The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA
Midwives have long been the guardians of normal physiologic birth, recognizing that labor often does not progress as efficiently and safely
when interrupted by routine procedures or unnecessary interventions.
Waterbirth International desperately needs Your financial support.!
The best way to donate is to send a check to Waterbirth
PO Box 1400 Wilsonville, OR 97070 USA
or Donate online today so they can continue to advocate for safe, gentle birth for mothers and babies everywhere.
~DONATE any amount you can
~Become a MEMBER of Waterbirth International
~Buy a birth pool for your local midwives
~Buy a birth pool for yourself
~Buy a birth video and donate it to your local library
THANK YOU! from all those lucky waterbirth moms and babies,
past, present and future.
Waterbirth Mirror - Major Innovation!
The 'Howes Birth Mirror' is a new design by midwife Virginia Howes that provides the visibility you need without the hazards of glass or the sterilization challenges of plastic mirrors.
this program from Tributaries Radio
"Waterbirth International wants to hear from mothers and fathers who have chosen this gentle, peaceful way to give birth. List your babies' birthdates and their first name on our "I WAS BORN IN WATER" page.
You don't have to list your baby's full name, so there's no
invasion of privacy.
Waterbirth Database - For the first time, an opportunity for midwives and doctors world-wide to collaborate to collect consistent data, and contribute to the evidence concerning water immersion during labour and birth.
This site also offers the Waterbirth
Guidelines - an evidence-based set of practical guidelines
for midwives on using water in labour and birth, as well as many
other resources. A must-read for midwives attending
WARNING!!! If you have Aetna health insurance, you may want to change at the next opportunity, when your employer has their annual "open enrollment". Aetna doesn't cover homebirth, citing a single study based in rural Australia which shows that high-risk births far away from a hospital are high risk. They further cite the policies of the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists, both business competitors to homebirth providers. Their policy statement ignores a mountain of evidence that homebirth is as safe as or safer than hospital birth for normal, healthy pregnancies.. If their policymakers have any integrity, this logic will soon lead to cessation of coverage for planned VBAC's . . . there's no dearth of studies and AAP and ACOG policies proclaiming the danger of VBAC's . . . and then they'll stop coverage for any woman who declines standard ACOG/AAP recommendations regarding routine ultrasound, routine induction, routine IV's, routine use of continuous electronic fetal monitoring, routine administration of antibiotics for all GBS positive women (up to 40% of birthing women), and prompt cesareans for any woman who fails to progress in a timely fashion during labor and pushing. They may also stop coverage for children who are not vaccinated according to the full schedule of vaccinations recommended by the AAP, even though many intelligent parents decline the newborn hepatitis B vaccine and practice selective vaccination according to their child's own needs.
If this is troubling to you, as it should be, let them know. You can easily send e-mail to Aetna's National Media Relations Contacts and simply tell them that they should not be in the business of denying coverage for reasonable healthcare choices, such as homebirth, waterbirth and VBAC. They will especially want to know if you are choosing another healthcare provider because of this unreasonable policy. You might also suggest that they expand their research beyond ACOG and AAP recommendations. They could start at: http:
Using Water for Labour and Birth - why people use birthing pools - excellent YouTube video featuring Amy Maclean, childbirth educator.
Wow! She really does a great job of explaining all this!
The only point she missed is that the increased warmth around the
belly increases the blood flow to the uterus and so increases
oxygentation of the baby during labor. And I think it's
always important to note that women can labor in the tub and then
get out for the final pushes if she doesn't want to have a
waterbirth. Great video!
Water (click on the video icon on the left bottom) - lovely
tribute to waterbirth. [Notice how erect the nipples
are! This is a key sign to help you distinguish between the
"real" contractions of active labor, where the oxytocin levels
cause nipples to become erect.]
YouTube.com has some waterbirth and homebirth and unassisted birth videos.
birth - a nice one from an Australian doula -
although this may look like an unassisted birth, there was a
midwife providing hands-poised care.
Baby Born Underwater in the Sac - YouTube video
Here's a great whale
birth. Note that in the absence of the natural whale
midwives, they had aquarium staff to make sure baby made it to the
surface for that first breath!
These organizations are focused on waterbirth:
Waterbirth International -
host of the International Waterbirth Conferences (Barbara Harper's
Web page). They have a large set of resources,
including articles and protocols. Barbara is available to
come to your facility to present a workshop
Waterbirth International also maintains a practitioner referral directory.
And they have a collection of waterbirth birth stories.
Notes from the Gentle Birth World Congress, 2007, in Portland, Oregon
The Waterbirth Website
(Karil Daniels' site, including information Learn About
Waterbirth, The Benefits of
Water for Labor and/or Birth, How to
Prepare for a Joyous Waterbirth, and her video, "WATER
BABY: Experiences of Water Birth")
See also: Responses to Waterbirth
Discussion - http:
Google group started by Barbara Harper to get around the Spam
problem on the Yahoo! group at http:
Power of Water, by Sarah J. Buckley, MD
- Excellent Patient Education from Kent Midwifery Practice in the
UK (Kay Hardie and Virginia Howes)
Being is available from the dealingwithgravity.com
web site. In 1982 - 89 Elena Tonetti was one of the leaders
of the "conscious birth" movement in Russia. She worked
closely with Igor Charkovsky, organizing birth camps at the Black
Sea where babies were delivered with wild dolphins. Elena is now
in the Marin area, offering workshops for birth trauma
release. This is a fabulous video!
Alternatives [unavailable as of 2/05, but here's a copy of
an article - What
A Gentle Birthing Experience?]
Birth Balance - A
Resource Dedicated to Integrating Balance and Birth Since 1987
Rental FAQ from 9 Months & Beyond
- Labour and birth in water - About waterbirth in Holland -
"Most Dutch midwives will be glad to help you have a natural birth
Waterbirth/Tub Insurance Coverage
"With Child Retreat" A watery weekend retreat for pregnant couples in Florida with Waterbirth midwife pioneer Marina Alzugaray. Experience paradise and learn about Gentle births, Waterbirths, and AquaNatal prenatal water exercises in the beautiful tropical waters of the Florida Keys. This is a retreat for couples who love water, the ocean and want to treat themselves to a magical weekend during their pregnancy.
Contact Marina Alzugaray of
the CoMadres Institute for more information.
Waterbirth section from Sheila Kitzinger's site.
BIRTH EXPERIENCE from another Sheila
waterbirth from babymoon birthpools in the UK
from the HomeBirth Association
- Water Birth - from Motherstuff
Babies - Your Waterbirth Resource on the Web
Under Water Child Birth - The Miracle of Water Babies - from "The Marnie Ko Collection" on Nurturing Online
Birth Resources - at Robin Elise Weiss' pages at The
BirthWaves - Your
resource for home and water birth information and products
Labor Reduce Pain, Don't Cause Infection
Waterbirth Figures Prominently in Nice
Summary of Comfort Measures w/Focus on Avoiding Drugs
increase when water tubs offered (UK, Mar., 2009)
EDLICH, R (and others) Bioengineering principles of hydrotherapy
JBCR 8(6):580-584, 1987
DONIEC-ULMAN, I (and others) Water Immersion-induced endocrine alterations in women with EPH Gestosis Clin. Nephrol. 28(2):51-55, 1987
Report by Michael Rosenthal in "THE FEMALE PATIENT/vol.16/August
1991. [pg40]Warm-Water Immersion in Labor and Birth"....This
article also includes their statistics for approximately 1400
women who labored in the water, and 679 births occurring in the
tub. Super article!!!!
Water Birth: One Birthing Center's Observations by Linda Church
in Journal Of Nurse-Midwifery Vol.34, No $. July/August 1989 and
Jet Hydrotherapy for Labor and Postpartum Pain Relief by Kathleen
Aderhold and Leslie Perry in MCN (Matrnal Child Nursing?) Vol 16,
March/April 1991 Report of experiences at St. Lukes Hospital,
Waterbirth Increases Safety of Breech
There is a doctor in Ostend, Belgium who is experienced assisting
delivery of both breech
twins in water.
This article contains a level of anxiety about birth that is unsettling. However, evaluated as an obstetrical document, it has a relatively non-interventive attitude.
Trust discusses the pros and cons of waterbirth.
I'd like to find out about how people on this list view
waterbirth. I have been hearing from lots of other women lately,
and the same phrase keeps coming up. When I ask moms & birth
care providers what they think of it, many say "I'd never want to
have a baby any other way!"
I've been doing waterbirths since I started doing homebirths over a year ago - probably 50% of my clients now use the pool during labor, and most stay in the pool for birth. All who have birthed in water say that they wouldn't want to do it any other way. Those who have had previous babies out of water inevitably find waterbirth much more comfortable. I haven't had any client who felt otherwise, or who wouldn't do it again.
I enjoy waterbirths, but do find that the babies' lungs sound "wetter" than babies born out of water. This sometimes keeps their color from pinking up as fast, and tone is a bit diminished. However, this seems to have no detrimental effects - it's just different. Once the waterbabies nurse, their lungs clear up rapidly. They are much more relaxed, as a group, than babies born out of the water.
The pool we use is a 60" x 22" inflatable kids pool - works
great, and very portable.
I am an Italian obstetrician and I have experienced with some midwives water birth in a small public hospital on the hills of Florence-Italy. We had about 600 deliveries a year and we had alternative obstetrics and also water birth in a small room at the second floor of the hospital. Three months ago administrators and politicians (even women) decided to close this hospital: to rationalize sanity in the city of Florence???
Any way water is the most wonderful element where to stay during
labor. It does relax wonderfully (have you ever had a warm bath
after a heavy and tiring day, may be even without sleeping since
the night before?). It does reduce pain. Many urologist suggest a
warm bath when a patient has terrible pain for a stone in the
ureter that wants to come out (urinary colic).Water pushes you up
so you feel very much relived. The warm water creates a relaxing
atmosphere for the woman and for every body who is there. We have
considered the water another possibility for the woman during
labor. She can sit , walk, lay down, be hold by her partner, or
stay in the pool with water. We had to fight hardly against other
doctors, some midwives, administrators, politicians, architects
(the water is heavy at the second floor). We wanted this pool
against the general tendency to generalize epidural during labor.
The water is very good against pain and with no problem. Even if
rarely we used epidural if it was necessary for the woman. Some
women spent a short or a long time in the pool and then they
decided that they felt much better and decided to come out and
walk or sit or whatever they wanted to do. But sometimes they
decided to stay in the water and deliver the baby there. Water
birth is a wonderful experience. Nothing happens to the child if
you do not stimulate him. The baby starts breathing movements only
if you stimulate touching, especially if you panic. Otherwise the
baby starts breathing only for the change of temperature from the
water to the air. Of course there is no need to keep the baby
under water afterwards. Of course sometimes it is necessary to
assist the birth but that is not a problem. Our pool was blue and
made by an artisan that makes boats with resin and the design was
made by the midwives.
In addition to all the other benefits of waterbirth, it seems
also to reduce postpartum perineal pain; this is in keeping with
Chinese medicine theory that heat applied to the perineum after
birth helps with healing.
embrace the gentle option of water birth
by Darlene Pfister, Star Tribune
Published Oct 1, 2002
A continuation of the work of Igor TYcharkovsky in water research and exploration with babies water and dolphins.
Basia Barbara Szpak DEC,LMT
1814 RH, Alkmaar, NL
tel/fax: 31 (0)72 540-1920
My practice is geared around waterbirth as the cornerstone to support particular values in my practice. There seems to be three main feelings about waterbirth among practitioners. Love it, it's an option, and not really comfortable with it. As would follow, midwives that are "into" waterbirth have a vastly higher rate of waterbirths.
My prenatals last approx. 2 to 2 1/2 hrs. for firsts time
clients, not just first time parents. I prefer my clients to NOT
take "prenatal classes" because they are ultimately geared to an
institutional based paradigm of birthing behavior rather than of
an undisturbed spiritual or ritual nature.
It ALWAYS goes back to empowerment and waterbirth, and not just facts about waterbirth .
"Transition" as described in childbirth classes does not exist in homebirth as we practice it. The hall marks of transition with the the "Third Emotional Sign Post: Self Doubt" as labeled by Bradley just don't exist at home. "Transition" happens in a hospital because the staff starts to change their behavior, i.e.. flipping on the warmer, rolling in the instrument table, more staff in and out as they perceive the intensity in her labor. This activity registers in the brain as danger to the birthing environment causing distress to the laboring woman. As well, most childbirth education classes are very outdated in presenting that somehow a woman is in a place of self doubt because she is not able to verbalize what she wants or needs. Rather the model should be constructed that she is in the deepest part of her work. Are men in a place of self doubt because if you were to ask whether they want chicken or fish for dinner in the most intense moments before they orgasm during sex they might fumble for an answer? So I feel like we are teaching a whole lot of women that when they are in the deep mystical night so to speak of their labor, they are in the land of self doubt. How utterly disempowering!" Transition" has become a buzz word that I have to de-program out of my clients birth view.
So that brings us back to the tub.... it becomes the sacred ritual circle where a woman can go to be in that intense dark night of her labor protected from even me. Water becomes, in my practice, not just a medium but a psychic location if you will. I encourage my women to decorate the tub with prayers or mantras and during the set up of the tub, and usually again in early labor if I am there, I tell many of the names of the children who were born in the tub, and that I have never transported a baby that was born in that tub, which is wonderfully true.
So really in the wonderful way of things, my clients chose me because of my emphasis of waterbirth, but soon discover that waterbirth is much more than simply giving birth in the water, it is the underpinnings of a birth experience that values the strength and empowerment of the family as well as the spiritual and ritual nature of birth.
Studies show neonatal GBS colonization is lower in babies born in water; one might guess that this applies to other infections as well. In fact, research does show that overall infection rates are lower in waterbirth babies.
How hard is it to control a baby's temperature in a tub that's 100 degrees? It's way easier than in a room that's 60 degrees!
Greater risk of umbilical cord damage than dropping the baby on the floor? I don't think so.
Breathing problems from inhaling water? Babies are BORN through amniotic fluid, and nobody seems to worry that they're going to inhale that. In fact, we know that sometimes they do, and the only problem is if there's meconium in it. Yes, I know there are significant differences in the content of amniotic fluid and tap water, but they're propagating the fear of fluid, in and of itself.
