births In birth centres or home births, almost 30% of births take place in water, as in the Quality report of QUAG e. V.
Perhaps you would also like to give birth to your baby in a birthing tub. If so, it is important that you find out where you need to deliver your baby in order to have the option of a water birth.
Many women wish to have a water birth during pregnancy. However, many women give birth in a different way. There are various reasons for this. Some women do not feel well during labour in the water - then it is good if the woman giving birth is open to a different form of birth. Sometimes there are other reasons against it. These include medical reasons. I will come back to these below.
During her pregnancy, Anastasia had hardly thought about the possibility of a water birth. In the delivery room of the maternity clinic, the midwife then suggested to her at an advanced stage of the labour that she temporarily get into the warm water of the birthing tub. This was intended to stimulate the contractions and at the same time give Anastasia some relaxation. "I coped much better with the contractions in the water and felt so comfortable that our little Laurenz was ultimately born in the water," she says. When I visited the new mum at home in the postnatal period, Anastasia beamed at me and told me enthusiastically about this unplanned and yet so pleasant birth process.
Even if the list of possible risks of a water birth below may seem very long, I would like to mention it at this point: If your pregnancy proceeds without any significant problems and no complications are to be expected during labour, you can generally opt for a water birth without any problems. And even a large British meta-study of midwifery scientists came to the conclusion that there is no higher health risk for mother and child during a water birth than "on land". Giving birth in the bath even offers some advantages for mother and child.
Feel good in the water
In a water birth, the mother gives birth in a birthing tub or birthing pool. This is possible in more and more maternity clinics and means that the midwives and doctors employed there are trained accordingly.
The birthing tub is significantly larger than the models we know from home. Above all, it offers the woman giving birth more space so that she can move around. She can assume different positions in the filled tub, such as the quadrupedal position. The handles and holding options as well as footrests make it easier for the mother.
Most birth centres also give you the option of having your baby in water. For a home birth, you can give birth in a normal bathtub, but you can also hire a mobile, inflatable birthing pool.
The water is at a pleasant temperature of between 32 and 37 degrees and reaches up to your chest when you are lying down. In lukewarm water, many labouring women can also relax better - both muscularly and mentally. As a result, labour is perceived as less painful. This is also confirmed by research: for example, significantly fewer painkillers are used during water births. In addition, this type of birth often shortens the labour process because the warm water promotes or intensifies the contractions. It has also been shown that fewer birth injuries, such as a perineal tear, occur in water.
The woman giving birth decides for herself when she wants to get into the water. For example, some women may only enter the tub when their cervix is fully open so that they can process the contractions better. Others find the wet environment soothing right from the start of the opening phase. Some women in labour, on the other hand, only stay in the water temporarily and then ultimately give birth "on land".
If you realise during the birth process that you do not feel comfortable in the water - for whatever reason - you can leave the tub or pool at any time. This is because the woman giving birth decides for herself how long she wants to stay in it. It is only different if an unexpected circumstance arises that makes it necessary to leave the water immediately. Incidentally, the personal labour companion, i.e. usually the woman's partner, is usually not allowed to enter the water with her.
Ideally, the woman should be continuously supervised by two midwives or a midwife and doctor while she is in the birthing bath. If necessary, they can intervene quickly and lift her out of the water. Incidentally, mum's contractions and baby's heartbeat can also be monitored in the water, as there are also waterproof CTG devices. The Dopton used by midwives to monitor heartbeats is also designed for use in the water.
Many mothers prefer to get out of the bath again for the afterbirth with the corresponding haemorrhage. "On land", the doctor or midwife can also better control blood loss during the last stage of labour. You can monitor the birth of the Placenta However, you can also wait in the water if you wish.
The baby dives into the world
Many pregnant women who are considering a water birth ask themselves: won't my baby have breathing problems if it is born in water instead of air? I can reassure you - for the baby, a water birth is actually a gentler entry into this world than "on land". Many obstetricians have found that an underwater birth is much less stressful for babies. After all, they were safe in the body-warm amniotic fluid in mum's belly for many months - and are now born in the comparably body-warm water (approx. 37 degrees) of the birthing tub. This element is therefore pleasant and familiar to them.
Nature has also provided the little ones with the so-called Diving reflex equipped: The newborn automatically holds its breath in the water. It is still supplied with oxygen via the umbilical cord and only starts to breathe at that moment. first breathwhen it reaches the surface of the water with its head. It therefore only begins to breathe on its own as soon as it has "air around its nose". The newborn is not under water for any length of time anyway, as it is lifted out as soon as it emerges and placed on its mother's chest to familiarise itself with her. What a lovely start for the Bonding!
What are the advantages of a water birth?
Women who are allowed to give birth in water are more satisfied with their labour.
This is because the warmth of the water and the fact that you feel lighter in the water makes labour pains easier to deal with. The need for painkillers is significantly lower during a water birth.
Water birth not only results in emotional relaxation, but also relaxation of the muscles and tissue. This is why injuries to the pelvic floor occur less frequently in the birthing bath. It is not surprising that studies show that women have fewer episiotomies than when they give birth in a delivery bed.
It has also been proven that mothers lose significantly less blood during a water birth.
The baby is born more gently. This is partly due to the loosened tissue, which then exerts less pressure on the baby's head, and partly because the baby also benefits from the fact that it feels lighter in the water than on land.
What speaks against a water birth?
From the perspective of the maternity clinics In times of a shortage of skilled labour, the fact that two midwives should be present at all times during a water birth speaks against this. If another pregnant woman comes to the hospital with contractions at the same time, staffing can be so tight that another midwife may even have to be called in from the on-call service. Clinics try to avoid this.
Some clinics, where water births are increasingly taking place, therefore work with the so-called attending midwife system. In this system, the woman giving birth brings her midwife with her to the water birth, which then ties up the time of only one other midwife instead of two.
Incidentally, in large maternity clinics, where many high-risk births are also cared for, water births are only very rarely carried out. This is also mainly due to staffing reasons, as the available specialist capacity must be available for difficult cases. In addition, certain risk factors rule out a water birth anyway (more on this below).
From the clinics' point of view, there is another reason that speaks against a water birth: the vaginal examination of the woman giving birth in the birthing tub is more cumbersome for doctors and midwives than "on land". This is because the professionals have to bend far down into the tub to examine the woman, which is not very back-friendly.
From a medical point of view a water birth can become critical if emergency medical intervention is required during the course of labour, for which the mother must first be taken out of the bath and dried off. This can result in valuable time being lost for the necessary preparations, for example for an emergency caesarean section. If the umbilical cord is very tight and is pulled unfavourably, it can break. However, this is not a medical emergency in the classic sense, your baby will not be harmed.
The risk of infection for mother and child in the water is also discussed in obstetrics. According to current studies, however, the risk in the bath is no higher than in the delivery bed.
For certain Risk situations however, it is not possible to give birth in water. This means that
- Pregnancy complications such as Pre-eclampsia rule out a water birth. The same applies to multiple pregnancies.
- If the child is lying in Pelvic presentationis often the baby per is Caesarean section delivered in the water. If a vaginal birth is intended, this is also not carried out in water. However, there is nothing to be said against a relaxing bath during labour.
- Weak/conspicuous heartbeats of the baby also speak against a water birth.
- If the mother has a Peridural anaesthesia(epidural), she must leave the birthing tub or the pool or cannot get into the water at all. This is because she cannot give birth with an epidural in the water. However, most women who wish to utilise the pain-relieving effect of the bathtub during birth do not need any further painkillers.
