The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS,
a homebirth midwife in Mountain View, CA
The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS,
a homebirth midwife in Mountain View, CA
|
If you know any birth attendants who are still practicing premature clamping and cutting of the cord, encourage them to watch this video of a grand rounds with Dr. Nicholas Fogelson at USC. It's got lots of research and an open-minded perspective. |
Waterbirth International desperately needs Your financial support.!
The best way to donate is to send a check to Waterbirth International
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.
Listen
to 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 waterbirth.
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!
Birth
Through 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.
Blaze's home birth
- a nice one from an Australian
doula - although this may look like an unassisted birth, there was
a midwife providing hands-poised care.
Waterbirth 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
about waterbirth.
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")
Waterbirth
Basics - from Newborn Breathing to Hospital Protocols by Barbara Harper,
RN
Waterbirth Discussion
- http:
by Barbara Harper to get around the Spam problem on the Yahoo! group at
http:
Waterbirth:
The Power of Water, by Sarah J. Buckley, MD
Water Birth -
Excellent Patient Education from Kent Midwifery Practice in the UK (Kay
Hardie and Virginia Howes)
Birth into 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!
Gentle Birth Alternatives
[unavailable as of 2/05, but here's a copy of an article - What
Is A Gentle Birthing Experience?]
Birth Balance - A Resource
Dedicated to Integrating Balance and Birth Since 1987
Birth
Tub/Pool Rental FAQ from 9 Months & Beyond
Aqua-baby - Labour
and birth in water - About waterbirth in Holland - "Most Dutch midwives
will be glad to help you have a natural birth in water."
Waterbirth/Tub Insurance Coverage and
Reimbursement
"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.
THE
WATER BIRTH EXPERIENCE from another
Sheila Kitzinger site.
About waterbirth
from babymoon birthpools in the UK
Water Birth from
the HomeBirth Association of Ireland
Childbirth
Methods - Water Birth - from Motherstuff
Water Babies
- Your Waterbirth Resource on the Web
Under Water Child Birth - The Miracle of Water Babies - from "The Marnie Ko Collection" on Nurturing Online
Water Birth
Resources - at Robin Elise Weiss' pages at The Mining Co.
BirthWaves - Your resource
for home and water birth information and products
Baths
During Labor Reduce Pain, Don't Cause Infection
Waterbirth Figures Prominently in Nice Summary
of Comfort Measures w/Focus on Avoiding Drugs
Home
births 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, Denver, Colorado.
Waterbirth Increases Safety of Breech Birth
There is a doctor in Ostend, Belgium who is experienced assisting delivery
of both breech
and 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.
Britain's National
Childbirth 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.
Minnesota
women embrace the gentle option of water birth
by Darlene Pfister, Star Tribune
Published Oct 1, 2002
[Local copy]
A continuation of the work of Igor TYcharkovsky in water research and exploration with babies water and dolphins.
Basia Barbara Szpak DEC,LMT
Aalbersestraat 14
1814 RH, Alkmaar, NL
tel/fax: 31 (0)72 540-1920
e-mail:basiaszpak@hotmail.com
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.
Is there really that much difference between a rigid-sided birthing
pool and the kiddie pools or paddling pools?
Why 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.
Neonatal
group 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.
Just
Cool 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 waterbirth."
Try doing a search on "Related Articles" for some of these citations
to get the newest studies!
Water births
'ease slow labours - 26 January, 2004 - BMJ article discusses benefits
of the "birthing pool".
Randomised
controlled trial of labouring in water compared with standard of augmentation
for management of dystocia in first stage of labour. [PDF
text]
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.
Waterbirths:
a comparative study. A prospective study on more than 2,000 waterbirths.
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.
Effects
of 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.
Perinatal
mortality and morbidity among babies delivered in water: surveillance study
and postal survey. [Medline
entry]
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 " 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.
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.
Birth
under water.
Unfortunately, even the abstract is not available online.
[Water
births and the exposure to HIV]. [Article in German]
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.
There is an Australian waterbirth video called "
Water Immersion
and Pain Control in Labor
Effects
of intrapartum hydrotherapy on labour related parameters.
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.
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
birth. 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 stress hormones.
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 After Cesarean!
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 hydrated.
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 for waterbirth?
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 pool!
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
stock 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!!)
Birth 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 on.
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.
Respiratory
failure associated with amnioinfusion during labor.
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.
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.
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 much.
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 everything.
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 harper)
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
Cool It]
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
chambers.
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 anatomical explanations.
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 have thought.
[Water
births and the exposure to HIV]. [Article in German]
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.
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
Guidelines.
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.
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.
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 for
Waterbirth
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 me.
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 this
process.
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 for Labor, Birth and Beyond" A 12 CEU's course approved
for ACNM/Nsg/MEAC credits This is an educational journey into the realm
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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
Marina Alzugaray, CNM with 14 years
of experience as a waterbirth midwife and also a diver.