From the waterbirth study done in the UK: "There were five perinatal deaths among the 4029 babies born in water in England and Wales, giving a perinatal mortality of 1.2 per 1000 live births (95% CI 0.4-2.9). This compares with a perinatal mortality of 1.4 (95% CI 0.7-2.3) for a comparable group of low-risk primiparous women having a conventional birth (relative risk 0.9; 95% CI 0.2-3.6). "
And I'll point out that even though they don't like having the birth in water, they speak well of providing facilities for women to labor in water. So why don't we see this in more hospitals?
In fact, I would argue that laboring in a warm tub (100 degrees)
actually *IS* good for the baby in that it increases the blood
supply to the uterus, thus increasing baby's oxygenation.
Some people are concerned that the baby might inhale water; this
concern is easily addressed. When a baby's head is
born underwater, you can look at their face to see if they're
unconscious, gasping or with a normal facial expression. (When a
mom's on hands and knees, you get a really great view, and you can
use a mirror for other positions.) With the chest compressed in
the pelvis, baby can't take a breath until the chest is out. If
you're not confident about the expression on the baby's face, you
can get the mom standing before the baby's chest comes out, thus
avoiding any possibility of inhalation of tub water.
Personally, I find that there is a lot of extra work for everyone in planning a waterbirth. And it's a lot harder on my back, and I sometimes get soaked. I am also theoretically exposed to more pathogens. However, I rarely see any decelerations when mom is in the tub, for whatever reason. I think the buoyancy helps prevent cord compression, and the warmth increases oxygenation. So I actually feel that waterbirth is safer for the babies.
I have a small volume practice, but I've attended about 100 waterbirths. None of the babies born underwater has needed transport for respiratory issues.
Babies born out of water are three times more likely to develop early onset GBS than babies born under water, and this is among women who were screened as GBS negative. For homebirth midwives who don't screen their clients for GBS or who have GBS positive clients who decline antibiotics, then waterbirth is significantly protective.
The numbers here were quite small, as in 1 out of 1500 babies. But it does mean that a baby with respiratory issues is more likely to be incubating a GBS infection if they were born out of water than if they were born under water.
So I'd be more vigilant about a baby born out of water than a baby born under water.
Is there really that much difference between a rigid-sided
birthing pool and the kiddie pools or paddling pools?
Kiddie Pools Don't Work - You can find comparative photos of
a Gentle Birth Pool and a 22-inch high kiddie pool at -
www.waterbirth.org (The GBPool is exactly like the AquaDoula
in size and similar construction.)
This is written by Barbara Harper, Director and Founder, Waterbirth International
"Having started the first waterbirth pool rental service in this country, we tried every pool available before creating our current pools. The photos on our site tell you everything. I am not telling women they can't have waterbirths in kiddie pools - they do and it happens every day. But from a physiology stand point alone - they have missed one of the biggest benefits of water labor - buoyancy.
"Janet Balaskas of the Active Birth Center, Jayn Lee-Miller who created SplashDown Waterbirth Pools in 1989, Michel Odent, and myself are creating a paper statement telling the facts about how disappointing the experience is with kiddie pools or paddling pools as they are called in the UK.
"I know many women will have their own opinions about this and my purpose is not to "sell" pools - we give free rentals to women every single month - but to have women understand the true benefits of immersion and what we fought hard and long to win over the past 25 years.
"Please have a look at our website and decide for yourself.
As a midwife for the past 20 years, also, I have attended births
in kiddie pools, horse troughs, swimming pools and lots of Gentle
Birth Pools and I would prefer over and over our Gentle Birth Pool
or a horse trough - not a kiddie pool."
Barbara Harper's web pages have an excellent collection of Articles/Protocols.
Neonatal GBS colonization is lower in babies born in water.
B streptococcus colonization in water births.
Zanetti-Dällenbach RA, Holzgreve W, Hösli I.
Int J Gynaecol Obstet. 2007 Jul;98(1):54-5. Epub 2007 May 1.
It - Athletes, and patients, know that overheating hurts a
body’s performance. A new device, called at various times
the RTX, Core Control or simply The Glove, cools the body's core
so that blood isn't diverted from the muscles to the surface for
cooling. Mammals have specialized blood vessels in their palms and
other hairless skin surfaces—ears, nose, cheeks and soles of the
feet—that are designed to dissipate heat. (Maybe this is why
a cool cloth on the face and forehead feels so good during
pushing!) Heller and Grahn theorize that more blood, and
thus, oxygen, is available to the muscles when the body doesn’t
have to route extra blood to the radiators for cooling.
Cooling allows an athlete to recover from intense exertion
quickly, allowing someone to do more work in a shorter period of
time. They now believe that the reason why pushing IV fluids
can help with exhaustion isn't the minerals or the rehydrating,
but rather the invasive cooling; they had noticed that if the IVs
were kept on ice, they worked better.
Immersion in water in pregnancy, labour and birth (Cochrane Review)
The Cochrane Collaboration is an international committee of specialty-specific physicians who evaluate all known research in their area. They conclude:
"Evidence suggests that water immersion during the first stage of
labour reduces the use of epidural/spinal analgesia. There is
limited information for other outcomes related to water use during
the first and second stages of labour, due to intervention and
outcome variability. There is no evidence of increased adverse
effects to the fetus/neonate or woman from labouring in water or
Try doing a search on "Related Articles" for some of these
citations to get the newest studies!
births 'ease slow labours - 26 January, 2004 - BMJ article
discusses benefits of the "birthing pool".
trial of labouring in water compared with standard of
augmentation for management of dystocia in first stage of
Cluett ER, Pickering RM, Getliffe K, St George Saunders NJ.
BMJ. 2004 Feb 7;328(7435):314. Epub 2004 Jan 26.
CONCLUSIONS: Labouring in water under midwifery care may be an option for slow progress in labour, reducing the need for obstetric intervention, and offering an alternative pain management strategy.
Study Shows Benefits of Underwater Birth By Hannah Cleaver
BERLIN (Reuters Health) Jan 22, 2003 - Giving birth in water should no longer be considered an "alternative" method restricted to specialist centres, according to European researchers who evaluated the outcome of more than 1500 births.
Drs. Albin Thni and Konrad Mussner, from the regional hospital in Sterzing in the South Tyrol region of northern Italy, compared data from 969 water births, 515 births in bed and 172 using a birthing stool.
After removing complicated births that required vacuum extraction, other manual help or epidural anaesthetic, the results show a clear advantage for water births, they report in the December issue of the German-language journal Geburtshilfe und Frauenheilkunde (Obstetrics and Gynaecology).
"Our results suggest that water birth is associated with a significantly shorter first stage of labour, a lower episiotomy rate, fewer perineal lacerations and reduced analgesic requirements compared with other delivery positions. Water birth appears to be safe for the mother and the foetus-neonate if candidates are selected appropriately," they write.
Average duration of first-stage labour was 381 minutes for women in water compared with 473 minutes for those using the other delivery methods. There was no difference in the duration of the second stage of labour.
The rate of episiotomy was significantly lower when the women were in water (0.52%) compared with 17.2% of those in traditional beds and 7.6% on stools.
Water births were not associated with an increase in perineal tears, which remained at 23% in all groups.
Of women having their first child, 58% experienced no lacerations during a water birth compared with 36% of those on traditional beds and 48% of those on a stool. None of the women giving birth in a pool needed analgesics.
Other factors examined included arterial cord blood pH, and maternal haemoglobin levels at baseline and postpartum. No differences among the three groups were found.
The researchers report that much criticism of water births has been based on ideas that are no longer valid, such as that the child might aspirate water and drown.
This can be ruled out, they wrote, as the reflex to breathe air is only activated once the child's head comes into contact with air.
"We believe that the water birth will lose its 'outsider' status and will, in the next few years, will take up a fixed place in obstetrics. It leads to minimal intervention and is a woman-friendly method and thus results in higher satisfaction of the mother," they conclude.
Geburtshilfe und Frauenheilkunde 2002;62:977.
comparative study. A prospective study on more than 2,000
Geissbuhler V, Eberhard J.
Fetal Diagn Ther 2000 Sep-Oct;15(5):291-300
CONCLUSION: Waterbirths and other alternative forms of birthing such as Maia-birthing stool do not demonstrate higher birth risks for the mother or the child than bedbirths if the same medical criteria are used in the monitoring as well as in the management of birth.
intrapartum hydrotherapy on labour related parameters.
Aird IA, Luckas MJ, Buckett WM, Bousfield P
Aust N Z J Obstet Gynaecol 1997 May;37(2):137-42
The results showed that nulliparas [first-time mothers] who used the birthing pool had significantly reduced operative delivery rates, a shorter second stage of labour, reduced analgesic requirements and a lower incidence of perineal trauma. In multiparas [repeat birthers] there were significant reductions in analgesic requirements.
and morbidity among babies delivered in water: surveillance
study and postal survey. [Medline
Gilbert RE, Tookey PA
BMJ 1999 Aug 21;319(7208):483-7
"The risk of perinatal mortality for babies delivered in water is similar to the risk for babies born by normal vaginal delivery to women at low risk of adverse outcome"
The above article references a single case of a baby born with "waterlogged lungs". I am wondering how they knew the water was from the birth tub rather than amniotic fluid? Many babies are born with amniotic fluid in the lungs; clearing this is a normal part of respiratory initiation and happens uneventfully in a healthy newborn.
What the research says about waterbirth from the UK
They address the issue of babies who "drowned" or died from
waterlogged lungs: "Although there have been one or two
reports of babies who have died of waterlogged lungs, this seems
to have been because they were kept underwater for a long time
after birth, rather than being brought to the surface immediately.
For an excellent collection of research about pain relief provided by laboring in water, follow the "Related Articles" link from this abstract.
In 1987, women in a Copenhagen hospital were offered the choice
of taking a warm bath in their first stage of labour. Over
half the women accepted the offer and found that they dilated at
twice the rate of women who stayed dry.
[Warm tub bath during delivery.
Lenstrup C, Schantz A, Berget A, Feder E, Roseno H, Hertel J
Acta Obstet Gynecol Scand 1987;66(8):709-12 ]
Harper and Odent both offer an enormous amount of experience with waterbirth from all over the world. Odent is meticulous in his physiologic explanation of the initial breath, and they both offer research as well. Please read this stuff before you set your head on this option (birth in the water). It has proven to be extremely safe and is a wonderful choice to have available.
Lancet 1983 Dec 24-31;2(8365-66):1476-7
Unfortunately, even the abstract is not available online.
and the exposure to HIV]. [Article in German]
Colombo C, Pei P, Jost J
Pflege 2000 Jun;13(3):152-9
Because of the diluting effect of the poolwater, we estimate the potential risk for a HIV-exposure to intact skin as minimal and, therefore a potential HIV-infection as "low level" and to be unlikely. However, a risk for nosocomial HBV-infection is significantly
Enning Modified APGAR- Scoring for
Babies Born in Water
Pretty cool huh?? Now you have babies in the 9 & 10 range
again instead of 6 or 7.
I bought "A Clear Road to Birth", "Birth into Being: The Russian Waterbirth Experience", "Waterborn", and "Birth Joy and Raspberry Leaves" from this website. My favorites are "Birth into Being" and "Waterborn". "A Clear Road to Birth" shows a few empowering births. The "Birth Joy" video footage is quite poor, but it's still good to see.
I bought "Born in Water: A Sacred Journey" from this website, the Andaluz Waterbirth Center. Seven wonderful births! This is another of my favorites. This video helped empower me a great deal! As I watched these women confidently give birth, the feeling that "I can do this!" grew and grew inside me.
This webpage is where you can order the wonderful "Waterbaby: Experiences of Waterbirth". I don't own this one but was fortunate enough to be able to borrow it from another home/waterbirthing mom in my area. I watched it by myself and then watched it again with my husband when he came home. I would have watched it again, but I had to return it that same day I got it. I rank this one right up with "Birth into Being". This "Waterbaby" video is just about an hour with about half of it spent talking with Dr. Michel Odent, hearing his experiences with waterbirth and learning about his waterbirthing maternity section. This video shows at least three births in water, two with Michel Odent. It also has a section with Dr. Michael Rosenthal in California at the Family Birthing Center. He shares some of his knowledge, and a few mothers talk about their experiences at the Family Birthing Center, comparing "land" hospital births with their wonderful "waterbirths". This video is just about $70 (shipping included) but definitely worth it!
There is an Australian waterbirth video called "The
of Birth: The story of four gentle births in water". It
shows 2 waterbirths in a birth centre and 2 at home. One of the
midwives involved is Shea Caplice, an independent midwife working
in New South Wales.
Immersion and Pain Control in Labor
intrapartum hydrotherapy on labour related parameters.
Aird IA, Luckas MJ, Buckett WM, Bousfield P
Aust N Z J Obstet Gynaecol 1997 May;37(2):137-42
The results showed that nulliparas [first-time mothers] who used the birthing pool had significantly reduced operative delivery rates, a shorter second stage of labour, reduced analgesic requirements and a lower incidence of perineal trauma. In multiparas [repeat birthers] there were significant reductions in analgesic requirements.
From The Waterbirth Handbook by Dr. Roger Lichy & Eileen Herzberg:
When asked what was their most successful form of pain relief, women at West London Hospital who had had three or more children said that a warm bath was more effective than drugs.
In 1987, women in a Copenhagen hospital were offered the choice
of taking a warm bath in their first stage of labour. Over
half the women accepted the offer and found that they dilated at
twice the rate of women who stayed dry.
[Warm tub bath during delivery.
Lenstrup C, Schantz A, Berget A, Feder E, Roseno H, Hertel J
Acta Obstet Gynecol Scand 1987;66(8):709-12 ]
The John Radcliffe Hospital has just published some research that
shows that women who have laboured and given birth in water were
less likely to need drugs for pain relief. [Water
Pooling information.- Select "Related Articles" for lots
more references.] It seems likely that bathing in warm water is
helpful in relieving pain during labour an may even encourage
labour to progress more rapidly because of its soothing effect on
Heat Halts Pain Inside The Body - 7/5/06
The old wives’ tale that heat relieves abdominal pain, such as colic or menstrual pain, has been scientifically proven by a UCL (University College London) scientist, who will present the findings today at the Physiological Society’s annual conference hosted by UCL.
Dr Brian King, of the UCL Department of Physiology, led the research that found the molecular basis for the long-standing theory that heat, such as that from a hot-water bottle applied to the skin, provides relief from internal pains, such as stomach aches, for up to an hour.
Dr King said: “The pain of colic, cystitis and period pain is
caused by a temporary reduction in blood flow to or
over-distension of hollow organs such as the bowel or uterus,
causing local tissue damage and activating pain receptors.
