Associate Professor Steve Robson explains safety concerns surrounding labour and birth in water.
Some women find comfort and relief by spending time in a shower, warm bath or birthing pool during their labour. Some (but not all) studies of water immersion have shown water can help provide relaxation and reduce the use of epidural anaesthesia, with some women rating the pain of labour as less severe when immersed in water. However, actually delivering the baby while in water is a different and more contentious matter.
Labouring In Water
When women ask about the safety of immersion in warm water during labour, it is difficult to provide exact answers. Issues that concern obstetricians relate to safety and ensuring the best possible outcome for mother and baby. There is cautious agreement that for healthy women with uncomplicated pregnancies, serious complications from spending time in a warm bath seem to be uncommon, provided care is taken with infection-control procedures and close attention paid to the selection of the women allowed to do so during labour (protocols for allowing labouring in water differ between institutions).
Water immersion is safest for women with a single baby (not twins); with no complications or risk factors; where the amniotic fluid does not have meconium staining, a complication where a foetus has its first bowel movement while in utero; and where there are no risks or concerns that require the baby's heartbeat to be monitored continuously during labour.
Another very important consideration is the size and weight of the woman. For example, it can be extremely difficult to remove a 100kg woman from a bath in an emergency situation, for example if the woman collapses. It is absolutely critical there are failsafe ways of ensuring a woman can be removed quickly and safely from a bath in an emergency. Also, a water birth may be unwise if the woman is exhausted (which may happen when a labour has been abnormally prolonged) or when the woman needs other pain relief, such as pethidine.
Water immersion is safest when the team providing care, such as midwives, obstetricians and paediatricians, work well collaboratively. It is also important that any birth service or hospital unit planning to have water immersion keeps careful records so accurate information can be provided to women. It is critical any woman wanting a water-immersion labour ensures that the unit she chooses has such an audit, and can provide accurate information to her.
Giving Birth In The Water
Actually delivering a baby underwater may be planned, or an 'accident' while a woman is using a bath for relaxation and pain relief in labour.
There have been reports of serious consequences for the baby when attempts are made to deliver in water. These include drowning, near-drowning, breathing problems, pulling the cord off the baby and infections from the bathwater. There are also some severe and unexpected complications that can occur in labour, which are impossible to treat when the woman is in a bath. For these reasons, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists does not support the practice of trying to deliver a baby in a bath or birthing pool.
Making An Informed Decision
Women interested in water immersion during labour should make an informed choice and clearly understand that information about safety is still lacking. Units offering such facilities should have a collaborative environment between midwives, obstetricians and paediatricians, and appropriate and up-to-date training. They should have the highest standards of hygiene, and measures in place to swiftly and safely deal with emergencies. Such units should be able to provide accurate information about the numbers of births in their unit and the outcomes of those births.
Associate Professor Steve Robson is vice-president of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists and a practising obstetrician.