I start in the water

Generality

Water birth is an alternative to the more usual ways of dealing with labor and the phases that take place before the birth of a child .

From a practical point of view, the future mother is partially immersed in a tank full of water, heated to about 37 ° C, where she is free to assume the positions she prefers to face uterine contractions. In the final phase of the birth, the newborn passes directly from the amniotic fluid to the water, then it is brought to the surface and given in the arms of the mother, the doctor or the midwife who attends the procedure.

Water birth promotes a sense of well - being in the pregnant woman: during labor, heat and immersion in the tank can accelerate cervical dilation, as well as reduce muscle and general tension .

Furthermore, it should not be forgotten that hot water helps to alleviate the pain of contractions by stimulating the production of endorphins (neurohormonal substances that promote relaxation).

Like other methods of giving birth, even water does not exclude the possibility of complications . For this reason, this alternative must be carried out only under the control of specialized personnel, if there is no risk for the health of the woman and the child.

What is water birth?

Water birth is a procedure that allows the pregnant woman to face labor in a special tank. This option is proposed in the maternity wards of some adequately equipped hospital facilities.

Compared to traditional methods, delivery in hot water seems to have positive effects on both the future mother and the unborn child.

First of all, the heat of the water reduces the secretion of adrenaline, induced by pain and emotional tension associated with the particular event that the woman finds herself living; if it remains at high levels during labor, this hormone "stiffens" the cervix, necessitating more contractions to achieve complete dilation. Therefore, water birth would seem to be associated with a reduction in labor time : the less the mother is stressed, the shorter the expulsion phase will be.

Among other benefits, an increased elasticity of the birth canal and perineum were also hypothesized, reducing the need to resort to episiotomy .

Water birth has the ability to also stimulate the release of endorphins, which allow the woman in labor to relax better between contractions.

Despite these considerations, water birth remains a highly controversial medical practice. For this reason, before opting for this mode, you should always seek advice from your trusted gynecologist.

Why give birth in water?

The goal of water birth is that labor is relaxed and comfortable .

Compared to traditional methods of childbirth, immersion in warm water improves muscle relaxation and reduces uterine contractions that are the cause of pain. In the tank, the pregnant woman moves more easily and can change position, increasing her comfort and experiencing the moment with less stress .

The cervix tends to dilate faster, making the descent of the unborn child easier and less painful in the birth canal. Finally, for the child, being born in water means moving more gradually from intrauterine life to the external environment.

When can it be done?

Water birth is indicated to all women, provided that the pregnancy is considered physiological, that is, at low risk and with a regular course, and labor is well underway .

More in detail, water birth can be performed when:

• Pregnancy is single;
• The mother is well (she has no fever or other pathologies that require specific assistance);
• The cardiotocographic tracing (which provides information on the heartbeat of the child, on the type and frequency of contractions of the mother's uterus) is regular;
• The amniotic fluid is clear (a sign that everything is progressing well);
• The hospital is equipped for this type of assistance;
• The doctor and the midwife agree on this type of choice.

Before evaluating the possibility of resorting to water birth, it is advisable to gather sufficient information . In particular, the reference department must have a dedicated area, with midwives specifically prepared for this type of assistance. The requirements to access this mode may vary, then, from one hospital to another.

Other indications for water birth include:

• Cephalic presentation of the fetus;
• Pregnancy at term (37-41 weeks);
• Negative result for serological tests for contagious diseases, such as hepatitis B or HIV infection, for the protection of medical personnel;
• Absence of skin infections and fever.

Clearly, for the success of the procedure, the pregnant woman must feel totally at ease in the water: if this means induces discomfort or nervousness, it is better to give birth in other ways.

Once the hospital to be referred to has been identified, it is advisable to consult with the specialist in gynecology and the midwife who will follow the delivery in the water, to know exactly how it takes place . Some maternity wards have equipped themselves, for example, to favor only labor in the water, but the birth of the child takes place on the normal bed; other times, the woman is allowed the freedom to enter and exit the tub, to relieve pain from time to time or to give birth.

How to do it

Water birth is offered in specially equipped hospital facilities, when the active phase of labor has begun (smoothed uterine neck and dilation of at least 3-5 cm, in the presence of valid and regular contractions). During the procedure, the well-being of the unborn child is monitored thanks to wireless instruments that detect the fetal heartbeat and can be immersed in water, without limiting the mother's movements.