OK, people, it's time for a new acronym - WBAC - Water Birth
Some hospitals prohibit laboring in water for women having a
VBAC. This is not based on any particular evidence. If
the hospital requires continuous monitoring, they should have a
waterproof continuous monitoring device.
Water is by far the safest place to have a VBAC. The support of the water allows for 3 key safety supports for VBAC/;
Deep water immersion increased amniotic fluid volume by squeezing
fluid from the mother's interstitial space in to her vessels,
increasing the mother's intravascular volume and thereby
increasing perfusion of the uterus and placenta, so the baby gets
Deep water immersion reduces both peripheral edema and blood
pressure in pregnant and non-pregnant individuals. The water
pressure pushes extracellular fluid back into blood vessels, and
peripheral vasodilation drops the blood pressure (obviously this
part doesn't work if the water is too cold.) The effect lasts for
some hours after the immersion. Tom Strong in Phoenix published
data showing an increase in amniotic fluid volume after deep water
immersion (at least shoulder deep).
There's a reference in Susanna Napierala's "Waterbirth a midwifes
perspective" of an Unpublished abstract of Myra Smith, Effect of
Warm Tub Bathing During Labor, Grady Memorial Hospital Atlanta,
Georgia, 1987. "After studying thirty-one low-risk women, Myra
Smith found that the mean arterial pressure and anxiety level
significantly decreased after fifteen minutes in the tub and
remained reduced (1987)".
I would be grateful if any body could help on the
following: There are a set of criteria for women being able
to use the water birth. Is there any reason to be concerned
about maternal BMI and consider it as an inclusion /exclusion
criteria? If yes, what cut off point is reasonable (BMI 30 or 35)
and is there any evidence for it? If NICE Antenatal
guideline suggest women with BMI more than 35 to be referred
to consultant care (as high risk), can we assume the same basis
I think it's fairly unlikely that there is any evidence for large
BMI being contraindicated f r labouring and/or giving birth in
water. Personally I feel it's extremely restrictive to exclude a
woman with a large BMI from having this resource in labour, after
all even large woman can have normal births! In fact anything that
makes it more likely that an overweight woman has a normal birth
the better- that way she is more likely to avoid the
problems/complications she will be more at risk of if she has a
surgical intervention. I can imagine that labouring in water would
offer a 'large' woman definite advantages: buoyancy and support
and easier mobility being several. Hopefully guidelines are only
ever that and aren't translated into absolute 'allowed' and 'not
allowed' which don't always appear to facilitate maternal choice.
At Maidstone, a DGH with a medium sized consultant unit, we offer waterbirth to almost all women, regardless of their BMI. We also "permit" women with a uterine scar to use the pool, although we ask that they are first "risk assessed" by their consultant and our senior midwife, who is a waterbirth researcher. In reality, only a very few women are not "allowed" to use the pool. Our only real criteria for inclusion is that women are able to enter and leave the pool independently, they have a "normal" blood pressure and that they have not had pethidine within 3 hours. They also should be in established labour.
I wholeheartedly agree that the mobility which the pool
facilitates and the increased likelihood of a normal birth
outcome, makes larger women ideal candidates for the pool, and
that they should not be excluded unless there are other reasons
for doing so.
I have also found that women with body image issues (which
applies to some but not all women with high BMI) often feel more
at ease in the water - they may feel a little less "vulnerable" in
their bodies with the security of water. Fitness instructors often
find the same thing with women who are much more comfortable going
into the pool for exercise than working out on the gym floor.
So many thanks to all who responded to my query on water birth
and BMI. From your responses, there is no evidence against
offering water birth to women of high BMI. I should say obviously,
some of us seem to have more clinical freedom than the
others. In our unit we are fighting to keep the option open
at least for women of BMI less than 35 not just under 30s.
We are told bigger ladies may be more at risk of collapsing in the
I was having a look at the discussion and in the hospital where I
was a member of a Midwifery Led Unit, the exit criteria for
weight was (and is) a BMI of 40 at booking. Anyone below
that BMI who is booked in the MLU has automatic access to
waterbirth and in any case, weight is not part of the waterbirth
policy in either the Midwifery Unit or the Obstetric Unit.
I have had several heavier than 250# moms who did wonderfully!! I find that it is the person's attitude, preparation, & general overall health that are the most affecting factors to a successful birth no matter where it takes place and weight is way down on the list of contributing factors.
Water laboring is very freeing, again for anyone, as you weigh
1/10 your 'land' weight. I have a Rubbermaid
tank I loan to those who want to get into deeper water than
their own bath-tubs. If you check at a farm store they will
sometimes loan you one free of charge. Just attach a garden hose
to the washing machine faucets. Clorox out the tub before and
after use, fill with water to 95-99 degrees. Top it up with
boiling water from the stove if it cools down before babe is born.
Works GREAT!!! Your midwife/MD may want you to deliver out of the
water so the decent of the babe can be controlled better. In water
in a tub like mine, the best position for someone that is heavier
is usually on their knees leaning forward against the end so the
midwife can catch the babe behind you. This way gravity will work
with you and the practitioner can reach the introitus better.
(This having been said however--the best position is the one in
which you can relax the best!!)
Without Violence by Frederick Leboyer (online version)
Well, if you can't arrange a waterbirth, you still might be able to arrange a Leboyer bath for the baby.
Purchase a plastic storage container the appropriate size. Then, if there aren't any complications and the nurses aren't busy, try the following:
The best place for the bath would be on the infant warmer/stabilet bed. It's got the heating unit over it so the baby won't chill. (a possible concern of the nurses) The "tub" can just be placed on the mattress and then the whole set-up is at a VERY convenient height for dad. The infant bed can be pushed up next to the mom's bed, which can be raised to an equally convenient height for mom so she can participate and still remain comfortable immediately post-birth. Put one of the blue chux from Mom's admit kit (bag in room) between the container and mattress so that any "sloshing" doesn't get the bed wet for baby. You can put one of the warmed baby blankets in the container as a "liner" and then use the edges of it as a soft washcloth. Once they've played in the water long enough, have Dad lift JUST the baby up out of the water, you can then whisk off the tub, wet blanket and chux and slide in fresh from the blanket warmer baby blankets and then baby is in a nice warm spot to get dried off.
As for the umbilical cord. Since at birth it is moist, there isn't any problem with cutting it short and clamping as usual before putting baby into the water. The reason we tell parent's NOT to tub bathe until after the cord has fallen off is, after the first 12-24hrs the cord has started to dry and re-immersing it in water can keep it from "healing" properly. But IMMEDIATELY at birth, there isn't any harm to immersing baby in the tub.
The "best" scenario for a hospital birth Leboyer bath is, at
birth, have baby go directly up to mom on warm blankets. Let the
labor nurse do her fussing (bulb suction, apgar assessing etc.)
there while mom finishes delivering the placenta. If stitches are
needed, you start setting up for the Leboyer bath while that is
happening. If no stitches needed, hand baby off to dad, you set up
the bath while the nurse is getting mom+bed put back together and
then bath. Be sure to offer to take pictures while they're bathing
the baby (especially ones where MOM + DAD are in the picture). You
can get some GREAT shots of baby gazing up at dad and mom looking
AquaCranial(R) Therapy - An
Exclusive Ocean Treatment Originated & Developed by Rebecca
Goff & the Cetaceans. - what a lovely form of therapy!
This section has been moved to Birth Stories/Waterbirth Stories
If the woman births on dry land, do you worry about water
embolism if she wants to hop into the bath soon after the birth???
If not, why is this a different risk than staying in a waterbirth
tub? Does it have something to do with time - if so, how long
after birth does the risk of water embolism remain?
I think there probably is no real risk of water embolism; it was just something tossed out as a theoretical possibility (as in -- a meteor could come crashing through my roof today).
I think the idea is that the placenta could act like a plug and when it's lifted/pulled out of the vagina water could "rush back" inside and be pulled into the wide open placental bed.
Objections of course, are that the placenta doesn't usually "pop out', and the vagina and cervix are lax and well closed and the vessels at the placental bed should be tightly contracted by the time the placenta is expelled.
But -- I guess it could "theoretically" happen. It's also my
understanding that it hasn't ever happened.
I find that most women are ready to get out of the tub/pool soon
after birth - often before 3rd stage is complete and often these
women are watered out by this time.
Yeah. This is our experience too.
In addition to the fact that water embolism is an imaginary concoction, which we seem to be in agreement hasn't ever happened, there's also the question of "what's the big deal if it happens?"
"Water embolism" is a contradiction in terms, because an embolus is a solid or viscous liquid. Water is neither. If a woman were to take on a volume of water per vaginum, it would pass right through the lungs without sticking there, and there would be no obstruction of bloodflow at all. Hence, no embolus effect.
It's conceivable that the "free water" in question could drop the plasma concentration of NaCl and thereby cause a degree of hemolysis, but this would not be life-threatening unless the volume of water were several liters.
I'd like to remind you all, from whom I draw inspiration, how
much you sound like obstetricians when you say things like, "well,
the risk may be very small, but might as well be safe," when
dealing with imaginary threats.
Water embolism doesn't seem to happen with amnioinfusion, given
the way everybody is going happy happy joy joy about that. I can't
see why it should happen if you're just sitting in the bathtub but
not if someone is actually pumping water into the uterus.
Amniotic fluid embolism is a recognized risk of amnioinfusion, but I don't see any OB's railing against its use because of the very low risk of AFE. How comical it is that they rail against the theoretical risk of AFE in waterbirth but ignore the AFE risks inherent in standard OB interventions.
associated with amnioinfusion during labor.
Dragich DA, Ross AF, Chestnut DH, Wenstrom K.
Anesth Analg 1991 Apr;72(4):549-51
Dibble LA, Elliott JP. Possible amniotic fluid embolism
associated with amnioinfusion. J Matern Fetal Med 1992;1:263-6.
Just to add one more story to this wonderful discussion. Michel Odent told me that when he wrote that 1983 article, the outcomes were so good that he was asked to put more medical risks in it. So, he made up the whole "water embolism" thing. He then went on to say that to get a water embolism, you would have to sit on a fire hydrant at full blast.
I have a midwife friend who allows all placentas to come out in
the water, leaves them attached to the baby and then leaves some
sterile scissors with the daddy. She tells him to cut the cord
whenever they feel comfortable to do it. She relates that is
usually about 12 hours in every case.
I often conduct education sessions around waterbirth for midwives (and have done a presentation for obstetricians, neonatologists and others at one tertiary hospital considering the use of water for labour and birth following publication of articles related to near drowning) and this question always comes up from those midwives (and doctors) in discussions who are not familiar with using water for labour and birth.
Anecdotally, I hear midwives say this theoretical risk of water embolism is one reason why they are scared of waterbirth and will not offer it to women [but these people have a rather large range of issues with physiological birth anyway usually]. I have heard doctors say the same thing - in every instance I ask them to let me know of any instances they have heard of this happening and where it is reported. There appears to be no reported cases, as you say.
At out new hospital (tertiary referral unit, 4000 births per year) opened in Feb 2009, we have 12 labour and birth rooms and every one of them, including the HDU rooms, have a bath or birth pool. I have initiated ongoing data collection round the use of these pools and baths for labour and birth. In this city, the only place for birth, apart from home, is in the tertiary maternity unit [sadly]. One of my aims is the reduce our CS and intervention rates and increase the normal birth rates and the use of water for labour and birth is one way in which we might support women to birth physiologically [notwithstanding the considerable difficulty achieving this in a tertiary unit!!] One of the key targets is to work with the midwives to increase their knowledge, competence and confidence to do this.
I think we are lucky to have managed to get a bath or pool in every room. Many maternity facilities have to struggle long and hard with everyone from the plumber, electrician, infection control officer to the health and safety people [and many in between and beyond] just to get one bath/pool - all because these people do not have an understanding of the impact of the environment of birthing women and put up barriers, such as the theoretical risk of water embolism that has absolutely no evidence of existing, it is such a battle.
I think that any references to this theoretical risk in textbooks are in relation to trying to dispel the myth which is persisting in the minds of some. See the excerpt below (the second edition is due out before the end of 2009) from:
Maude, R. and Caplice, S. (2006). Using water for labour and birth. In: Pairman, S., Pincombe, J., Thorogood, C. and Tracy, S. Midwifery Preparation for Practice.
Third stage and blood loss
There have been no documented cases of complications in relation to the third stage being conducted in the bath. In 1983, Odent proposed a theory that water embolism could be a risk factor. This has now been largely dismissed, and Odent himself has withdrawn the hypothesis, admitting that it was unfounded and a mythical concept.
Many birthcare providers I have spoken to about this issue feel
that if there was placental separation and the baby was in
distress as a result, it would be easily and immediately visible
to the midwife or doctor, who would bring the baby right out of
the water. Also, regarding the time for the baby to be kept in
water or brought out to the mom: Rapid emersion, when the baby is
brought up and out of the water within a minute or two, is the
most common approach. Right after delivery, the mother is usually
anxious to hold and touch the baby, and so the "slow emersion"
method would be frustrating to her because she would not be able
to touch and hold the baby right away.
There are a couple of reviews about when to bring babies to the
surface at a waterbirth.
Johnson P (1996) To breathe or not to breathe? Br.J. Obs.Gyn - can't remember the volume number/pages but it was April or May last year.
Rosser J (1994) Is water birth safe? The facts behind the controversy. MIDIRS. vol 4(1).
What about aspiration pneumonia from meconium aspiration
Isn't the current idea that aspiration pneumonia occurs before
birth, given that suctioning on the perineum doesn't seem to help
In the case of the mother, the risks include: infection from
exposure of the uterus to maternal feces
I read somewhere that statistics showed a lower infection rate
for water birth, probably because all the water dilutes
This weeks Lancet carries a report from a London teaching hospital (well known to be sympathetic to both home and waterbirths). The birth was at home in water. Water temp was maintained at 36 Celsius. She wanted a physiological 3rd stage. The cord was left intact and baby went to the breast. 3rd stage lasted 35 minutes. No immediate problems.
Subsequently baby was plethoric and peripherally cyanosed and admitted to hospital. All investigations and observations were normal, except for marked polycythaemia - PCV >85%.
Authors postulate that mechanim is that in prolonged physiological 3rd stage in warm water that there is a large progressive placento-fetal transfusion, as cord vessels remain open in warm water. They advise clamping cord after ~5mins in these circumstances.
Babe needed dilutional exchange transfusion with albumen.
Don't think you'll find it in Lancet WWW version as it's a
"research letter", but will be listed in "contents".
