Labor is uncomfortable and most women are very frightened of the pain. This fear keeps many women from even considering natural childbirth. Those who often refrain from taking any medication their entire pregnancy will allow very strong medications to be put into their epidural space for their delivery. Even when they know that the epidural can lead to longer labors, more medical interventions, higher risk of cesarean and severe vaginal tearing, they will still choose an epidural because they are terrified of experiencing labor pain without relief.
If a woman is provided concrete alternatives to epidural anesthesia for the discomforts of labor, she is more likely to consider an unmedicated birth. Non-pharmacological pain interventions have significantly lower health risks to both mother ad baby. Water can be used in a myriad of ways throughout the birthing process.
Water in Labor and Birth
1. Water Immersion
Most people recognize the relaxation that accompanies entering swimming pools, hot tubs, and bath tubs. In labor, water gives a woman pain relief, freedom of movement, less stress on joints, a feeling of safety, decreased stress hormones, increased endorphins, and increased oxytocin. All these benefits reduce the need for pharmacologic pain management. A woman in the tub tends to be more independent, assuming the positions that are most comfortable. Women generally experience less labor pain (as much as 50% less) and less pelvic pressure as their baby moves through the birth canal. With water immersion, women often enter the tub and experience the “ahh” effect, a phenomenon where they completely relax in the water and the cervix opens quickly— going from 5cm dilated to full dilated and delivering the baby in less than an hour.
I have observed the “ahh” effect progress even faster: one woman literally entered the tub at 5cm and started pushing after three contractions. The baby was born within 15 minutes of entering the water. Women themselves cannot believe the baby could possibly be coming, but it can and does happen.
Delivering the baby while in a tub or pool has several benefits:
- Allows a more independent delivery. The buoyancy of water makes mother and baby float! Immersed women can easily maintain more upright positions which allows them to catch their own babies and be assured that they cannot drop their baby. Because she is more comfortable and less afraid a woman is rarely frantic when delivering in the tub. Delivering the baby by herself results in a very gratifying birth experience.
- Promotes physiologic birth. The woman is more able to access her hindbrain and behave more intuitively in the tub. Waterbirth helps a woman labor by reducing her discomfort. The water’s buoyancy and increase in endorphins helps mitigate her fear and results in a decrease of adrenaline. Care providers are not able to interfere with labor as much because women in their hindbrain or “zone” are less aware of the activities and sounds around them. The more a woman can turn inward and allow her body to do the work that needs to be done, the more normal labor becomes.
- Eliminates the need for the birthing mother to move. Women often become “fixed” in one spot once the baby has delivered. They find it very difficult to move at all. A woman may even need assistance to turn from one side to another. Having the option of a water delivery rather than simply water immersion allows the mother to stay where she has become comfortable.
- Helps the mother control the delivery resulting in less perineal trauma. When women are not in the water, they feel significant pain and pressure with the delivery of the baby’s head. Frequently they cannot tolerate the time it takes for the perineum to stretch, resulting in perineal tearing and lacerations. In the water, women are much more tolerant of the sensations of the birth, so they are more likely to wait for the perineum to stretch. Women in the tub often deliver in a supported semi-squat or on their knees. These are optimal positions for reducing tears.
- Provides a gentle birth for the baby. Babies born in a pool have a soft landing and then move directly to their mother’s arms. Waterbirth tends to be a more physiologic, family-focused process which gives the baby a gentle start in life.
Water immersion as a pain management plan is often discredited by hospital personnel. When a woman wants an epidural, they will move heaven and earth to get it for her. This is not the case for the tubs.
A few years ago, I had an example of the difficulties midwives encounter when trying to facilitate physiologic birth. Our client came to the hospital in very active labor along with her very supportive husband and doula. She was 9 cm dilated on admission so after the routine admission process was complete, we started filling the tub. Very quickly we realized there was no hot water!
I went to the nurses’ station to ask for someone to investigate why the tub suddenly had no hot water. The other tub rooms were occupied so there was no option to move the woman to another room. The staff had no solutions to our dilemma. The fact that a tub filled with warm water was an integral part of this woman’s birth plan was not a concern. I had to find the tech on the unit and ask her to please call maintenance to see why the hot water heater was not working. The sink in the bathroom had hot water but I knew that the big tubs had their own hot water heaters.
Meanwhile, the mother continued to labor, laying on her side in bed with her husband and doula supporting her. The fuse was fixed, and the hot water heater was back in business. Two hours later, the tub was finally filled. As the mother climbed in, she was already bearing down with contractions. Pushing began in earnest once she was in the tub and she easily delivered her first child in the water. Baby weighed an incredible 10 pounds!
Later, the woman described her birth as the most incredible experience of her life. She felt like every cell in her body was “alive” and she experienced the birth on a higher plane than most life events.
Many hospitals have showers instead of tubs. The steady spray of water can assist the laboring woman to focus inwardly to allow the contractions to “flow”. Showers keep hospital personnel from interrupting your progress–they generally like to avoid getting wet! Hospitals usually have unlimited hot water, so the shower time can be longer than in a woman’s home. The sound of running water is soothing to all involved: the laboring woman, her family and her care providers. Keeping everyone calm is optimal to the promotion of normal birth.
Applying ice packs to body parts can numb and decrease inflammation. Some women like a cold pack applied to their pubic bone during labor.
5. Hot Water Bottles
Moist heat applied to a woman’s lower abdomen or back can reduce pain. Alternatives to hot water bottles are heating pads or warm rice socks.
6. Drinking Fluids
Labor is a time of incredible fluid and caloric needs. A woman should be encouraged to continuously sip water while laboring. Avoiding dehydration will keep her body functioning optimally. Try the Labor-ade recipe below to stay hydrated and reduce pain.
- 1 32oz. mason jar with lid
- Juice from 1 lemon
- 1/4 c. raw honey (amount can vary based on sweetness preference)
- 1 tsp. Natural Calm (powdered magnesium supplement)
- 1 scoop Calcium Citrate powder
- A pinch of sea salt
- Your choice of filtered water, coconut water, or red raspberry tea (start with the water and see how you like it before adding additional flavors). Red raspberry leaf tea has additional benefits such as increased milk supply and reduced risk of postpartum depression.
- When using the red raspberry leaf tea, prepare it at double-strength and add the honey so that it can dissolve. If not using tea, skip this step.
- Fill mason jar half-way with the water
- Add the juice of the lemon, honey, magnesium, and salt to the mason jar
- Close the lid and shake
- Shake and stir until the honey is dissolved
- Fill the rest of the way with water and refrigerate
Water makes up 60% of our bodies and 70% of the Earth’s surface. Turns out people have a strong affinity to water and all of its benefits. Women should use water in all of its forms to make their birth more pleasurable.