Your Baby Can Make A Splashy Entrance
Content from: http://www.angelfire.com/ca2/birthingwayplace/
Water for Pain Management for Labor and Delivery
As I reflected on my first two deliveries, I pondered over what I would change, should we have a third child. There was no comparison between the first two. My oldest daughter was born in a hospital, which was a horrible experience, and my youngest was born at home. While it would be hard to improve upon my homebirth experience as a whole, for it was truly remarkable, I felt I could have used a bit more help with pain management.
I used my glider chair and my bath tub to help deal with the pain. I remember how I enjoyed the water during my second labor (it was forbidden with my first). We bought a hand held sprayer for my homebirth and I had my husband spray the water all over my abdomen. It lessened my pain and reduced my tension. I would stay in the tub until the hot water ran out, go to my glider, and then return to the tub when the water heater had filled again. During that labor, I wished the tub were deeper, wider and that we had some way to maintain the water temperature. I would have loved to have birthed in the tub, as I am somewhat of a water person anyway. But, we ran out of hot water just as I entered stage two and it was getting mighty cold in there.
Now that my midwife has a birth tub, my task is to become educated in the various aspects of waterbirth. My first issue became one of safety. The first question I had was, “What if the baby tries to breathe underwater?” I started asking midwives and reading articles. According to information I received from Global Maternal/Child Health Association, Inc., “Many people ask if it is safe to give birth in water. To date, there are estimates that more than 25,000 water births have taken place worldwide with no reports of life-threatening complications for either the mother or the baby.” The reason? “There is a complex physiological mechanism which inhibits the baby from taking a breath when it is born in water. It is commonly believed that the stimulus to breathe is from the baby’s face coming in direct contact with air. Up until the time that the baby is lifted out of the water, the baby receives its oxygen from the mother via the placenta and the umbilical cord.”
My next question was, “What if there is a shoulder dystocia?” On rare occasions, the cord may be pinched from the tight position and then the out of water baby gets signals to prepare for breathing–CO2 is rising or O2 is falling–and baby will be showing that stress quite soon if it can’t begin to breathe (the head becomes darker and more blue, then pale). The underwater baby does NOT get these signals until his skin reaches air. Until then, his body THINKS he is still in the womb, and the still functioning placenta and cord are taking care of him just as they were moments earlier before his head was born. So, the water actually buys time!
“Many women over the years have found great relief from labor in the water,” said Patricia Edmonds, an Oregon Midwife. “Some women get into the water and just can’t get comfortable, so they birth outside the tub. Others, I think, decide it is a crazy place to have a baby and don’t get back in. Some ask for it specifically for laboring in, with no intention of birthing there.” None of Patricia’s moms who have birthed underwater have had any tearing. Patricia has never seen a painless birth, but, “The women do report they are much relieved in the tub or shower. They only get out to break the monotony.”
Of her most recent waterbirth, Patricia says, “This was a mom who had an out-of-home birth with her first baby and was absolutely determined to have a home waterbirth, but was so very fearful of the pain. She had an epidural with her first birth and just did not know if she could handle the last few hours of labor without the same ‘help’ she had gotten before. She always had the option open to transfer to the hospital if it got to the point where she felt she could not handle labor.” This Mom did indeed go on to have a home waterbirth. She had a 9 pound baby girl, 3 pounds bigger than her previous baby, and she never asked for drugs!
Heather, mother of two, was in labor for a total of 11 hours, and in the water for 2-3 hours of her labor. She had many interventions during her first labor and birth, and said this about her waterbirth. “I was allowed to rest comfortably between contractions–just floating. I could speak and was fully coherent, aware of what was happening and engaging in conversation. It took away some of the discomfort and allowed me to relax better to cope with the rest.” She birthed her 9 pound, 1 oz daughter with no lacerations and no swelling. When asked if she would recommend waterbirth to others, Heather enthusiastically replied, “Yes, without reservation! I would recommend it to anyone, at least for labor and pain management. Then, they can decide if they want to get out–but, at least have it available!”