But what's their theory for the cause of polycythemia when in occurs in an "air" birth?
seems to me that polycythemia shows up on very rare occasions; if it shows up more often in waterborn babies than in airborn babies then the theory might carry some weight. Interesting...
(I don't recall any case of polycythemia -- might be something to
ask global-maternal-health ( -- the waterbirth group -- with barb
What are others' thoughts on this theory? It seems like pure speculation to me. Another case of the one person sample population being used to discredit an "alternative" birth practice.
I've attended many waterbirths with physiological 3rd stages and know of some midwives whose practices are almost entirely comprised of such cases, and I don't know of any resulting polycythemia. The only case of polycythemia in one of my clients' babies occurred after a hospital delivery where the beautiful, fat, pulsing cord was cut within moments of the baby's birth. Had this woman chosen to deliver at home, I'm sure my practice of waiting for the placenta to deliver before cutting the cord would have been blamed for the condition. (When a complication occurs in the hospital, authorities assume it happened DESPITE the location of birth. When the same complication occurs at home, they assume it happened BECAUSE of the location of birth.)
I think I'm going to suggest adding the categories of waterbirth
and time of cord-clamping to the NM quarterly report forms so we
can collect some statistical information on this issue.
Keeping the baby warm at birth is vitally important. During the first five minutes after birth, the blood vessels to the baby's lungs have to expand as part of the conversion from umbilical oxygenation to "adult circulation", i.e. getting oxygen from the lungs. If the baby is cold, the blood vessels to the lungs will not expand properly, causing complications.
Once this process has happened properly, it's less important to keep the baby warm, but extended cold periods could still cause hypoglycemia and related complications.
If you read the protocols pages carefully, you'll notice a
distinction between temperature requirements for labor and
birth. For labor only, the water can be any temperature that
is comfortable for the mother, as long as it's cooler than 101
degrees. For birth, the water temperature should be between
95 and 100.9 degrees.
I was just at a birth where the midwives said to keep the water
at 85, 90 at the highest temp...it was so COLD!!! They said, Anne
Fry, Midwife said to keep the water at that temp. I would
say, 97-99...IF it is too warm for the mother, holding ice,
drinking fluids, add some cool, get out, take it moment to
moment...the water at 85-90 is TOO COLD for the baby!!! When
I started working with this modality in 1987...use to be, 99-102
degrees...now over 99 is considered TOO HOT! Best, for the
comfort of the mother...women are warmer during labor anyhow...but
the 87 degree water for a transitional woman was too cold for
her! She made the comment, so we kept adding hot
water. Hope this helps.
I agree! In addition to wanting the water warm enough to
keep baby warm at birth, I think warmer water is more relaxing to
all the muscles, and it increases oxygenation to the uterus. The
increased uterine oxygenation increases oxygen transfer to the
baby and decreases uterine muscle spasms from lower oxygen
levels. For moms who like warmer water in their baths, I
suggest 100 degrees; for some reason, they do NOT seem to feel
overly hot. If they do, the quickest way to cool them is to
have them hold ice or put their hands in cold water, as there are
special heat radiators in the hands. [Mammals have specialized
blood vessels in their palms and other hairless skin
surfaces—ears, nose, cheeks and soles of the feet—that are
designed to dissipate heat. See Just
Anne Frye had this in her Holistic Midwifery (Vol II: Care During Labor and Birth, 492):
Cool water results in babies who are more actively involved
in their own birth, exhibiting better muscle tone and more
movement as they emerge. These babies seem optimally
conscious and aware at the time of emergence from the water
and stabilize more quickly than those born into body
temperature water or hotter, who tend to be limp and
lethargic. Several newborn reflexes are elicited during
emergence in slightly cool water. The baby will
reflexively push himself out with his feet as he
emerges. In addition to the diving reflex, the asymmetric
tonic neck reflex (ATNR ) is triggered as the baby reaches
out with one arm and bends the other. The baby will
also flex into a fetal position. The symmetrical tonic
neck reflex is then triggered as the baby cross crawls with
his head extended, all of which result in the baby spiraling
out. If all is well, the midwife should not touch the
baby as he emerges, allowing this dance to proceed. At
the time of birth, the undisturbed mother reaches down to
touch the head as the baby spirals out and the baby, with the
assistance of the ATNR, turns to face his mother as she
touches him, they make eye contact, mother lifts the baby
under the arms and brings him to her chest. A healthy,
unstressed newborn, when gathered to his mother enface against
her chest will turn his face and anterior body to his right
and the mother's left side (over her heart). Unhealthy
babies tend to go to the opposite side (Enning, 2003b; Polin
& Spitzer, 2001). After birth, immerse the baby to
the nipple line with the heart under water; the increased water
pressure helps increase the blood volume in the heart
On one birth story I watched the cord was wrapped super tight and they had to cut it before the body was birthed. I am assuming you couldn't do this under the water or else the baby wouldn't have any oxygen. I am guessing you would have to stand to cut the cord and deliver the body.
Anyone have any experience on this?
From my reading and my limited waterbirth experience, I've come to believe the following:
In the relatively weightless and frictionless environment of a
waterbirth, the baby will either rotate itself away from the
resistance of the cord or do its own somersault maneuver, which is
a way of birthing the body without cutting a very tight
cord. This is the best way of keeping the baby's oxygen
supply intact while the baby figures out the breathing thing.
You can only get the cord around the neck if it is nice and
long. In the book "Waterbirth" by obstetrician Yehudi Gordon
and exercise instructor Janice Balaskas, Dr. Gordon tells
practitioners not to even feel for the cord and to just let the
baby come out in the water tub and then unwrap it.
Just got in from the International Waterbirth Conference.
Barbara Harper outdid herself this year. The speakers were
truly international and the new videos and ideas were
fantastic. Meconium in the water was largely thought to be
handled best underwater. This came from physicians and CNMs
as well as CPMs and LMs. Lots of good reasoning and
Does anyone have any thoughts on a waterbirth for a woman who is
Group B Strep positive (who makes informed choice to decline
antibiotic therapy)? Extra infection transmission risk to
baby from being born in water or not?
As someone who studied microbiology, I would have thought that
anything (such as water) which diluted/washed off vaginal
secretions/amniotic fluid present on the baby's face would tend to
reduce the risk of infection, especially as baby won't inhale
until above the water line. Not research based, but logical I'd
and the exposure to HIV]. [Article in German]
Colombo C, Pei P, Jost J
Pflege 2000 Jun;13(3):152-9
Because of the diluting effect of the poolwater, we estimate the potential risk for a HIV-exposure to intact skin as minimal and, therefore a potential HIV-infection as "low level" and to be unlikely. However, a risk for nosocomial HBV-infection is significantly higher. We recommend wearing long-sleeved gloves, waterproofed garment, and HBV-vaccination to all HCW.
I sent a question about the possibility of HIV infection during
waterbirth to Dr. Rosenthal who has a Q and A page link from the
WB web page and got the attached response. I had never been
worried about it until I ran into a doc who said she wouldn't do
them because of this "risk". Now I feel better informed and am
sending her a copy. It would be great if she decided to offer this
option in this area (Mt. Shasta, CA). So far no other docs do.
Date: Wednesday, 19-Mar-97 08:58 PM From: Dr Rosenthal \ Internet: (firstname.lastname@example.org) To: Troy Taschereau \ Internet: (email@example.com) Subject: Re: Fwd: HIV riskHIV is a very fastidious virus, meaning that it has a very hard time surviving outside of its preferred environment. You can't get it from a toilet seat or from any contact that is not intimate and that would allow rapid entry into the blood stream, such as through break in the skin. It would never survive contact with bath water.
Hepatitis virus is another story. It does survive in varied conditions. Even so, there are no reported cases of hepatitis transmission at water birth.
Fear of HIV transmission is a pretty weak excuse for not wanting to participate in water birth. If anything the water would provide a barrier to transmission that is not available in a hospital delivery room. It is not uncommon for a birth attendant to get fresh blood in a "surprise" splash or squirt at the time of birth. When the mother is in the tub that blood goes into the water first.
I always HIV tested my patients during prenatal visits and that
provided 99. 99+% assurance that I wasn't going to get exposed.
[Summarized from a discussion on the list in November, 2002.]
Can anyone here point me in the right direction for evidence that
a 3rd stage in water is safe? My midwife told me I would
have to leave the pool to avoid water embolism.
There's a section about this in Waterbirth
From RCOG Statement on Birth in Water
"Consider leaving the pool for the third stage Warmth has a relaxing effect on uterine muscles that could, theoretically, lead to increased bleeding after delivery of the placenta or possibly retained placenta. The amount of blood lost during delivery may also be difficult to estimate when diluted in the birthing pool water. Also, if the placenta is delivered under water the combination of vasodilatation and increased hydrostatic pressure could theoretically increase the risk of water embolism. Again, this is a theoretical risk and there is no evidence about whether or not it is a real concern.
Until further evidence becomes available it might be prudent to advise women to leave the pool for the third stage. "
In other words cover your behind practice means get em out. I think if the risk is theoretical my inclination would be to decline if I felt I wanted to remain in the pool.
At the 1995 International Waterbirth conference in Wembly, Michel
Odent said he invented/dreamed up some theoretical risk in
waterbirth when writing a medical paper for fear that his
obstetric colleagues would negate the whole article unless he came
up with some "down" sides.
The waterbirth video used for training purposes at the John
Radcliffe Hospital, Oxford, has a pool placenta birth - and this
is common practice up
Staying in the
water after birth? Third stage in water?
I have attended many waterbirths, most without incident.
Just lately we've experienced 4 women who have birthed beautifully
in the pool, had little or no blood loss, birthed their placenta,
and then promptly fainted. All has been well but it's
getting to a point where I'm going to have to start pumping iron
just in case! Dragging an 80kg woman and her baby out of the
pool in the middle of the night isn't my idea of fun, and while
the women have all been fine, their partners might need some
counselling for a while! (Just to clarify, this is not a
case of PPH, there has never been significant bleeding associated
with any of these situations). My partner and I don't want to
start insisting that women leave the pool immediately after the
birth of the baby, but I'm wondering what other midwives do in
this case? Is it common practice to exit the pool soon after
the birth of the baby, or do others support women to birth the
placenta in their own good time, wherever they feel
comfortable? Keeping in mind what Michel Odent says about
that time, we should really be disappearing into the wallpaper and
just letting a woman get to know her baby, with no focus at all on
the 3rd stage, so hauling her out into the cold just doesn't seem
right to me.
Blood pressure can be very funky in the hours shortly after
birth. During pushing, she's got huge adrenaline levels
going, which raises her blood pressure. Then, after the
birth, her adrenaline levels fall, and her body starts shedding
all that extra fluid she put on during the pregnancy. You
know . . . when women start "peeing like a horse". All of
this can result in unstable blood pressure. My practice in
general is to get a woman to stable position within about 15
minutes of the birth, so she doesn't need to be moving around
during the time when blood pressure is most changeable. This
is even more important when she's been laboring in the water,
which pushes fluid out of the tissues and into the blood stream,
another wild card for blood pressure, especially if she hasn't
been drinking enough during labor.
'Howes Birth Mirror' is a new design by midwife Virginia
Howes that provides the visibility you need without the hazards of
glass or the sterilization challenges of plastic mirrors.
My waterbirth kit list is (in order of importance!)
Torch and mirror (Torch is quite small and unobtrusive rather than million candle industrial size one I see in a lot of hospitals!! and my mirror is a mirror tile from the bathroom dept of IKEA which should satisfy and health an safety worries as is has no nooks or crannies to breed bugs!)
digital thermometer (mine is just a cheap one - you can check mum and water temp with it - I don't check room temp - you would want it warm anyway)
Change of clothes - I always get soggy arms and boobs and have on one occasion climbed in the pool to get better access!!!
Some of my colleagues use long gloves - i don't.
See also: Third Stage
A few weeks ago I had a really great conversation with Barbara Harper on this very subject of cords. I was telling her that I was teaching my apprentices that you don't have to touch the cord to know when it stops pulsing, especially with waterbirths, which is pretty much all I do. What I have noticed is that every time the baby starts to give a little cry, it seems that mom is having a ctx, and then when the placenta is full off, that is when we see a good long cry, and mom gets "the Look" and says hmmmm... I think I felt something.
I also know from experience that water babies don't start to "breathe" like land babies. They are pink with good heart tones, but irregular resps. With each cry, they start to breathe more regular till that final good cry. I was telling Barbara all this as my apprentices were having a difficult time with this as I generally cite studies as to why I am so hands off, and for this I had no studies, just what I know and am comfortable with. Well Barbara proceeded to tell me that there is a good amount of research out there being done combining neonatal and hyperbaric (diving) studies explaining what I am seeing. The mechanism is as follows and supports that we should not be touching cords or baby faces unless absolutely necessary.
First- in land or water births the stimulation of the trigeminal nerve which extends into the baby's cheek area, signals the shunts in the baby's heart to close, moving the respiration system from a maternal-fetal to a pulmonary system. You want that fetal-maternal system to be working as long as possible so don't stimulate it unnecessarily.
Second- when the baby's head breaks the perineum or the water, the change in air pressure changes the blood ph by changing the cellular pressure gradients and activating the NA and K+ ion pumps. This in turn, changes the ph of the cerebrospinal fluid which triggers the release of a hormone ( I don't know the name) from the hypothalamus, which in turn signals the shunts in the heart to close, and brings about a SLOW and GENTLE change to pulmonary circulation.
Third- with each ctx., 15-20 ml. of blood moves from the placenta
to the baby and even minor third party touching can disrupt this
process. When the placenta finally comes off the wall it is
estimated that close to 60ml. of blood goes to the neonate. We
have known for awhile now that early cutting encourages jaundice,
and now we can see why. It is estimated that the baby gets
anywhere from 120 to 200ml. of needed vit. K rich
blood if this process is left undisturbed. Anyway I was
THRILLED to know that this research was going on. It is
being done by a doc at Columbia in NY and I can pass it on if you
would like. I also have to thank Barbara for sharing all this with
I often agree with you and have felt the same thing--- but I do
see much more TTN on babies that have a lot of mucus and can't
clear it. The best way to clear it is to have good cries and
suction if necessary. Not every baby is wet== and not every
baby needs suction-- but some really do.
we still agree! Every baby is unique. Crying and/or suctioning are things which some babies need. (I do carry a bulb syringe and delees. I don't use them often, but i got 'em) I think though --- that we might just see babies doing better at handling the transition to air breathing, if we allowed them to handle it at the pace they were designed for -- a more gradual 30 sec - 90 sec process -- rather than the more rapid process we can "stimulate" them to attain. Laid head downward in a draining position, lightly handled (not rubbed and flicked) -- just allowed to rest for a moment -- the baby is designed to begin the transition-to-breathing process with very shallow, almost imperceptible respirations, and to gradually breathe more deeply as his lungs and alveoli expand; within several cycles he is generally breathing well and may do a deep inspiration-cry.
