Water birth is more than just giving birth in a water-filled tub. Get the facts about this natural birth experience.

By Bekka Besich

You may think water birth sounds like something out of Creature from the Black Lagoon. Contrary to lingering misconceptions, water birth is not a fad among celebrities or a fringe practice outside the realm of normal birth. It's a birthing option that's in growing demand. "One doesn't have to be a hippie to have a water birth," explains Ami Burns, a Chicago-based childbirth educator and writer and owner of Birth Talk. Water is a common choice when it comes to managing labor.

To be clear, water birthing is different than immersion labor, which involves getting in a tub or shower to ease discomfort during labor but not during delivery. True water births, on the other hand, occur in a warm, water-filled birthing tub, usually at home or in birthing centers, and with the assistance of midwives, rather than hospital-based OBs. Moms who desire a natural childbirth -- no medication, epidurals, or C-sections -- sometimes choose water birth because it can provide "a gentle, natural experience. They find being submerged in a tub provides more comfort during contractions than being 'on land,'" Burns says. The buoyancy of water allows more relief during labor. "For women who are skeptical about water births, I always ask if they have ever taken a hot bath to relieve terrible menstrual cramps. That is usually the aha moment for most of them," says Amber Ford Cottrell, a doula practicing in New York City. Some women even refer to water birth as a "liquid epidural" or an "aquadural." But that doesn't mean it's pain-free. In fact, "labor pains are just as present in the birthing pools as they are anywhere else, but the environment is more relaxing and soothing therefore offering a more pleasurable experience," says David Ghozland, M.D., an ob-gyn practicing in Santa Monica, California.

Choosing a Water Birth Tub

The key to achieving buoyancy, and ideally, pain relief is in the choice of tub. Most birthing tubs are inflatable and similar to a kiddie pool. Their pliable sides are softer than those of a regular bathtub, so they allow women to labor in different positions. Unlike a kiddie pool, however, the tubs are wide and deep enough to fully submerge a pregnant belly and, if desired, a partner as well. Birthing tubs can be rented or purchased on the Internet or through a midwife, and they average $250, with liners and filters. If you don't want to rent or buy a birthing tub, you may use your own home bathtub; just make sure your belly can be fully submerged in water and your midwife has easy access to you to assist with labor.

Choosing Between a Birthing Center, a Hospital, and the Home

Although some hospitals do allow water births, the majority of these births occur at home or at stand-alone birthing centers. Birthing centers are not mini hospitals; typically, a birthing center is an independent facility, though a growing number are affiliated with and often housed inside of or adjacent to traditional hospitals. The centers are equipped with IVs, oxygen, medication, and infant resuscitation equipment, so if need be, emergency care can be started while mother and baby await transport to the hospital. Even though birthing centers are not as common as hospitals, a quick search on the Birthing Center Locator (birthcenters.org) can show which centers are close to you. Delivering at a birthing center is usually less expensive than a hospital because women typically stay for a shorter time and use fewer interventions. The majority of insurance companies cover births in a birthing center, but only some providers cover home births. Check with your insurance provider to understand your birth coverage.

Understanding the Risks and Reality of Water Birth

There is increased risk with water births because the majority of them take place at home, where there may not be immediate medical help. One of the best-known studies on water birth trauma comes from the 1999 British Medical Journal, which found a similar perinatal mortality rate between water births and low-risk conventional births. The American College of Obstetricians and Gynecologists says that "although the absolute risk may be low, planned home birth is associated with a twofold to threefold increased risk of neonatal death when compared with planned hospital birth." But even though steps are taken to avoid these more serious outcomes, and advocates state that underwater birth is safe, Patrick Weix, M.D., Ph.D., an ob-gyn practicing in Irving, Texas, and contributor to the medical website healthtap.com, reveals that there have been "no adequate randomized controlled studies have been done on water births to demonstrate this."

The serious medical risks include pneumonia, the tearing of the umbilical cord, and drowning. "By virtue of the fact that water is utilized, there is a risk for drowning for anyone. However, with proper technique and attention, this risk should be exceedingly low," says Edwin Huang, M.D., an ob-gyn practicing in Cambridge, Massachusetts, and an assistant professor at Harvard Medical School. To prevent pneumonia, the water must maintain the correct temperature, between 95°F and 100°F. Using a trained and licensed midwife -- someone who is experienced in water births and has dealt with the situations mentioned above -- is important in achieving a successful water birth.

It is also important to remember that where there is birth, there are body fluids. During nearly all vaginal deliveries, women have a bowel movement. In a conventional birth, the feces are often wiped off the table by a nurse before the parents even notice. Similarly, if this occurs during a water birth, the midwife scoops out the feces as they enters the water. But with a water birth, it is harder to avoid the messier aspects of childbirth. Birthing in a tub means you will sit in blood, urine, and possibly feces. It is not a sterile environment, and the British Medical Journal study discusses the possible risks of water aspiration and infection for the baby. Once the baby is born underwater, he is immediately placed on the mother's chest to take his first breath. Although babies do not typically breathe until they reach the air, a baby that experiences stress in the birth canal might gasp for air in the tub and possibly inhale contaminated water. If this happens, you and your baby would need to be rushed to the hospital where a pediatrician could take a chest X-ray and blood cultures.

Before You Choose a Water Birth

You must have few to no risk factors in your pregnancy to be a good candidate for water birth. This is designed to prevent any life-threatening complications from occurring in the first place. "High-risk conditions or complications in labor often necessitate continuous fetal monitoring or immediate intervention, which is better accomplished outside of the water," Dr. Huang says. There are certain circumstances in which women should not choose water birth. Marra Francis, M.D., a gynecologist practicing in San Antonio, specifies that women with "Group B Strep positive cultures, gestational diabetes, preeclampsia, macrosomia, intrauterine growth restriction, prematurity, unproven pelvis" should opt out of water birth. Of course, always talk to your health-care provider to understand the full risks and reality of your choices. Water birth is a very personal decision, one that requires much thought and research -- because there's more to water birth than the tub.

Copyright © 2013 Meredith Corporation.

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