Having a water birth

You may be considering using immersion in water for your labour and/or birth. The following information is designed to help you make an informed choice for you and your baby.

You will also be required to complete a water birth consent form before using the facility. 

Benefits for you and your baby

Water births are associated with minimal risks for both the woman and baby when care is provided by midwives and/or doctors who follow best practice guidelines.

Women report the following benefits could include but are not limited to:

• increased feelings of control and satisfaction
• water immersion
• • appears to be aligned with a positive birth experience
  • is an effective pain relief
  • provides an opportunity for skin-to-skin contact
  • allows the woman to move more freely (buoyancy).

Exploring your choices

Firstly, confirm with your maternity care provider if immersion in water for labour and/or birth is an option. Include this as part of your birth plan.

Talk to a midwife and/or doctor to find out more information, in particular:

• whether there are any reasons why immersion in water for labour and/or birth is not advisable for you
• the benefits and risks to you and your baby
• details about when you would be required to leave the water.

You will be asked to sign an agreement form if you choose to use water for your labour and/or birth.

Common concerns about using water for labour and/or birth

You and your baby may get too hot
If your body overheats your baby may also overheat. This can cause the baby’s heart rate to increase. You should feel comfortable in the water but not too hot. During your labour and birth, your midwife will check your temperature and the water temperature regularly. You may be asked to leave the water if you are too warm.

Infection control
There are strict guidelines for keeping the water clean and clear during labour and birth, and for cleaning the bath or pool to minimise the possibility of infection.

Prevention of water inhalation
If you choose to stay in water to birth, your baby should be born completely immersed in the water, then gently but immediately lifted out of the water face down. There should be minimal handling of the baby under the water to prevent the baby initiating breathing.

Once your baby is brought to the surface, your baby’s head should be kept above the water so that breathing can start, and potential inhalation of water can be prevented.

Who can use water for labour and/or birth?

You and your baby must fit all of the following criteria to use a bath or pool for your labour and/or birth:

• have no medical or pregnancy complications risk factors
• be having only one baby who is presenting headfirst
• be at least 37 weeks pregnant
• not be a carrier of, or infected with HIV, hepatitis B or C virus
• weigh less than 125 kg after 37 completed weeks of pregnancy – this is to ensure your safe evacuation from the pool should the need arise
• when your waters break, they need to be clear in colour
• your observations and your baby’s heart rate must remain within the normal range
• if you have an injection for pain relief, you cannot enter the water within 2 hours of the injection. It may be longer depending on the side effects.

Special circumstances

This includes a vaginal birth after a previous caesarean section.

This requires discussion between yourself and a doctor, to enable an assessment of you and your baby’s individual risks. The plan can then be recorded in your notes.

If your baby requires continuous monitoring of its heart rate during labour and birth, the appropriate monitoring equipment needs to be available for immersion in water to be facilitated.

Conditions for using water during your labour

• You must never be alone while immersed in the water.
• Your midwife will advise you about the best time to enter the water.
• The bath or pool must be filled with only pure tap water with no additives such as bath oils, gels, soaps or salt.
• When sitting in the bath or pool the water should reach the level of your breasts.
• You should feel comfortably warm.
• You can leave the water at any time.
• You must leave the water to urinate.
• You should keep well hydrated throughout the labour to avoid dehydration.
• You must leave the water when advised to do so by the midwife and/or doctor if:
  • there are changes in the baby’s heart rate
  • the colour of your waters are not clear
  • your midwife and/or doctor has any concerns for you or your baby.

If you choose to birth in water

• All the conditions for immersion in water during labour and/or birth must be met at all times.
• You must leave the water if the midwife or doctor is concerned about you or your baby’s wellbeing and safety.
• You must be assisted when you leave the water to avoid any injury to you or your baby.
• The baby must be kept warm after birth using skin-to-skin contact, drying the head and keeping the rest of the body under water.
• The baby must be removed from the water immediately if they need help to breathe.
• You must leave the water for the birth of your placenta, unless you are having a physiological third stage.
• If you require stitches, this procedure will be delayed for at least one hour after you leave the water.

Acknowledgement: Water birth patient information booklet (Women and Newborn Health Service, King Edward Memorial Hospital).