There will be exceptions -- the kid who is howling as his head is born etc. -- but generally the process is slower than US-trained docs and midwives are taught to allow. It ain't very long -- but it can seem long to those of us who were taught to instantly rub up and dry off babies --- and it DOES need to be interfered with if we have a kid who shows he isn't doing well -- or who is born in bad shape -- but I think the kids might be better off in the long run. The natural process lets kids self-expand and self-adapt during that first half-minute or so while the placenta is still functioning and supplying the baby with oxygenated blood and his normal blood-volume. When his is fully breathing well he will often/generally cry on his own -- or if needed we can stimulate him then. I just wonder whether our interventions in those initial 30 seconds or so might be causing some of the problems we sometimes see with poorly expanded lungs, wet lungs etc.
I was thinking about this recently when remembering Dr Leboyer
--when was that --mid to late 70s? He advocated "minimal
handling of the baby, low lights, quiet, for the first minute or
so - and is famous for the "leboyer bath" -- allowing the baby to
relax in warm water just after birth. Changing standard american
practice from harsh lights, routine head-down-hangs, and even
spanking the baby, wasn't too hard. But the other part of his
advice has been almost forgotten - and seldom implemented --
letting the baby adapt WITHOUT STIMULATION during that first
minute or so. Many of Leboyer's recommendations were pretty
rapidly adopted even by the medical unity --- not just because it
was clearly a more "humane" way to deliver a baby -- because he
was able to document the health advantages. I think my next
project is gonna be studying those physiologic changes in the
first minute of life -- and trying to see how we can best help
It seems to me that the most important issues are:
- Safe temperature regulation, i.e. lower temp whatever is
comfortable for mother, but don't go above 37 - 38C
- Water hygiene if the water was not freshly drawn, i.e. check it's not manky stuff that's been sitting around untreated for a fortnight.
- Monitor with waterproof sonicaid or get mother to raise belly out of water to use normal sonicaid or Pinard.
- Get out if any suggestion of foetal distress in case baby gasps when born
- Baby either all in the water, or all out of the water, for birth - not part in, part out, in case sensation of air on body stimulates it to breathe early.
- If any complications once head is born (shoulders, tight nuchal cord) mother can stand up in the pool. Action of stepping out of pool apparently frequently resolves stuck shoulders.
- If baby born in water, bring to surface immediately and keep warm
- Be aware of issues regarding third stage in water and possible risk of overtransfusion of blood to the baby through dilated cord vessels.
"Water for Labor, Birth and Beyond" A 12 CEU's course approved for ACNM/Nsg/MEAC credits This is an educational journey into the realm of water for professionals wanting to incorporate WATER in their prenatal or intrapartum services, the course covers from prenatal water exercises to waterbirths, implementation, protocols, and benefits. This is more than a workshop this is an experience in the tropical waters of Florida. In The Florida Keys August 5 to 8, 99 In Panama City Beach in September 16 to 19, 99
Contact Marina Alzugaray of the CoMadres Institute for more information.
CoMadres Institute is based in the Florida Keys, directed by Marina Alzugaray a midwife with over a 15 years of waterbirth experience and developer of the American AquaNatal exercise program. Marina is an international speaker and author who has had a long relationship with dolphins in the wild.
CoMadres Institute is dedicated to the enhancement of women and
family health through the art and science of midwifery.
CoMadres has an international scope with a multidisciplinary board
including Michel Odent, Margot Early, Carol Lankton, Gloria
Medcalf, Sakae Kichuchi, and Anne Davenport.
There's a midwife in Florida who teaches midwives about waterbirth:
The educational program is given in a retreat style and lasts 4
days in the beautiful Florida Keys where we can go snorkeling and
have fun in
Key West, too. It is approved for 12 CEUs for Nursing and ACNM/MEAC. With 3 hours of AquaNatal prenatal water exercise program, 4
hours on labor and birth including dealing with common complications. The rest of the education program deals with water care promotion,
global overview of water care, strategies for implementation, hospital protocols, CDC recommendations for tubs, maintenance, etc. For more
Marina Alzugaray, CNM with
14 years of experience as a waterbirth midwife and also a diver.
PO Box 420180
Summerland Key, FL
[NOTE - These courses are apparently conducted in sea water, so
Marina might be the expert on the safety of ocean water or sea
water during pregnancy.]
If you need more room in the hips for the baby to descent or
rotate just before birth, a mom in a birthing tub can "straddle" a
stepstool to hold her femurs wider without too much effort,
especially if she rocks a bit to "jostle" the baby through.
I try not to lean. I usually pull a chair up next to the tub and sit near the mom. Leaning over the tub is a drag -- very hard on your back. better to kneel beside it if you need to.
some of the blow up pools will give way and let water slop over. some are more rigid. The non-blowups are firm and no problem, will usually hold the full weight of someone sitting on the edge.
I never get in the tub.
I don't support the perineum at all during a waterbirth. I
verbally coach mom, she can use her own hands to give a little
pressure if needed. There is generally no need to give perineal support -- in spite of what we are taught -- Peris do fine without it! The incidence of tearing seems to be the same or lower as air birth. Just let mom do what she needs to do -- concentrating on relaxing as the head is born, and then gently bringing her baby to the surface. Coaching a mom to catch her own baby is the neatest thing!
On rare occasions I may put my hands in to direct shoulders or something. I try to stay out unless really needed. If delay with shoulders it's best to get mom to stand up anyway. Usually that takes care of things. If it doesn't then mom steps out of tub to the chair or floor space beside the tub. It's really hard to do any maneuvering under the water (too much buoyancy, difficult to get any purchase).
Moms can be in any position they want. But this brings up a
thought. Some think they see more tears in their waterbirths I'm
wondering if maternal position might contribute to this. When in
the water, a mom can really open wide her legs, she can be in the
equivalent of a full squat and be quite comfortable. I think this
might put more stretch on the perineum and maybe we should be
watchful and remind moms to keep their legs a bit closer together.
In our experience, we prefer the inflatable tubs where the sides are three rings of inflation and when inflated are about 8-10 inches thick. They will support MILD leaning, and the midwives can usually manage to lean over without spilling the water. The mother however, can get completely unconcerned about spillage and if she feels like leaning too much on the sides then you will have a wet floor! We like a big sheet of visqueen under the pool for that reason. We do not do perineal support in water births because you just can't reach it. We do reach in to help the baby to the surface if needed, though usually the mother will do that. Our support is mainly to keep the baby's body in the water for warmth and the face just out of the water to breathe. We've never had sticky shoulders in the water, which I think is just luck, but would surely require quick thinking and a possible trip into the tub. For labor comfort, the moms try lots of positions and one of the favorites is stretched out in the water with the belly down and her arms draped up on the sides of the pool. It's like lying on her stomach but with no pressure on the belly. For delivery, most do a semi-reclined, semi-sitting position. We've had one who got over on her hands and knees but then the baby came out above the water!
I my mind, almost ALL births are hard on the midwife's
back! That's why I love training apprentices. The
hardest thing about the water births is that you can't see what is
happening as well as you can in the air, or on the bed. So, you
have to trust more, and just peer down into the dark, wiggly water
til something looks familiar.
i love the idea of pulling up a chair to the tub to save my back. duh, bet i'd stay drier, too, not kneeling on the floor. getting drenched is my biggest problem.....
i haven't noticed more lacerations with water births but i have noticed a strange phenomenon in the freestanding tub, that the woman in there alone seems, i don't know, awash, and it's hard for her to get in a really good position to push since there's nothing solid to hang on to, especially for primips. (by far, if my intending-to-water-birth-clients change plans at the last minute it's because pushing is more challenging in the tub.)
so, my favorite position for water birth is for the partner to be
in the tub too, seated, legs extended, leaning his/her back
against the side of the tub. mom sits on his/her lap, with her
back against partner's front, in a sort of semifowlers, partner's
arms encircling. then, there's an extra set of hands/arms
for bracing against, partner gets to feel the intensity of
pushing from closer up, mom can melt onto partner between
contractions, and when she lifts the baby from the water (i
basically keep hands off, too), they all three get to be en
A good trick during pushing is to have 2 helpers (one on each
side) with a big sheet or blanket under you lift you up in the
water so you are kind of weightless, it really helps.
I think the baby's face should be lifted to the air immediately and that a bit more stimulation than usual is required to get them to inflate their lungs. Then the hard part is..... 1) getting Mom to leave her baby's body in the warmth of the water. Mothers want to hold the child to her heart which is in the cooler air ( I do not fill tub above her fundus. This allows room to suction if mec necessitates moving her to hands and knees in the tub).... 2) Delivering the placenta....either standing in the tub with a metal bowl floating/held between her legs ...or get her out and deliver placenta on land. The latter makes pp blood loss assessment and management much easier!
I personally have never gotten in a tub with a laboring woman.
Some do. I just lean over the edge with short sleeves and shoulder
length equine delivery gloves on. Also have immersible Doppler.
In my own practice, I do like to keep a woman active, squatting, walking, carrying on the activities of daily life until her labor is very well established and working on an even pace. In other words, the contractions are long and strong and close together. If I check for dilation, I like to see a woman at 5cms or better if it her first baby, before encouraging her to use the bath. But that parameter is bendable depending upon each individual woman. One of my clients was having her first baby and she had been induced with prostaglandin gel on her cervix. She had also done castor oil before coming into the hospital. So, the combination of both of these things made her contractions almost intolerable right from the beginning. They were long and strong from 1cm on. For her I recommended a bath after dancing, squatting and walking for over an hour. She got in and four hours later had a baby.
So, it is hard to judge with hindsight whether or not the water
actually "slowed you down." It may have, but I always find
that your mental ability to focus, turn off all other thoughts and
relax are much more important than where you are physically within
the birth environment or physically. I tell women that birth
happens between your ears, not your legs, illustrating, as you
pointed out, that many other factors come into play, not just the
My usual recommendation -- subject to mom's whims in labor -- is to use the pool for late dilation/transition and maybe those first few kinda-sorta-pushy contractions. Then I usually suggest getting out to go to the bathroom "one last time before birth", and mom can push a bit on the toilet. When we start to see some head, then we make our way back to the tub for the crowning and birth.
For multips, it's OK, but for a good portion of primips, the early pushing seems to go better out of the water (and I LOVE the toilet for this!)
We do a lot of in and out with the tub. I know others who get in
and never get out. I think there are advantages to using the water
interspersed with walking, toilet/stool, standing etc. etc.
I use a small exam light with a flexible head. I aim it into the water just in front of the woman's perineum, but have the head low enough that it is not shining in the eyes of the couple or really lighting up the room much. Then I can see everything clearly. We happen to have a white tub, so once you aim the light straight down at the bottom of the tub, the reflections light up the whole underwater area. You could do the same thing with a strong focused flashlight beam -- do not point it at the perineum, but point it at the bottom of the tub just in front of the woman. The light spreads by refraction in the water and reflection from the sides of the tub (obviously light colored tubs spread more light).
I also find that I have to do very little during the actual birth. We have a very small padded stool (about 6 inches high) that I kneel on next to the tub. I am perpendicular to the woman, kneeling next to one of the long sides of the tub. Because I am right handed, I like to be on the woman's right side. Luckily our tub is open on three sides, so we have a choice.
Most women seem to naturally assume a semi-sitting position, some partners want to go behind them as someone else described. Our tub has handles on both sides about halfway up, so sometimes women grab hold of those to get some leverage. Our tub also has these cut outs below the handles that can work like stirrups to put your feet in, if the woman is short enough. The handles and the cutouts can help a lot. Of course those of you using inflatable have none of that.
With the gentle light shining to illuminate the perineum, I can coach her as she births the head. One other trick with the light. If she wants to squat, I still want to see if there is progress, so I slide a small mirror onto the floor of the tub (right under the perineum) and shine the light into the mirror. The light reflects onto the perineum and from the right angle, you can see everything.
I do like to still check for a cord after the head is out, but I also find the perineal support is impossible to do and seems useless. The counterpressure supplied by the water will do much of what our hands would have done.
With the next contraction, I ask her to push for the body. I keep my hands there to guide the body out, and once the whole baby is in the water, I gently lift the kid up to moms arm. If it doesn't come, I find I can easily do the usual maneuvers to deliver the shoulders, as long as she keeps her butt down on the floor of the tub. Once in a while the woman is freaking and aches her back and lifts up her butt and you are trying to push down on the head to free the ant shoulder and nothing is happening because there is nothing to push against. Tell her to keep her butt down. It is also very easy to change to hands and knees for sticky shoulders. The only problem then is that the head is out of the water and you have to be very careful as the body delivers not to dip that face back down in the water. I have asked the nurse to put her hands under the head to make sure the head stays out of the water as I deliver the body. Then, of course the mom has to stand up so you can slide the baby between her legs and she can sit back down in the water and hold her baby.
I can do all of this by leaning over the tub, with my knees on the small stool. My belly is on the edge of the tub and for really sticky shoulders I have leaned all the way over, so that my legs left the stool (once was enough for that). Of course, again, that would not work for an inflatable.
We also keep the tub room very very very warm for a water birth. The nurses and midwives are sweating and stripped down to tee-shirts, but the wet baby can lose a lot of heat from evaporation. I have found it is hard for the excited mom to keep the baby's body but not head under water, so we lift the baby up to chest level and put a towel over the baby and a hat on its head. Even if the towel is wet, it still provides some protection from heat loss.
What do you all do about the placenta? Most of the published sources on waterbirth recommend not delivering the placenta underwater, because of the theoretical risk of water embolism. I start to drain the tub right after the baby comes out, so either the tub is empty by the time the placenta is ready and they deliver the placenta squatting or sitting in the empty tub, or if the placenta wants to come sooner, I put a shower stool right in the tub and have the mom sit above the water to deliver the placenta.
One more cool thing about waterbirths -- the placenta pan will
float on whatever water is left in the tub. After I cut the cord
(when pulsing has stopped) I like to let the blood drain into the
pan (some say it aids separation). So mom is sitting on the stool
(holding the baby) and the pan is floating in the water below her
and the cord trails down into the pan, keeping it right there.