[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
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 face. awesome.
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
water.
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 on top
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.
[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 ]
Odent M
Lancet 1983 Dec 24-31;2(8365-66):1476-7
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
Waterbirth Videos
Pain Relief in Waterbirths
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.
[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 ]
WBAC - Water Labor and Waterbirth for VBAC
Water Immersion Increases Amniotic Fluid
Water Immersion Reduces Blood Pressure
See also: Oligohydramnios
WaterBirth for Large Women
I have had lots of experience with women labouring in water,
it
certainly is easier for larger women to move in the tub. A number of
women have chosen to wear sports bras or t-shirts for modesty reasons.
Leboyer Bath for Baby
Waterbirth Stories
Risk of Water Embolism
Dragich DA, Ross AF, Chestnut DH, Wenstrom K.
Anesth Analg 1991 Apr;72(4):549-51
Third stage and blood loss
Concerns about Alleged Risks
Won't the Baby Drown?
It is primarily the air touching the skin and cord that are signal to the
baby's body that it should start to breathe.
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).
Possible Risk of Mom and Baby Staying in Tub
with Unclamped Cord and Attached Placenta for 35 Minutes
Water Temperature
Concerns about Shoulder Dystocia or Very Tight Cord
Meconium
Waterbirth and Group B Strep (GBS)
Waterbirth and HIV
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.
Date: Wednesday, 19-Mar-97 08:58 PM
From: Dr Rosenthal \ Internet: (mrmd@earthlink.net)
To: Troy Taschereau \ Internet: (troytash@ptw.com)
Subject: Re: Fwd: HIV risk
HIV 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.
Third Stage / Placental Delivery in Waterbirth
here.
Fainting in the Water
Midwife Equipment
Midwife Technique - General
- 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.
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
information contact:
PO Box 420180
Summerland Key, FL
33042 USA
(305) 744-3370
midwife@aol.com
Does the Midwife Get Into the Tub?
I am curious about the technicalities of doing water births. Does
one lean over the tub, do the tub side walls hold the weight or do
people climb in the tub also. Is it hard on the back to lean over
and then how do you support the perineum during the birth. What position(s)
can the mother be in?
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!
Do the Tubs Slow Down Early Labor?
There are various theories about good times to get in the tub. Michel
Odent recommends waiting until the mom feels like she needs more help with
the intensity of labor, and then starts filling the tub. He says
the woman is typically 6 cm when she gets into the tub and usually gives
birth within a couple of hours.
Extra-Long Gloves - Sources
Something I've discovered that works really well is to use the vet gloves
with a latex glove on top. For extra dexterity and sensitivity in
my fingertips, I cut off the fingertips of the vet glove. The water
doesn't get inside the latex glove, so I'm protected.
of them on our hands.
Tubsider
The Tubsider
is is an orthopedically designed, kneeling seat designed for adults who
are bathing kids. It happens to work beautifully for midwives attending
waterbirths. [NOTE - Production of this may have been discontinued
- if you want it and can find it, buy it quickly! Old info: You can
call 1-800-314-3535, Fax 213-269-7418 Tubsider, 5315 Lindbergh Lane,
Bell, CA 90201]
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 Dopplers.
Cascade is now selling the Birth Pool in a Box (as of 5/09)
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.
Birthing Pool 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.
How to 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
Baptistry 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 portable
electric heaters that could be used with any tub, as well as the propane-powered
"instant heater", which would be ideal for a birthing tub far away
from hot water. Anyway, I think these folks are pretty ingenious!]
Labor
and 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.
Active Birth Pools
in England sells and rents tubs with the nice seat-step feature.
9 Months & Beyond sells the
Birth Pool in a Box.
This Inflatable
Heated 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 costs less.)
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.
http:
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.
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 tubman@wa.net
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 Comfort Spa!
The birth pool on Dinah is one that can be purchased at Toys R Us.
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 that
Sharper
Image 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 Logistics
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.
SpaSupplies.com
carries weighted spa pillows for $12.74
Aquarium supply
houses are great places to find the plumbing parts for filling the
tubs - contamination-free hoses, faucet adaptors, anchor tubes.
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.
Do it 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 Logistics
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
All 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 kit.
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 back.
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 best ?
Some things to think about which may make it easier for you to decide:
Different kinds of Bathtub Grab Bars are available online from
Comfort
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 spas.
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 plastic away.
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 to use.
Would you use any chemicals or additives at all in the actual birth
water?
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.
[From the
CDC's web pages on Disinfection Water for Drinking, Cooking, and Personal
Hygiene]
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
reactions : understanding symptoms of the digestive tract by W. Grant
Thompson.
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!
So, an
"average 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 very nicely.
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 County
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 seem right.
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 another.
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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