Using a Bathtub for a Home Water Birth

During a water birth, a person delivers their baby while submerged in warm water. Many prefer laboring and even giving birth in water since buoyancy can reduce labor pain. In fact, according to the American College of Obstetricians and Gynecologists (ACOG), water immersion may be associated with shorter labor and decreased need for spinal and epidural analgesia when used in early labor.

This natural method of pain relief is typically available in a stand-alone birthing center or at home, says Marra Francis, M.D., a gynecologist practicing in San Antonio and the former chair of the OB-GYN department at Memorial Hermann Hospital. Home births tend to be more comfortable, but they require you to have a safe and acceptable birthing tub.

Wherever you give birth, and whatever kind of tub you choose, they need to meet certain safety measures for size, accessibility, cleanliness, and water temperature.

Sure, you can shell out $250 for an inflatable birthing tub online. You can also ask your midwife about a birthing tub rental. But did you know that home bathtubs are often an acceptable alternative?

Read on to learn about guidelines for using your home tub for a water birth and some alternatives if your tub doesn't fit the bill.

Guidelines for a Home Birth Tub

If you want to use your bathtub for labor or birth, there are some things to keep in mind. Size, accessibility, cleanliness, water temperature, and knowing the risks and benefits are all things to consider as you evaluate whether your bathtub is adequate for the job.

The tub should be the right size

Most birthing tub rentals are about 2 feet deep, inflatable like a kiddie pool, and made with soft sides. Although your bathtub doesn't have pliable siding, it's about the same depth, which works well for a water birth. (Even better if your home has a bigger Jacuzzi-sized tub!)

Give your tub a test run to ensure you and your partner (if you choose to have them accompany you in the tub) fit comfortably. The most important thing is that your belly can be fully submerged; this increases buoyancy, alleviating some of the labor pain and pressure.

The tub should be safe and accessible

While your bathtub doesn't need to be a certain shape, you do need to think about accessibility. Sharon Mikol, M.D., an OB-GYN practicing in Cleveland, says that most home bathrooms are not made to accommodate the number of people that might be needed to get you out of the tub quickly if you need assistance. In addition, most bathtubs are not positioned in such a way that someone could get on either side to help you out of the tub.

If you're using a home tub in a confined space with limited access, speak with your midwife about your options in case of an emergency, and plan what you'll do if something goes awry. Asking a full-term pregnant person in the throes of labor to get up and out of the bathtub alone without slipping and falling is not reasonable or safe, Dr. Mikol warns.

The tub should be properly cleaned

Take a cue from birthing tubs in hospitals, which are clean, sterile, and sanitized. Before the water birth, clean the tub with a non-abrasive cleaner, such as Comet or Lysol. Then use a 10% bleach and water mixture (one part bleach for every nine parts water). A good amount to start with is 1/4 cup of bleach and 2 1/4 cups of water. Rinse thoroughly. You'll want to bleach the tub again after you deliver.

Some state health departments provide guidance on cleaning pools and tubs for water birth. For example, the Arizona Department of Health Services recommends against in-home bathtubs with jets because the jets can harbor bacteria that can't adequately be cleaned. Before using a home bath, the tub should be cleaned and disinfected. They also recommend using a pool liner for added safety.

The water should be the right temperature

It's vital to keep the tub water at the correct temperature. The American College of Nurse-Midwives (ACNM) recommends keeping water temperature between 95 and 99 degrees F. Maintain the temperature by using floating thermometers available for baby bathtubs; if it starts to cool, add warm water to keep the temperature stable.

Warm water is necessary for a birthing tub since cold temperatures can be detrimental to a newborn. "Newborns lack the ability to regulate their body temperature in the first moments of life," Dr. Mikol says. She adds that if the baby is born and placed in water that is not warm enough, their body temperature will lower, which can be dangerous and life-threatening.

"Babies with low body temperature cannot shiver to get warm as adults do, and it can predispose them to breathing problems, increase their risk of infection, and decrease their oxygenation," Dr. Mikol says.

On the other hand, water that's too warm can burn your skin or the baby's skin. It also can cause your blood vessels to dilate, leading to a lack of blood flow to your head. If that happens, you might get dizzy or feel sick, Dr. Mikol says.

You should know the risks

According to ACNM, possible risks of water birth include:

• You or your baby getting too hot
• A baby could aspirate water into their lungs (this is rare)
• Umbilical cord tearing

If a fetus gets too hot during labor, it can affect their heart rate. If you get too hot, you may not feel well. Keeping water at the right temperature can help you avoid these problems.

Babies don't typically breathe in water immediately after birth. But if they're left under the water for too long or resubmerged after they've come out of the water and taken a breath, this risk is greater. Pulling your baby directly up and out of the water when they are born can reduce this risk.

An umbilical cord may tear if it's short and your baby is pulled up too quickly. This can cause hemorrhaging, a medical emergency that requires a blood transfusion. This is especially risky in a home birth setting and requires an emergency hospital transfer. Your health care provider can prevent this by checking the cord length before pulling the baby up.

What You Need for a Home Water Birth

You don't need much more than a birthing tub and water, but there are a few things that will make the process easier and perhaps more comfortable:

• Towels (preferably old) to soak up water spills and to keep you and your baby warm
• Mat to catch water outside the tub and prevent slipping
• Bucket to hold towels or additional warm water
• Labor or delivery gown to change into after birth
• A debris net or colander to scoop out any matter from the pool
• Gloves to clean the tub
• Plastic drop sheets to protect the floor
• Baby hat to keep the baby warm after birth
• Floating thermometer to monitor temperature

Another thing to keep in mind is timing. It's important not to get into the tub too soon—Dr. Mikol recommends waiting until active labor or even pushing. "Getting in the tub in early labor can feel comfy, but it can also slow the process down and stall things," she states.

Alternative Birthing Tub Options

If you decide not to use your bathtub, your midwife can help you find a company that offers birthing tubs. You can also buy an inflatable birth pool that can be used for multiple births; these usually cost around $250 with liners and filters.

An inflatable pool can also be cozier than a home tub because the sides are softer, making it easier for you to change positions during labor. Your midwife might have a birthing tub rental option if you don't want to keep the tub.