Then she can squat over the pan, or I can do controlled cord
traction and drop the placenta right into the waiting pan. I
happen to think it is pretty neat.
Those vet gloves are enormous. We put rubber bands around
the top of them on our upper arms, and regular birth gloves snug
of them on our hands.
we just purchased water birth gloves. they come in a bright blue- the other choice was orange!!. We bought those elastic hair tie-scruchies to hold the gloves above the elbow/upper arm.
our supplier - Birthwaves-
will happily ship anywhere.
I'm curious about what type of water Dopplers people have and how
well they like them. I bought the first one that came out (or at
least the first one I saw) (1995?), but I didn't like it at all,
made the salesman take it back. But I sure do get tired of
encasing my arm and non-waterproof doppler in a plastic trash bag!
We use the Huntleigh AquaDoppler. Works very nicely in
water and out.
I believe the one we have is the Sonicaid. Works well, but
wish the digital display was backlit, as someone has to hold a
flashlight to see it because we always have just a little night
light on in the tub room.
I have a Sonicaid. It's okay....looks like a star trek phaser
...it works . I know people who have a Huntleigh and like it. Some
of the waterbirth gurus seem to like the Huntleigh best.
I love mine...but works better in water of course....out of water
picks up a lot of other sounds
I have an Imex Pocket Dop OB for which I bought a waterproof
head. I works very well both in and out of water - very
little static, FHT easily found.
Aqua-Eez offers waterproof
Cascade is now selling the Birth Pool in a Box (as of 5/09)
Everything Birth, Inc.
It looks like there might be some satellite or independent rental places for birthing tubs. Search around in your area to find out. Here's one in Lafayette, CA - The Nurture Center, LLC, 1-888-998-BABY (2229)
Portable Pools (from Global Maternal/Child Health Association, Inc., Barbara Harper's organization)
9 Months & Beyond ships the Birth Pool in a Box and AquaDoula tubs nationally.
Home and Hospital Rentalsfrom Aqua-Eez
AquaDoula rentals local to Mountain View, CA
Gentle Beginnings - Labor and Waterbirth Tub Rentals for the San Francisco Bay Area. They are also a distributor for people who want to purchase the Spa-N-A-Box tub.
Gentle Birth Tubs - Spa-N-A-Box tub rentals within a 40 mile drive of Tracy, California. This typically includes San Joaquin County and parts of Alameda, Contra Costa, and Stanislaus Counties. If you are outside of this area, please contact me as I may be able to deliver to you for an additional fee.
Rentals - Tacoma, Washington
Active Birth Pools in England sells and rents tubs with the nice seat-step feature.
babymoon birthpools - portable water birth pools to hire for your home birth or hospital birth, throughout the UK.
Gentle Water birthing
pools - another British tub rental company.
Make a Portable Waterbirth Tub by Melanie Moore
See also: Birthing Tub Rentals - many
rental companies also sell high-grade tubs, especially suitable
for purchase by midwives who provide tubs for their clients or who
offer local tub rental deals.
Birth Balance maintains an excellent list of a great variety of tubs!!
They also have a
great list of accessories
AquaDoula Waterbirth Spa
Rentals and Sales - a U.S. company that rents and sells
tubs. [NOTE - if the floor pad doesn't have the holes
pre-cut, they should be 3 and 5 inches from the edge, i.e. 2
inches apart.] 1-888-217-2229 or (425)348-6729, e-mail: waterbirth@AquaDoula.com
The folks at AquaDoula have been heavenly in their support of my
"stable" of four AquaDoulas - they've provided information on
debugging problems, and they've provided terrific turnaround time
on repairs. I am THRILLED with my AquaDoulas! [NOTE -
TUBS TO GO! Inc. is the company that makes the AquaDoula.
They are now also making the Portable
tubs, and they make one that is significantly bigger and
takes 435 gallons of water. This might make sense for a
birth center, although the bottom isn't flat. And they offer
heaters that could be used with any tub, as well as the propane-powered
heater", which would be ideal for a birthing tub far away
from hot water. Anyway, I think these folks are pretty
Birth Pools for Hospitals and Birth Centers from Waterbirth International
Aqua-Eez Deluxe Hydrotherapy Pools
- some portable units and some suitable for permanent installation
in hospitals or birth centers.
Pools in England sells and rents tubs with the nice
9 Months & Beyond sells the
Birth Pool in a Box.
Whirlpool Spa is an interesting combination of an inflatable
tub (with built-in motor?) and a heated tub with whirpool
jets. It costs between $800-$900, just a little less than
rigid-sided tubs, and it seems a little harder to transport, but
easier than the Spa-In-A-Box. It might be just the right
thing for midwives who bring their own tubs to the birth, instead
of having the clients set them up beforehand. This tub holds
250 gallons, which can take a very long time to fill unless you're
in a multi-unit building with seemingly endless hot water.
But it could obviously hold two adults very comfortably. (A
very similar one is called Spa 2 Go and
External: 65" long (165cm), 53" wide (135cm), and 25" deep (65cm), Internal: 45" long (115cm), 37" wide (95cm), Because of its oval shape a 100 gallons gives you the perfect water depth. (They also offer a larger Labor & Birth Pool. This pool measures 72" X 25" and holds 190 gallons.) [NOTE - The calculation of the area of an oval is (Length x Width x 0.8) So, the area of the internal bottom of the La Bassine is 45 x 37 x 0.785 = 1307 square inches. The area of a circle of 45 inches = 1590 square inches. So the ratio of the oval to a comparable circle is about 82%.]
Midwife feedback about La Bassine:
I have done 2 births in this pool, and really like it a lot. We have been using the 3 ring kiddy pool from IMEX for a few years, but it just wasn’t quite deep enough for some of our moms. The extra couple of inches in the La Bassine seem to make all the difference. Also the bottom and sides are soft! I had one mom that really liked the handles on the inside during second stage. One thing that really surprised me was how long the water stayed warm. We filled the tub at 9am and laid a plastic sheet over the tub, and right on the water. She was ready for the tub at 9pm that night and we checked the temp thinking we were going to have to drain and refill. But, the water had only lost 1 degree in all of that time.
I offer both pools because the IMEX one only costs $25 where the La Bassine is a little over $100. But, at a little over $100 it is still much less than a rental tub, and the family gets to keep it after the birth.
ThinkBaby - La Bassine - a discussion forum in the UK
Please also be warned that the Sevylor pools are made of PVC vinyl, which has a very, very strong odor and will probably cause a reaction in someone with chemical sensitivities. It's not my first choice for materials, but the pools are otherwise great. One approach to the problem is to order the pools ahead of time, inflate them, and leave them outdoors in the sunshine for a couple of months before the birth. Far from ideal.
More pools from Sevylor
Inexpensive inflatable tub kits from yourwaterbirth.com
You can get the Intex Aquarian Birth Pool (60" X 22") for $35 from birthwithlove.com These pools don't seem to have much of an odor at all and didn't cause any kind of reaction in my very sensitive body. [I haven't been able to find the tub at the previous site, but you can contact the manufacturer - Intex Corp. - to ask about local distributors or mail order.]
Inflatable Aquarium Ocean View Swimming Pool from The WetSet costs only $18.95.
If you're a do-it-yourself kind of person, you might enjoy hunting down all the plumbing parts you're going to need for filling and draining these pools. If you really dislike doing that sort of thing, just order one of the kits or get one of the rental packages.
Intex tubs are also sold at qualityinflatables.com.
The advantages are:
Dolphin Circle Waterbirth Tub
Kits - They also carry really cute t-shirts that say, "Water
Babies Rise To The Top!"
Some people are using the Rubbermaid 150-gallon trough.
Or, you can rent or buy a "factory direct" "super portable
waterbirth spa from 1-800-882-7864 or firstname.lastname@example.org
Comfort Line Spas
are portable, heated spas. They're expensive, but are
suitable as rental tubs or for midwives or doulas who want to
provide them to their clients as part of their service.
You can purchase a Spa-N-A-Box tub from Gentle Beginnings.
spadeals.com carries the SPA-N-A-BOX from
The birth pool on Dinah is one that can be purchased at Toys R
I haven't seen a rental tub in use. Most of our clients use
an inflatable kiddie pool that costs about $40 from Wal-Mart, Toys
R Us, etc. It inflates in several sections - the bottom
inflates which is nice and cushiony as well as being a good
insulator. The sides inflate in three sections which adds
strength. Every one I've seen is sorta aqua-green on the
bottom with fish printed on clear sides. I've also heard
sells a similar pool (maybe the same one at a
highly-inflated price??) for about $150. (Less on sale in winter.)
This mom did indeed go to the local feed and grain store and
spoke with the owner telling him the purpose of her purchasing a
cattle trough manufactured by Rubbermaid.
The cost of this large tub (with drain, hose, @4 feet high) was
$120.00. Imagine the store owner's surprise when she told him it
was for a birthing!! Since the "tub" would only be used once, he
agreed to return all but $20.00 of the purchase price upon return
of a "clean" tub"!!
You can get tubs from Barbara Harper that are really nice, and lots of other places, but I used a Rubbermaid water trough from the local farmer supply store. It's VERY sturdy plastic or rubber or something, with rounded edges, the perfect shape and depth for a laboring woman (with even back supports if she wants to sit sideways!), holds 150 gallons, the water stays warm, fits even through a trailer door (of course you have to do the birth in the kitchen then) (great story there sometime!), a very determined midwife can wrestle it around alone if necessary (empty of course!) and it only cost $120-150! (I can't remember exactly) It will last forever, easy to clean and disinfect. The only problem is that it's black, so it's hard to evaluate blood loss, but I made a white flowered flannel liner for it and that solved that. I hope Rubbermaid doesn't find out how perfect it is for water birth or they'll raise the price!
They have 3 different sizes but the 150 was just right.
I was reading a feng shui book that talked about the shape of the
circle: From Subtle Energy by William Collinge, "Circles
serve as funnels or vortexes for the movement of energy . .
. This shape is very conducive to creativity because it is a
natural vortex for earth energy emanating upward. As the
energy is in effect 'funneled' upward through the circle, it also
circulates or spins, and this vortical action stimulates ideas and
creativity." This brought to mind my preference for having
women labor in circular tubs, rather than rectangular tubs; it was
just a feeling that the private circle was like the womb - a very
creative place - perfect for laboring.
I'm interested in hearing about experiences using waterbed heaters under birthing tubs.
Does this work with tubs that have an inflatable bottom? It
seems as if the air in the bottom would insulate the water in the
tub from the heater, but maybe not.
I had one experience using waterbed heaters and I think everyone should hear about this. I sent the couple home with instructions for use, and they set up during early labor. The husband was German Speaking with English as a second language. This couple had an inflatable children's pool and they put it on top of two water bed heaters, on top of a waterbed liner on a hardwood floor. The water stayed about 94F through the whole labor, which was slightly too cold, and she complained on hot spots on the bottom. She had to sit on rubber pads to avoid getting the hot spots.
After the baby was born, and she moved to bed, her husband and I took apart the pool. We found that the water bed heaters had not been rolled out flat. He had put them under the pool all rolled up, they actually melted through themselves and started melting the water bed liner and pool. Another hour or two and the mom and baby would have been at serious risk for electrocution.
Thank God the baby came when he did.
Not my personal experience, but was related to me by someone who
tried to use a waterbed heater under an inflatable tub. She said
the bottom melted pretty quickly!
I simply don't have any desire to feel responsible for the use
and safety of a water heater in my tub. #1, I'd rather rely
on the good ol' fashion "stick my elbow or wrist " in the tub, use
a thermometer in and (ugh) add #2 the extra water as needed.
No ideal waterbirth is worth the risk of harming any mom or baby
in my practice.
One Midwife's Waterbirth Supplies and
It was a Craftsman #00911390000; you can see a picture of it if you go to their web page and search for 00911390000
I was thinking of getting one, but it's a rechargeable model, and I'm guessing that the battery and charger are fairly expensive.
You can also use those snake lights and shape them as
needed! They're also handy for suturing, since you can drape
them over your neck.
carries weighted spa pillows for $12.74
supply houses are great places to find the plumbing parts
for filling the tubs - contamination-free hoses, faucet adaptors,
You can get the fish nets at your local discount pet supply place, or online at petexpo.com. They also sell all the Python airline quality hoses and faucet adaptors:
PYC25 $ 22.95 ... 25' No Spill Clean & Fill
PYC50 $ 37.95 ... 50' No Spill Clean & Fill
PYE10 $ 8.29 ... 10' Hose Extension
PYE20 $ 11.85 ... 20' Hose Extension
PY13A $ 2.49 ... Hose Adaptor
pythonproducts.com has a nice schematic of the No Spill system to help identify the parts.
Here's another source - aquariumshoppe.com
You can also find the Python parts at MOPS
a Canadian aquarium site.
Yourself Waterbirth Set-Up by Ril Giles- this is a great web
page from a waterbirth mom who wanted to share her strategy
for a budget setup.
One Midwife's Waterbirth Supplies and
If you're using the AquaDoula or another rigid-sided tub frame,
you can easily create a cushion all around the edge of the tub
frame. Some tub users have purchased some inexpensive pipe
insulation to put around the edge of the tub frame. They got
2 six-foot lengths of pipe insulation (1 ¾” diameter) and
put it around the edge of the tub, under the thick plastic
aqua-colored tub liner. This works beautifully!
I put three layers under the tub: the bottom layer is a big
waterproof tarp. On top of that, I put a utility underpad,
which provides some cushioning and some water absorbency for any
water that might slosh over the edge of the tub. Then, on
top of both those, I put a king-size sheet. This is a nicer
surface underfoot than the bare tarp, and it is a lot less
slippery! I don't want my moms slipping as they get out of
the tub holding their precious new baby! I have found the Kimberly-Clark
Weather Utility Pad to be the ideal underpad for all kinds
of tubs. It is just the right size and it is the lightest
I've been able to find, so it doesn't add much weight to the tub
I think Dad needs to be out of the picture as far as set up of
the tub at the time of birth. If you are going to offer
waterbirth in our practice, it is imperative for the midwife to be
l00% responsible for the logistics. Own your own plumber's
wrench, tap/hose adaptor, clean hose, designated "dirty" hose,
sump pump, washers, air inflator, pools, tarps, etc. and learn to
use them just as you know how to use your speculums and hemostats
(it's all plumbing, right?) I believe that a birth is a
birth of a father as well and it is our job to support him in
being present at his birth i.e. not taking photos or cleaning up
water damage. [Ed. - I think it is unrealistic to add yet
another set of tasks to a homebirth midwife's already rather full
plate. However, I do agree that the dad has a more important
job to do . . . support the mom! It seems to work very well
to have the dad set up the tub ahead of time, and then have a
family friend responsible for filling/draining the tub. They
don't have to stay for the birth, but they'll have the joy of
seeing a very fresh baby as they're waiting for the tub to drain.]
