No Epidural? Pain management alternatives and tips – Part 3: Water Therapy, Water Immersion and Water Birth

The use of water during labour is used widely across the world. Apart from delivering and labouring in water, many women find using a bath or shower during labour provides significant comfort and support. Women report that when warm water is targeted where they are feeling contractions or discomfort, such as on their bump or across their lower back, using an electric or power shower is particuarly effective, with that extra water pressure providing both comfort from the warm water as well as the massage-like quality of the increased pressure. Most maternity units have showers or deep baths, whether shared or in a private ensuite, that women have access to during labour. Some units will facilitate having your birthing ball in the shower with you.

Research has shown that while it is unknown if water actually removes pain, warm water can help you relax and many women report it to be a good form of managing pain in labour.

Water Immersion in Labour

Water immersion is where a woman’s abdomen is completely submerged in water, so this would refer to labouring in a deep bath or tub that is larger than the average domestic-sized bath or a purpose-made birth pool.

A Cochrane Review in water in labour and birth published in 2012 showed that water immersion during the first stage of labour significantly reduced the need for epidural or spinal analgesia, without adversely affecting the length of labour, instrumental and C-section delivery rates or neonatal wellbeing. One trial showed that immersion in water during the second stage of labour increased women’s reported satisfaction with their birth experience. The review also found that further research is needed to assess the effect of immersion in water on neonatal and maternal morbidity.  

Advantages of Water Immersion

  • the bouyancy of the water enables you to move more easily than on land
  • water immersion may be associated with improved blood flow to the uterus, less painful contractions and a shorter labour
  • you are less likely to have interventions during labour
  • the ease of mobility may optimise foetal positioning
  • increased maternal satisfaction and sense of control
  • a comfortable temperature reduces blood pressure and promotes relaxation

Disadvantages of Water Immersion

  • as no maternity units in Ireland currently permit water birth, women labouring in water are likely to be asked to leave the water for the second stage (pushing stage) of labour. This also applies in hospital run homebirth schemes
  • care needs to be taken to ensure that the water is neither too hot or too cold. Some sources suggest that the water should be no hotter than 37 degrees centigrade while others suggest that the mother should be encouraged to regulate the temperature of the water to suit themselves
  • caregivers may feel that it is difficult to access the labouring woman when she is in labour although some may argue that it is this reason that leads to less interventions during the birth process
  • Due to the small number of birth pools available in a maternity unit setting, the pool may be in use when you would like to use it
  • Usually, water immersion in a hospital setting is only offered to low risk women

In a 2011 survey, AIMS Ireland asked:

“Do you think women should have access to water for pain relief during labour in Irish maternity units?”
Results: YES = 99.0% – NO = 1.0% – I DON’T KNOW = 0.0%” AIMS Ireland Waterbirth Survey Results (2011)

AND:

“Would you like to have the option of having a waterbirth in a birth pool available to you?”
Results: YES= 91.0% – NO = 5.0% – I DON’T KNOW = 4.0% ” AIMS Ireland Waterbirth Survey Results (2011)

From our 42 weeks gallery

From our 42 weeks gallery

Accessing Water for use in labour in Ireland

* Only a handful of maternity units in Ireland have birthing pools, namely The Coombe, Cork University Maternity Hospital, the Our Lady of Lourdes MLU and the Cavan MLU. There is a birth pool in Waterford Regional Hospital which hasn’t opened to date. Some have access to deep baths, while others only have showers.

* If you are having a homebirth, you will need to source an inflatable birth pool. These are available new or second hand from mothers selling them on. You may even be able to borrow one!

* You may wish to purchase or borrow a birth pool to labour in at home – even if you are having a hospital birth! Many mums contacting AIMS Ireland have found this an effective way to stay at home as long as possible and avoid routine intervention including medical pain relief!

What Women Say:

Would have much preferred to stay in water for at least the full labour if not for the birth. I feel that I wouldn’t have used an epidural had I been able to stay in the water.

AND:

On first an amazing foreign midwife suggested I use it – I was in early labour on an OP baby. The minute I got in the water I felt more relaxed and in control. Spent ages in the bath and it was fantastic! Unfortunately I got out later and lost the bath – found it a huge difference without the water. When the bath did become available again my new midwife wasn’t keen and I didn’t think to make an issue of it – her being the professional and all. Felt much more intense and out of control without it.

AND:

I laboured in a bath in a Dublin maternity hospital. I was progressing very well and found it very difficult to get out when I felt I had to.

AND:

I used the shower for hours during my first labour. I hated coming out of it for checks

Waterbirth

As mentioned above, despite 92% of respondents to the AIMS Ireland survey thinking women should have access to waterbirth in Irish maternity units, it is NOT an option available in ANY of Ireland’s maternity units. If you use the pool/bath or shower for labour, you will be asked to come out for the birth of your baby.

Although hospital-based home birth schemes also do not allow delivery in water, waterbirth can be facilitated at births at home with a self-employed community midwife, however, some midwives choose not to attend women who birth in the water.

If you would like a waterbirth, be sure to speak to your Health Care Providers about your options.

What women say:

I feel it is such a shame that my local hospital has a birthing pool but we are not allowed to give birth in it. I am aware a baby died during a waterbirth years ago. Does this mean that there cannot be another waterbirth in an Irish hospital for all eternity ? I am pregnanrt with my third and last baby so a waterbirth option is now gone for me

And:

I cannot understand why waterbirths are not an options in all maternity units. It cannot be because of a tragedy of a baby dying after being born surely, because these tragedies happen all the time regardless of where and how babies are born

References:

AIMS Ireland Waterbirth Survey 2011

Cochrane Review: Immersion in water in labour and birth

RCOG and RCM Joint Statement on Water During Labour and Birth

Related articles:

No Epidural? Pain management alternatives and tips – Part 1

No Epidural? Pain management alternatives and tips – Part 2: TENS Machine

No Epidural? Pain management alternatives and tips – Part 4: Using a Doula

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3 thoughts on “No Epidural? Pain management alternatives and tips – Part 3: Water Therapy, Water Immersion and Water Birth

  1. Pingback: No Epidural? Pain management alternatives and tips – Part 1 | 42 weeks

  2. Pingback: No Epidural? Pain management alternatives and tips – Part 2: TENS Machine | 42 weeks

  3. Pingback: No Epidural? Pain management alternatives and tips – Part 4: Using a Doula | 42 weeks

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