The use of water as pain relief has been well known for centuries – it’s called hydrotherapy and is used for rheumatic pain, for example, as well as muscular aches and strains. Many women find a bath enormously relaxing and when you’re in labour it’s no different, except that complete immersion in the water, so that you float freely, is most important. Whilst water cannot provide complete pain relief, it can certainly make things more comfortable, as it acts as a support and helps in the production of endorphins. Water will make you feel more mobile and lighter, as well as soothing you mentally. Most women who choose to labour in water do so in specially designed pools. In hospital, these are usually plumbed in, but you can hire pools for use at home or you may be able to borrow one, if your local trust has the portable ones.
useful points to bear in mind
1. Many midwives would advise that you get into the pool when you are in established labour, that is to say, when your cervix is 4-5 cm dilated. Sometimes however, if labour is taking a long time to establish, you may find it helpful to rest and relax in the water.
2. As a rule, you will have more privacy if you are using a birth pool, as the pool rooms (or bathrooms) tend to be more isolated than ordinary rooms in labour wards. You should always have someone with you, however.
3. You are much more likely to be able to do your own thing, with a supportive midwife in a low-tech environment, for example at home, or in a small unit.
4. You may have to pay to hire a pool – about 200GBP for four weeks hire.
5. You may have difficulty finding a midwife and/or hospital in your area who has waterbirth experience. If the local director of midwifery services is unable to help, you may have to consider alternatives, such as – go to a different hospital or GP unit, have a home birth, book an independent midwife – before you settle down to enjoy the rest of your pregnancy. Contact the local Community Health Council for advice on this issue.
6. The water has to be maintained at a temperature between 36.5-38 degrees C; not too hot so that you become exhausted and enervated and not too cold which stimulates the baby to breathe. With a portable pool, this may mean your partner trotting back and forth with buckets to keep the temperature right!
7. You can use some other forms of pain relief with water, such as traditional acupuncture, reflexology, massage, or Entonox for example, but not TENS (obviously), Pethidine (you may fall asleep and slip under the water) or an epidural (you need drips and monitors).
8. Some hospitals rule against using a birth pool if your pregnancy or labour is abnormal, e.g. pre-eclampsia, multiple pregnancy, or if your baby needs electronic heart monitoring. This doesn’t say much for choice, so if you are planning to use a pool, discuss in advance about what may happen if you have problems in labour and if possible, get the decisions in writing.
Everyone knows the benefits of soaking in a warm bath to aid relaxation and you may well feel that this is an option you would like to try. Birth pools, which enable ease of movement and a feeling of weightlessness is, for many women, an ideal way to cope with labour.
The water should be kept at a fairly constant temperature, 36.5 – 38.00 degrees C, about normal body heat. If it is hotter than this, it is exhausting and may cause the baby’s heart to beat too fast, and if cooler, will not give the benefits of the warmth. The water should be deep enough for you to be able to adopt whatever position you find comfortable.
The midwife will monitor your labour as she would if you were not in the water, that is, she will check your temperature pulse and blood pressure at regular intervals, and listen to the baby’s heart rate every 15-30 minutes. If there is not an underwater hand held Doppler available, you may need to lift your bump out of the water for the midwife to hear the baby’s heart beat. With an underwater Doppler this will not be necessary.
Ideally you should not enter the pool until you are in established labour. If you enter the pool too soon you may relax too well and stop the labour altogether! If the contractions are strong, however, and you need the pain relief offered by the water, you should get in. It is always helpful to check in advance what the policies are at your local unit, particularly if your partner would like to get in with you.
It is better if you wear nothing in the pool, because a wet T-shirt, when exposed to the air, may leave you feeling cold. It is important that you have plenty of cold drinks available and you should also eat small amounts regularly to prevent running out of energy.