For us it's been pretty simple. The inflatable pools are
pretty well insulated just by the air in them. Most people
put down a plastic liner (just a cheap roll of visqueen from the
hardware store) to protect the carpet/floor and then use blankets
and/or old towels around the pool on the floor to soak up splashes
and keep us from slipping in puddles. The towels/blankets
are also extra insulation. Draining is easy with a waterbed
kit. Water can be drained in labor and replaced with more
hot water. The other advantage, besides the $$ savings, is they're
more readily available - you don't have to worry about renting one
and not having it in time or having to pay more if you keep it
past the return date.
The only complaint we had about the dark Rubbermaid trough was
that because it was such a dark color it was very hard to see. We
wished we had a good underwater light or something. We used a
flash light but it didn't seem to work very well. We also thought
(for future births) about putting something light on the bottom or
even painting it if that could be done safely. It really was dark.
Well, What I do to solve that problem is have the mother purchase
2 king size WHITE sheets, and a roll of 3 mil plastic as part of
her "supplies needed for a water birth." Before we fill the tub,
we line the rubbermaid tub with the sheets, then the 3 mil
plastic. We drape the plastic to the bottom of the outside of the
tub, and tuck it under, or duct tape it to the bottom area of the
tub, and fill. We now have a white waterbirth tub! When it comes
time for clean up, we pull the liner out, throw it away, and OUR
rubbermaid tub is DRY and CLEAN. People seem to like the idea that
no one elses birth goop has ever actually been in their birth tub.
I made a light flowered flannel "fitted sheet" that had elastic
all around edges and is as big as the tank. It's pretty, provides
the light background for assessing water color (for blood loss or
meconium) and it's sterilizable between clients!
the liner of my pool is almost black. The only drawback to the
color is it makes it harder for the viewers to see (though I kind
of think it adds to the moms unconscious sense of privacy)..
ANyway, a long time ago I found a suitable compromise --- just
have mom sit on a white towel if you need to see better. No need
to line the whole pool - just the spot where the head is emerging.
That hasn't worked for me because it seems that hardly any of the
women I work with ever sit. They are kneeling, swimming
around, squatting, etc. It seems like anything not held down by
the liner just floats around.
I use a 150 gallon Rubbermaid feeding trough I got from a feed
store. It cost $70 and I picked up a spigot at a plumbing store
for $12. I put the spigot in the drain plug. The parents get two
hoses, one must be new and not weathered from out side. This one
they hook up from the kitchen sink, never direct form the hot
water tank or you will get sediment. The other hose is for
drainage. We put a old shower curtain under it and use a new one
for the cover with a blanket for insulation. Every hour we drain
off some water and add hot. We clean it with germicide (we have
the parents do ) when they bring it home and before they bring it
The problem that I have found with these kiddie pools is that
most people's hot water tanks are not big enough to fill them high
enough to cover the mom's belly. I end up boiling water forever. I
really dislike it. Next time someone wants a waterbirth they are
going to have to rent a real water tub or I will buy one and they
can pay me a fee.
My tub has a heater, but all heaters take a while to raise the temperature (mine will go about 5 degrees an hour). Heaters are great for maintaining temperature; they are slow to heat and we still usually need to fill the pool with warm water. With a fast labor we sometimes end up topping off with hot water because we don't have time to raise the temp with the heating unit.
Here's a trick which usually works -- Run about an inch of cold water into the tub (to protect the plastic); then turn on the faucet to HOT WATER ONLY... Start to fill the pool and keep an eye on the temp of water coming from the hose. When it begins to cool off, turn the hot water OFF to let the heating tank recover. Continue to fill with COLD water only until the temperature begins to fall below 102.. By that time the hot water tank will often have recovered -- many gas tanks only need 30 minutes -- and we can begin to use hot water (only) to fill the pool to the proper level.
It's a good idea to have a good supply of water simmering on the
stove in case it's needed.
Regulating temp is pretty easy since a LARGE body of water takes some time to cool off!
Also consider purchasing a "thermal blanket" -- looks sort of like a bed sized sheet of bubble wrap. You can cut this to size and it works quite well. Mine cost $12 I think...
I rented from my midwife because it was deep enough for the water to come up to and partially cover my shoulders. This meant I was buoyed and supported and surrounded by the warm water, and it felt positively delicious! For the Gate Control Theory of Pain to take effect (as describes in Water Birth by Janet Balaskas) it is best to have as much as the body covered as possible, so that the pleasurable nerve sensations block out the pain nerve sensations.
Renting the tub was the best investment I ever made!
I highly recommend renting from Global Maternal/Child Health. You'll have everything you need - you won't have to worry about how to keep that water warm - and the right temperature is important. You'll also get a pump to help you remove the water after the birth.
I recommend using 2 hoses of different colors - one to fill it
up, and one to take water away - if you have don't have a heater,
and need to add more water to keep it warm.
To get a kiddie pool that would ensure enough depth to allow floating and water over your belly, you could sit on the floor, measure to where you want the top of the water to be, and then find a pool deep enough. Some women go to Farm Supply stores and get Rubbermaid cattle troughs (I think that is the name).
You'll need 2 hoses of different colors. One for filling, and one for emptying. That way you can take out water and add more warm water. The new tubs from Global Maternal/Child Health have warmers built in.
If you get in the water too soon, it may slow down your labor. Being in the tub too long can slow things down as well. Some women use the tub for a while, then get out and labor while walking around, and then try the tub again.
We set up the tub in a separate room, with a tarp under it (in case). It can be set up in any room, as long as the floors are strong enough to hold the weight of the tub full of water.
Set it up a few weeks before your due date, in case you're early. Do a test run, and time how long it takes to fill up. Remember to leave room for the water to rise 1-2 inches for each person who gets in the water. When you start labor, you could fill it half way, and then cover it with a sheet. Then you can fill it the rest of the way when you need to get in.
The pool could be in a bedroom, living room, a finished basement.
Wherever you want it to be, as long as there is enough room and
the floors are strong.
The standard pool is 60" x 22", 3-ring inflatable pool with inflatable bottom by Intex.
If you are in early labour, water may have the effect of slowing or stopping ctx, this is good if it's the middle of the night and you want some sleep before the real work begins! :-) Otherwise it could be best to hold off on the pool until you are in really active labour, where it will probably have the effect of helping you relax and cope better with ctx.
Don't know what the rules are, here's how ours is set up. Shower curtain on the floor, covered by a comforter, followed by 2 waterbed heaters covered with thin cloth (I used pillowcases) and the pool is on top.
Well, since generally a midwife will not do a homebirth before 37
weeks, it doesn't need to be done before then. As for filling it,
the best way to find out is to have a trial run. Some people need
a few hours for this depending on the size and temperature of
their hot water heater.
We use inflatable or firm-walled portable, foam tubs, primarily. I would think you could certainly use any clean tub. Here are some of the things that come to mind in relation to birth in water.
The temp should be kept between 97 and 100 degrees F, on the
warmer end when the baby is born. Tap water, with it's chlorine
seems to be OK. After delivery I would empty the tub with an
immersible sump pump that drains via hose to the toilet (toilet
seat down holds hose in place). Then re-fill it with tap water and
add a cup or more of chlorine. Run the jets, run the filter and
let that drain. I would not think there would be any need to run
the filter during labor.
We filled up our pool (Kay Bee Toys has 5ft by 22 inch pools for
$20!) with straight hot water from our sink using a hose (we have
a 50 gallon water heater). Then we covered the pool with a piece
of plastic. When I went to get in the pool HOURS later it was so
hot that we had to add a lot of cold water. So I wouldn't worry so
much about the temp if you keep the pool covered.
What we did to keep the pool nice was: When we first filled it we
added bleach to clean it and then drained it through the garden
hose outside, thus cleaning the hose as well. We then hooked up
the hose to the kitchen sink and filled it 1/3 way until needed.
When I was ready to get in the first time, we filled it another
1/3 with warm water, then everyone kept the water warm by near
boiling it on the stove & pouring it in. The second time I
wanted to use it they drained 1/3 out and again filled it from the
kitchen. Another option is to take out water by the large
pan-panful, boil it, and add it back. For this to be effective,
you should have several pans going at once.
We bought an inflatable child's pool with I-beam construction in the sides. That supports the weight of an adult sitting on the side. It has an inflatable bottom also. Here is how we used ours.
We filled ours on a daily basis for a few days before the birth. I used the water to calm rather obnoxious Braxton hicks. On the big day (!) we filled it with water that was slightly hotter than the recommended 100 degrees, say 102. Then of course we had to wait for the midwife to come and check me to make sure that I was past 4 cm so that I could use the water to help speed my labor, not stop it. I was 5-6. We waited through another two contractions for her to get a good feel on the position of the baby and her head. By that time I was 6-7. Our water heater ran out of hot water before the tub was full enough (15" deep), so we got out all of the pots I have and filled them and heated them on the stove. We used a floating spa thermometer to monitor the temp to keep the boiling water from over heating the pool.
I didn't have the problem of being in there long enough for the water to get cold. My darling little daughter was born about 25 minutes after getting into the pool. Our plan was to just remove a few pots or buckets full of water and have that amount boiling on the stove handy.
If you can, keep the pool in a room where you can close the door
and trap the heat in the room. That was really effective for us.
It helped having the room warm for the baby too (nice perk). We
found that if you need to get out of it but think you might want
to get back in, that if you cover it with a mylar sheet (like the
emergency blanket you can buy in sporting good stores) and lay it
shiny side down, that really trapped heat in. Our baby was born in
the middle of February in Indiana, that's the coldest month of the
year here so we know it worked.
My friend had a few things in the pool with her (sterilised of
course)...inflatable pillow and a little plastic step/stool (the
kind children stand of to reach the sink or toilet.
In which room do you give birth ? My midwife says that it's best
to give birth on the same floor as you have your bathroom. For me
this is upstairs, but I don't have place enough for a pool there.
Downstairs is easier, but no bathroom. So what do you think is
Some things to think about which may make it easier for you to decide:
Different kinds of Bathtub Grab Bars are available online
House $(60), Able Medical
Supplies ($17-$22), Bruce Medical,
or search online for other sources. (I bought mine on sale
from those "Signature" flyers that come in the mail -
909-943-2021- orig $45, on sale for $29, Sept., 2001.) These
can be great to hold onto when moms are squatting in tubs.
I'm not sure how well it attaches to the sides of the portable
My husband says standard residential code is 40 pounds per square
foot for residential floors (currently) and it probably has been
for a long time.
37 square feet under the pool times 40 pounds per square foot equals 1510 pounds -
He says that it would be safer to put it near a load bearing wall and to be careful not to overfill it b/c weight will add up fast.
For the 60 inches X 22 inches pool, the water capacity at
80% of wall height is l09 gallons. Remember - "a
pint's a pound the world 'round". (Except perhaps for some
parts of Europe.) That's 872 pounds distributed over about
20 square feet. If you'd feel OK about having 4 football
players standing in the area, you're probably OK with the tub.
The standard garden hose is made with many dangerous chemicals (and technically shouldn't even be used to water a garden) these chemicals not only come out in abundance with the first use (flushed out along with manufacturers "grease" but leach out over time with break down of the hose. "Drinking safe hoses" are processed in a completely different manner and do not contain the same toxins or release toxins into the water. I do not have the list of chemicals anymore (they were on the paper that came with our outdoor hose) but I can inquire at the hardware store where I purchased all of our hoses (ones for birth rental/service and home use) and get a detailed list if anyone is interested.
It isn't necessary to use this sort of hose but I like to
eliminate all unnecessary chemicals where possible especially in
such a blessed, pristine event as a new life's emergence. For
similar reasons people should flush their birth tub before it's
first use. Not because of toxins but because of manufacturers
grease. There is a lot of filth in most plants and this transfers
to most products we purchase. Like when you buy dishes, you
was them before using them for the first time. Or when you buy
pots you are supposed to boil them for 15 minutes to eliminate the
harmful nickel (stainless pots) from them before cooking a meal.
Manufacturers grease can be anything from actual grease, to glues,
to unwashed hands. Just another effort to eliminate outside
contamination to our personal inside environments.
My midwife supplies special "airline quality" hoses. I'm
not sure what they have to do with airplanes, but they're
apparently completely clean inside - maybe they're the hoses used
to deliver oxygen to all those little oxygen masks? Anyway,
she gets them from an aquarium supply store - the name on the
hoses was "Python".
Abstract about Cleaning Waterbirth Tubs
and Infection Rates
Another trick I heard with this tub is instead of all the
scrubbing, use a piece of plastic such is used for insulation
inside houses, get at lumber yard. It is heavy plastic and comes
in rolls of 8ft x25ft. Just cut off the piece, unfold it and put
it in the tank. Just fits perfect. When birth done, throw the
We have 2 jacuzzis at our birth ctr. After each use we fill tub
with hot water and 2 scoops of dishwasher machine soap. Run the
jets, cleaning with a cloth as necessary. Empty tub. Fill again
with hot water and bleach. Run jets again. Of course we clean out
any debris before filling the tub.
I have in my backyard a 7 person hot tub - Now, I will be
labouring and birthing in this tub in late July. How would
one go about preparing such a tub to be clean enough?
I would drain it, scrub it, rinse it, then refill with water and
add the sterilizing agent which your manufacturer recommends. Then
I would drain it, dry it, and wait till labor is imminent. Then I
would fill it with plain water for labor and birth. Here we
recommend using no chemicals in the water if used for birth.
I guess it it's already filled you could wait and take a short cut and just run a full sterilizing treatment through it, then drain it, rinse and refill.
The water will keep for a couple days with no chemicals (as long
as no- one enters the tub).
It holds (for us Canadians) 1363 litres of water or 360 US
gallons. How much bleach would you add and circulate prior
Would you use any chemicals or additives at all in the actual
Absolutely not! Start with a clean tub, and clean water, and you won't need anything else. I would treat your hot tub the same as a portable tub and not count on having it always available as a hot tub. Either that or double check your chlorination when you go into labor and ONLY use the tub for labor rather than birth.
