Water birth

Question 1

what is the general consensus for women experience of water birth?

Answer 1

generally positive in terms of feeling relaxed, involved in decision making and being more in control (RCM 2012)

Question 2

how is water birth for analgesia?

Answer 2

seen as effective reducing in less need for epidural/spinal for pain relief during labour (cochrane review)

women should not enter the pool within 2 hours after having opioids (NICE)

not compatible with narcotic analgesia but entonox is commonly used alongside

Question 3

is water birth associated with different birth outcomes?

Answer 3

no difference in type of birth, apgar scores, neonatal infection or admission to NNU

no link between neonatal morbidity and mortality and immersion in water

Question 4

what support is there for midwives?

Answer 4

all midwives should have access to training in the use of water for labour and birth and protocols should be in place to support that (rcog/rcm)

Question 5

what is the guidance on the temperature of the pool?

Answer 5

should be monitored hourly to ensure the woman is comfortable and not becoming pyrexial

temp should be
1st stage 34-37 degrees
2nd stage 37-37.5
RCM 2012

no evidence to support the inhalation of water by shock of change in temperature

Question 6

does water birth have any link with the length of labour?

Answer 6

no differences in regard to duration of the second stage, instrumental delivery, c-seaction, perineal trauma

Question 7

what are the contraindications for water birth?

Answer 7

medical conditions- uncontrolled epilepsy or diabetes
prematurity
multiple pregnancy (no evidence to support)
malpresentation
thick meconium or heavy blood loss (baby may gasp if stressed under water and inhale underwater, nutter et al 2014)
hypertensive - water has been found to lower blood pressure, no evidence
IUGR
lack of space in home environment
any risk factors from previous pregnancies
raised BMI (midwife must be up to date with manual lifting and handling training
mobility issues (?SPD)

Question 8

when should women get in the pool?

Answer 8

not before 5cm RCM, there have been reports of slow progress when women get in the pool before this however no evidence.

Question 9

what are the benefits of water birth?

Answer 9

allows you to adopt an upright position which is beneficial for labour

less need analgesia, lower rate of intervention

better chance of perineal trauma and less blood loss (dahlen 2013)