The types of tubs: Patricia Edmonds carries a 3 foot high, black, oval Rubbermaid watering trough for cattle or livestock. It’s made of very thick plastic and is pretty well insulated. Heather used a metal trough that was 3′ x 4′. They put blankets on the bottom to make it comfortable, then a liner, and finally pipe insulation that went along the edges that they secured with duct tape. They used an aquarium thermometer to gauge the temperature and emptied and refilled it when it got below 96 degrees. Gail Hart, also a Midwife in Oregon, has a tub (available from SoftTub) with a built in heater with jacuzzi style jets. She can fill it with warm water and forget about it.
Water Temperature: The information I received from GM/CHA says that, “Water should be maintained at a temperature which is comfortable for the mother, usually between 90-100 degrees Fahrenheit. If the water is too hot, dehydration becomes a problem, as well as over heating which can often cause the baby’s heart rate to go up. It’s good to have plenty of cold wash cloths or a spray bottle with cold water available.” To regulate temperature, Gail says this, “A large body of water retains heat pretty well–much better than a tiny bathtub full–especially if you can cover it up. A waterbed mattress cover works very well for this–heavily insulated. Even a thick quilt will help. We get pretty good at regulating the water temperature. We can usually run a hose from a kitchen or bathroom faucet and “top up” the temperature as needed–sometimes we have to bail a little in order to add a little! It’s not as much trouble as it seems at first — like pancake making, it’s more complex to describe than to do!”
When should Mom get in the water? Patricia Edmonds said, “I have them wait until they are in active labor, contractions strong enough that no matter what they do, labor won’t slow or stop. The general consensus in this area is 7 cm. Seems like too long a wait, we just do it as it feels right and watch the labor pattern. If things slow, she can choose to go at an easier pace or she can change positions and stimulate her labor! It really is the mom’s choice.”
When should the laboring mom get out of the tub? Many midwives feel that she should be encouraged to get out every 30-45 minutes to empty their bladders. The only problem is that some love the water so much, they don’t want to leave it!
When should the newborn baby get out of the water? According to Dr. Rosenthal’s article from The Female Patient, Vol. 16/August 1991 pg. 41″….We have observed no instance of breathing efforts before the infant is brought to the surface, but we believe that there is no benefit to leaving the infant in the water…” Meaning that baby can stay IN the water after birth and bond with mom, just not UNDER the water!
As I hear more and more wonderful things about waterbirth, I feel this is perhaps where my baby and I belong when the time comes to do it again. Whatever you decide is right for your baby, may you have a truly empowering experience!
–© 1996, Kim Mayrose , mother of two, West Des Moines, Iowa
For more information about waterbirth, contact:
Global Maternal/Child Health Association
P.O. Box 1400
Wilsonville, Oregon 97070
Also, read these articles:
Report by Michael Rosenthal in “The Female Patient/ Vol. 16/ August 1991 Warm Water Immersion in Labor and Birth.”
Water Birth: “One Birthing Center’s Observations by Linda Church in Journal of Nurse-Midwifery” Vol. 34, No 4. July/August 1989
“Jet Hydrotherapy for Labor and Postpartum Pain Relief by Kathleen Aderhold and Leslie Perry in Maternal Child Nursing Vol. 16, March/April 1991” Report of experiences at St. Luke’s Hospital, Denver, Colorado.
Kitzinger, S. (1995). “Sheila Kitzinger’s letter from England: Is Water Birth Dangerous? Birth Issues in Perinatal Care, 22 (3), 172-173.”
A recent study conducted at the University of Florida in Gainesville and Case Western Reserve University in Cleveland, Ohio shows that a deep-water bath may be better for a newborn’s first bath than the standard sponge wash. The current standard practice in the United States is that the newborns spend just a few minutes with their mother before being wisked away to the newborn nursery for warming, etc… The sponge wash can cause a significant drop in temperature that some of the newborns have to be returned to the infrared warmer again. This results in longer separation from the mother and family, interfering with the bonding process. With the deep-water bath, there was no significant amount of heat loss sustained on their group of twenty healthy newborns. The direct consequence would be that the baby and family are not denied this important time together. Also, following Leboyer’s beliefs, it would be a much more peaceful and gentler method. What better way to incorporate this than with laboring and/or delivering in water? If this is not desired or cannot be achieved, having the tub in the mother’s hospital room (or at home in a clean, deep sink or tub) would suffice. Perhaps the guidelines mentioned above for waterbirth would work for the deep-water bath, as the water would be of womb temperature.