Characteristics of the tank - The water birth takes place in tanks made with very specific construction techniques. The dimensions of this structure must allow the future mother to move freely and to assume the positions she prefers. The depth must allow for at least 70-80 centimeters of water. As far as the construction materials are concerned, however, the water birth tank must be very resistant and guarantee perfect sanitation .

Water characteristics - The temperature of the water in the tank must be warm enough: in the preliminary stages of labor, it goes from 35 to 37 ° C; later, when the birth of the child is imminent, it is brought to 37-37.5 ° C. As in the whirlpool baths, in the birth tanks, this parameter can be easily adjusted by means of a device that keeps it constant for the duration of the birth.

Another element to consider is the exchange of water, which must be continuous, so that the contents of the tank are always clean. In fact, during labor and delivery, the emission of urine, faeces, blood and amniotic fluid is normal. For this reason, it is important to have a device that allows you to quickly change the water and therefore guarantee the hygiene necessary for the woman and the baby at birth.

When to enter the water - The ideal time to enter the tank coincides with the beginning of the active phase of labor . Therefore, water birth begins when the woman has a dilation of the cervix of at least 3-5 cm.

The position in the tank is free and the movements induced by the contractions can be accommodated: in the water, the pregnant woman can sit, supine, half-lying or kneeling. The midwife who follows the birth at the edge of the pool, then, will take care of all the maneuvers necessary for assistance.

Is there a risk of drowning for the newborn?

Water birth exploits the " apnea reflex " of the newborn child : this self-protection system is activated by blocking the respiratory act, when water comes into contact with the skin receptors of the face. A healthy child therefore does not risk "drinking" in any way. The respiratory act triggers only upon contact with the air, when it is received in the embrace of the mother.

Pros and Cons of water birth

Benefits and potential benefits

Given that the choice to give birth to a child in water is allowed only to women with a "low risk" pregnancy, the advantages are numerous:

• Water birth promotes a feeling of well-being: the possibility to float in the tank and to choose in full autonomy the position to take to face the contractions has a positive effect on the progression of labor and reduces the stress associated with the event.
• Immersion in hot water is able to alleviate pain, as it stimulates the release of endorphins, which act as a kind of analgesic: water birth can reduce, therefore the need to use painkillers, such as an epidural.
• Water birth increases the woman's sense of control over her body and, as happens when she swims, has the advantage of helping to support the child's weight (the belly) with significant relief for the lumbar area.
• Thanks to humidity, water birth facilitates deep and regular breathing (useful, in particular, in those suffering from asthma).
• The state of calmness of the pregnant woman optimizes the supply of oxygen to the baby through the placenta: the more relaxed the mother, the less agitated the baby is.
• Hot water relaxes the muscles of the pelvis and relaxes the perineum, reducing the need for episiotomy.
• For the child, it has been hypothesized that being born in water makes the abrupt and sudden transition from the liquid world (represented by the uterus) to the airy one less traumatic. Once born, he finds himself in an environment of conformation and temperature similar to the one he leaves in his mother's womb.

Risks and complications

Currently, few scientific studies are available that investigate the possible risks associated with water birth. However, neonatal respiratory problems, bleeding and infections due to being in dirty water have been reported.

The contraindications of childbirth in water are essentially all those that make one fear a possible complication during labor and / or during the expulsive period.

In particular, water birth is not recommended in all conditions that would require more careful assistance, such as:

• Presence of pathologies of the mother such as: preeclampsia, diabetes, nephropathies, pulmonary or cardiac pathologies and infectious diseases (eg hepatitis B);
• Placenta previa;
• Twin pregnancy;
• Irregularity in the fetal heart rhythm;
• Premature birth or protracted gestation;
• Severe fetal malformation;
• Presentation of the anomalous child (eg podalic position);
• Child too big for gestational age;
• Abnormal leakage of blood or meconium-stained amniotic fluid (material in the fetus's intestine).

Furthermore, water birth is contraindicated if the expulsive period does not proceed with due regularity or when signs of fetal distress appear in labor . The procedure is not suitable for the woman who is nervous and does not feel comfortable in the tub. Water birth should be suspended even if the future mother has excessive fatigue during labor.

To remember

The choice of the method of giving birth must always be evaluated together with your gynecologist and the midwife of reference, also in relation to the structure in which the child will come to light.