Folks here are quite strong on recommending against birthing in a hot tub treated with standard chemicals. It goes back to a birth maybe 15 years ago with a baby with undetermined respiratory problems (blamed --justly or not -- on the hot tub chemicals.). I don't know if there were other situations or if this is an example of "management by anecdote". One could make a case that any chemicals you are comfortable bathing in should be safe for a baby to be born in, I guess. If you did so, I would STILL recommend using a newly cleaned, recently filled tub.
How long does your tub take to heat up if you fill with cold
water --- or with hot tap water?
I finally found out what our local hospital uses to clean their tubs, that the nurses call scrubbing bubbles.
Brody is the brand and it contains m-alkyl dimethyl benzyl ammonium chloride. Their phone number is 1-800-488-2436.
It takes a capful per large jetted tub. then they fill the
tub up over the jets and run the jets. then take a long
handled swab brush and wash the sides and the edges. drain
and rinse with clear h20, filling above the jets and running
again. each run of the jets is about 5 minutes.
If your water supply is not considered suitable for drinking, then it is not suitable for birthing in. During the birth process, the uterus opens, and it's possible that water from the tub could go up inside the vagina and possibly inside the uterus. If there are any perineal tears, germs from the water could be introduced directly into the mother's bloodstream. This isn't a huge problem if the water started out as clean water and then got the mom's germs in it, but if the tub water was undrinkable to start with, this could be dangerous. Also, the baby could pick up nasty germs from the water and become ill from it.
This information is primarily from educated conjecture, rather than from any research. In general, women are discouraged even from swimming in bodies of water (such as lakes and rivers) that might contain weird organisms that could get inside the cervix and infect the baby. It makes even less sense to birth in questionable water.
However, you can disinfect water by adding household chlorine bleach. If your water supply is clear, add 1/8 teaspoon (approximately 0.75 milliliter) of bleach per gallon of water if the water is clear. For cloudy water, add 1/4 teaspoon (approximately 1.50 milliliters) of bleach per gallon. For an AquaDoula that holds 175 gallons, this translates to about 22 teaspoons of bleach for clear water, so really about half a cup of bleach for clear water or a full cup for cloudy water.
Use bleach that does not have an added scent (like lemon). Ideally, use bleach that gives instructions for disinfecting water right there on the label. Regular plain Clorox Bleach or generic is fine.
After adding the bleach, stir it around - a dinner plate can be a very effective stirring device - and then let it sit for at least 30 minutes to allow the bleach to kill all the germs. Then, you can add boiled water or heat the water (if it's in a birthing tub with built-in heater), and the heat will help disperse the bleach from the water. As the bleach leaves the water, it will tend to make the room smell bad, and you don't want a pregnant woman breathing this, so have someone else doing the work and, ideally, be able to ventilate the room as the bleach is leaving it. The water should then be sanitized for birthing even if it no longer smells like bleach.
web pages on Disinfection Water for Drinking, Cooking, and
People sometimes ask about using hydrogen peroxide to disinfect water. Hydrogen peroxide must be used full-strength from the drug store (which is 3%, I think) to sterilize things. You'd have to have a lot of some really concentrated hydrogen peroxide in order to sterilize a birthing tub full of water.
It's tough to find something that's going to kill nasty germs but not be a problem for humans. Heat is a good way but hard to manage with 175 gallons. Bleach has the beauty of killing the germs and then evaporating when heated. Although it smells bad while it's evaporating, after it evaporates, it leaves the water pretty pure. The chlorine levels used to disinfect clear water are less than the levels used in public swimming pools. If you drink and bathe in tap water, you're probably already drinking and bathing in chlorinated water which has had a lot of the chlorine bleach evaporated already. It's actually quite a good option.
If you want to learn a lot about sterilizing things, go and
search on the internet for sterilizing things for brewing
beer. These are methods that are effective enough to kill
any residual yeast spores (which are harder to kill than bacteria
or viruses) and still not leave any residues that would affect the
taste of the beer.
I'm concerned about the cleanliness of the water my baby might be
born into. Here I am buying a fishnet to scoop out fecal
matter that might be pushed out ahead of the baby - doesn't this
make the water toxic to birth in?
In a normal birth, the baby is born sterile and picks up germs from the mother during the birth process and infancy - from the vagina during birth, from the skin during skin-to-skin contact on the belly, and from the breasts during breastfeeding. This is nature's ideal plan to colonize the baby's skin and gut with the friendly bacteria that the mother carries - the baby is already as immune to this bacteria as the mother because the baby has been getting the mother's immune system through the placenta.
In order to digest all that beautiful breastmilk, the baby needs some e. coli, and better that it comes from the mother than anyplace else. I don't think it's an accident that the baby is born so close to the rectum!
And, of course, anytime you introduce antibiotics into baby's world unnecessarily, you're interfering with the natural colonization of baby's skin and gut that happens at/after birth. This leaves baby vulnerable to being colonized with the germs of whoever is around when the antibiotic effect wears off. This isn't a problem at home, where most of the germs in the home are germs that baby's already immune to, because they're germs from the mother's normal environment. But if the baby is in the hospital, the baby might end up being exposed to nasty stranger germs just at the time that the antibiotics are wearing off. And, of course, antibiotic-resistant germs aren't fazed by antibiotics, so a baby with antibiotics on board who's exposed to antibiotic-resistant germs is in the worst possible situation - exposed to the most dangerous germs without any competition from the normal, friendly bacteria that have been wiped out by the antibiotics. So think twice before you put that antibiotic ointment into baby's eyes or agree to IV antibiotics.
And . . . even the midwife's germs aren't really part of the mother's normal environment. As healthcare providers, midwives come into contact with lots of germs and could easily spread germs from one home to another. As a midwife, I personally make a point of donning sterile gloves at the birth and for the first 24 hours afterwards before touching the baby.
For lots of interesting information about gut bacteria, read Gut
: understanding symptoms of the digestive tract by W. Grant
Then again, the San Francisco Public Utilities Commission offers excellent information about chloramine in bath water - QUESTIONS REGARDING CHLORINE AND CHLORAMINE REMOVAL FROM WATER [Updated November, 2007]
[Ed.: I think this must be ascorbic acid or sodium ascorbate.]
In the section, "Q: Can Vitamin C be used to remove chlorine and chloramine for bathing purposes?", they state, "SFPUC determined that 1000 mg of Vitamin C (tablets purchased in a grocery store, crushed and mixed in with the bath water) remove chloramine completely in a medium size bathtub without significantly depressing pH." [Ed: It didn't make sense to me that you would have to crush the tablets, but they dissolve pretty slowly. I put them in the very hot water that I use to pre-heat the tub halfway full, and this dissolves them about halfway; then, I crush the remainder.] Apparently, some of the commercial tablets specifically sold for neutralizing chloramine in bath water lower the pH more than is ideal for bathing. And vitamin C is thought to be good for the skin! It's a win-win solution, and cheap, too!
bathtub" holds about 70 gallons of water. The
AquaDoula holds 175 gallons of water. It seems that 3 or 4
grams of vitamin C should neutralize the water in an AquaDoula
from Water Quality in the East Bay
"Chloramine Removal — Chloramine, unlike chlorine, will not
evaporate from water by itself and not all water filters that
remove chlorine will remove chloramine. For example, showerhead
filters and filter balls that are used in bathtubs do not remove
chloramine. Chloramine can be removed for drinking water purposes
by a carbon block or activated carbon filter that can be installed
on a kitchen faucet. According to the San Francisco Public
Utilities District, boiling water for 20 minutes will remove
chloramine. A short boil of water to prepare tea or coffee will
remove about 30% of chloramine. Adding fruit to a water pitcher,
for example slicing peeled oranges into a 1-gal water pitcher will
neutralize chloramine within 30 minutes. Both chlorine and
chloramine can be removed for bathing purposes by dissolving
Vitamin C in the bath water (1000 mg Vitamin C tablet will
neutralize chloramine in an average bathtub)."
from Chemicals in Drinking Water: Chloramines
"Chloramines can be removed from water using activated carbon
with low flow rates (5 to 10 minutes contact time), followed by
residual ammonia adsorption using mineral zeolite media. The
use of reducing agents such as sodium sulfite, sodium bisulfite,
sodium thiosulfate and ascorbic acid (vitamin C) also removes
monochloramine from water. Boiling and aeration are
ineffective methods for monochloramine removal."
What about Chlorine?
Here's a really nice discussion of how to neutralize chlorine - THE ENDANGERED SPECIES ACT AND CHLORINATED WATER DISCHARGES
"Water utilities have found that 2.5 kilograms of ascorbic acid will neutralize one kilogram of chlorine in water. For sodium ascorbate, 12% more is required." I'm not sure how this translates to bath water, but . . .
This Vitabath ad claims that 1000 mg will neutralize both chlorine and chloramines in 100 gallons of water. "Effervescent vitamin C de-chlorination tablets are comprised of ascorbic acid, citric acid and sodium bicarbonate. This powerful formula is designed to neutralize chlorine and chloramines in hot tub or spas."
Using Vitamin C To Neutralize Chlorine in Water Systems by Brenda Land, Sanitary Engineer, Project Leader - from the US Dept of Agriculture
Chlorine Concerns and the
Endangered Species Act: Vitamin C and Fish by Greg Peterka,
P.E., Engineering Manager, Public Utility District No. 1 of Skagit
I've heard that the purpose of adding salt to the water is so
that it has the same salinity as amniotic fluid and thus doesn't
sting the baby's mucous membranes at birth. [The ratio is
one generous tablespoon for each gallon of water.]
Some clients add things. Usually comfrey, sliced ginger, salt, arnica oil and St Johns Wort oil -- comfrey, ginger, or other herbs go into a clean pillow case with the end tied tightly, salt and oils just get dumped in. This is for labor only, early enough that they were in their own bath tub.- the oil makes a strange bath tub ring! -- but it does clean up with no problem.
Mom said it seems to help in labor..... I would get a bit nervous
about a baby birthing in it though-- but fine for labor if mom
wants to try it!-
Hydrogen peroxide is good for mom's bath, but not for the birth
because it hurts the baby's eyes.
International Bioxidative Medicine Foundation 405-478-IBOM, P.O.891954,Oklahoma City, Oklahoma 73189
Officially, Waterbirth International does not recommend adding
anything like this. But, as long as natural salt is used, I
don't see the harm in it.
My suggestion to most women is two drops of your favorite essential oil and that is it.
For my first water birth I wore nothing at all. But for my next,
my son was 8 approaching nine and we thought he would be more
comfortable if mom wasn't "starkers". I wore a really light
gauze nightgown, very "hippie earth mother". It's a favorite
now. At a birth I helped at in May, mom wore a tube top in the
tub. I thought that was terrific and helped with easy access
for the baby to nurse afterwards.
I've decided on my floral Bravado nursing bra and an oversized man's shirt to wear when I am out of the tub.
I saw a waterbirth picture once where the mom was wearing a black tank top. I think it would be easy to find, too. I think they are sold in the lingerie, sleep wear departments. They are the kind that are form-fitting, not loose and baggy. It would be modest, yet when lifted up to nurse, it stays up and doesn't fall down into baby's face, and when in the water it wouldn't float around and get tangled, or catch air bubbles when getting in and out.
Just FYI so you know my experience. The first time, I don't
remember thinking ahead so much what to wear, but I did end up
wearing a tie-on bikini top. That was modest and easy to
untie the neck tie to nurse, but in some pictures people have seen
the ties floating in the water and thought it was the umbilical
cord! (the ties are pink). The second water birth was so
fast, and in my own big tub, that I had nothing on. I do
wish I had some pictures that are more modest! My husband
got in with me and had only his underwear on, kind of funny to
remember the event and how at the time we didn't even think or
care how exposed we all were!
I had a home waterbirth 6 Mo ago. I wore T shirts. Next time I plan to wear panties too. After the birth a friend in the Netherlands wanted to see a pic of my birth tub. I was wishing I had a pic w/o so much of my backside showing. I was on hands and knees(sorta), facing the camera so the pics i had to choose from weren't graphic by any means, but showed more of my hips than I would normally show. And for me personally, the panties wouldn't have made me even a tiny bit uncomfortable. So that's what I plan.
Also I don't plan to take the shirt off immediately after birth as I did (at MW's suggestion) last time, I'd like the moments after birth pics to be ones that I can share with everyone! Just my (modest) opinion.
Did you keep the things that you wore? I can imagine that they become really special. I mean - the clothes that I will wear to bring my baby into the world are really even more significant than my very fussed over and well preserved wedding dress. Did anyone do anything special with your "birth clothes?"
I kept the dress I wore. I still wear the bra all the time. Sure, they become special things.
I bought special frilly socks for each of my deliveries. They were very special!!
I wore a short nightshirt for labor with nothing underneath, then just a sports bra when I got in the water. I felt more comfortable with "something" on than completely nude.
I wore the same short night dress with all my babies. It was soft on the inside & silky outside. What I really liked was that it was buttoned all the way down the front so if I was hot I could un-button it so it only covered my shoulders, or so DH could rub my belly with essential oils without me having to keep pulling up or holding up my shirt. It was easy to nurse in.
At the Hospital waterbirths I have attended (over 30) I have seen the Moms where anything from nothing, bikini tops and sports bras to actual long cover everything up maternity tops. I just want Mom to feel comfortable -- so I say wear whatever (if anything) you like. LOVE the tube top idea -- I will pass it on to the Moms I take care of. I bought a midriff T-shirt for my own delivery, but I ended up delivering in my birthday suit!
What do you WANT to wear? THAT's the key!
I wore a long sleeved black maternity dress until I got in the tub. Then I wore a navy blue cotton bra (Victoria's Secret) so it wouldn't turn transparent when wet.
Consider that you may be warm, you may want to move around, and
you may get body fluids on the clothing. I think comfort is the
key. And the items you wear will become very special to you!
OK, this is mostly a joke for a waterbirth crowd, but the
manufacturers are serious about this garment - the Birth-Day Suit
We used the "Aquaria"
DVD on our big-screen TV during the labor, and my wife
absolutely loved it. It was quite powerful as a form of
visual hypnotic induction; she would look at it and identify with
the marine life. The colors are very striking, and it really
brings people into a different part of the mind.. We also
had some PBS-like DVDs of dolphins and orcas, but these didn't
I have some of those plastic quart-sized pitchers that the
hospital gives out to every laboring woman, and they're great for
hanging on the edge of the AquaDoula. The midwife can keep
her Doppler in one, and the mom can keep her glass of fluids in
I use a 5-gallon collapsible water container in the birthing tub. We fill it with water so it sinks, and it makes a very nice cushy seat for the mom.
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