Water birth is childbirth that occurs in water, usually a birthing pool. It may include the use of water for relaxation and pain relief during the first stage of labour, birth into water in the second stage of labour, and the delivery of the placenta in the third stage of labour.
Approximately 10% of births in the UK take place in water, and approximately 20% of births include the use of water for pain relief [1] . A cohort study carried out in the UK of 73,229 women concluded that there was no association with adverse fetal or maternal outcomes. [2]
Health policy in England stipulates women should be given the opportunity to labour in water through the publication of Intrapartum care guidelines issued in 2007 by the National Institute for Health and Care Excellence (NICE). The Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives have jointly supported labour and birthing in water, and encourage hospitals to ensure birth pools are available to all women. [3]
Birthing pools are available in many public hospitals in the UK. [4] [5] [6] [7] [8]
The Royal Australian and New Zealand College of Obstetricians and Gynaecologists supports the use of water immersion during labour within safety and clinical guidelines, noting that there is evidence of benefits to the mother and no evidence of adverse effects to the mother or baby [9] . The New Zealand College of Midwives supports water immersion during labour when there are no factors that would prevent it, noting that there is no evidence for adverse fetal or maternal outcomes, but that further evidence is required for the delivery of the placenta [10] . The Australian College of Midwives also supports immersion in water during labour and/or birth [11] .
Birthing pools are available at many public and private hospitals in Australia [12] and New Zealand [13] [14] [15] .
Water birth is not commonly available in hospitals in the United States, and American clinical opinion is generally skeptical of the practice. The American College of Obstetricians and Gynecologists does not recommend birthing in water, although its 2016 Committee Opinion on the matter states that immersion in water during the first stage of labour may be offered to women with uncomplicated pregnancies [16] .
In a 2005 commentary, the Committee on Fetus and Newborn of the American Academy of Pediatrics (AAP) released an analysis of the scientific literature regarding underwater births. The Committee noted several positive studies for underwater birth but went on to criticize them for lacking proper scientific controls, a significant number of infant deaths and diseases, and the general lack of information to support the use of water births. [17]
Proponents believe childbirth in water results in a more relaxed, less painful experience. [18] A 2018 Cochrane Review of water immersion in the first stages of labour found evidence of fewer epidurals and few adverse effects but insufficient information regarding giving birth in water. [19] A moderate to weak level of evidence indicates that water immersion during the first stage of childbirth reduces the pain of labour. [19] A 2018 Cochrane Review found that immersion at this stage reduces the use of epidural analgesia; however, there is no clear evidence on the benefits of immersion for the second stage of labour, namely delivery (sometimes called full water birth). [19] There is no evidence of increased adverse effects for immersion during the first or second stages of labour. [19]
Water birth may offer perineal support for the mother, and some theorize that this may decrease the risk of tearing and reduce the use of episiotomy. [20] Evidence for this is not strong. [19]
A 2014 review reported that water immersion during the first stage of labour can reduce the length of that stage, labour pain, and the use of epidural or spinal anaesthesia. It is also associated with a lower rate of cesarean delivery and stress urinary incontinence symptoms 42 days after delivery. The review reported that immersion during labour did not appear to increase the rate of infections for the mother or the baby, and Apgar scores for the newborn infant were similar to those of conventional births. [21]
Waterbirth may lead to a higher rate of cord avulsion, or the snapping of the umbilical cord [22] . Statements on water birth by peak gynaecological and midwifery bodies in the UK, Australia and New Zealand all stipulate that exclusion criteria apply for high risk births [23] [24] [25] .
There is limited evidence for some of the purported benefits of waterbirth.
A birth pool is a specially designed vessel for waterbirth [26] . They are generally larger than bathtubs to enable buoyancy and freedom of movement during labour. [27] A birth pool can either be permanently installed or portable.
Before birth pools became readily available there were many stories of women labouring and birthing in re-purposed tub-like products including animal watering troughs. [28]
The original circular birth pool used by Michel Odent, the originator of the concept of birthing pools, at Pithiviers hospital in France in the early 1980s was 2 metres (6 ft 7 in) in diameter and 60 centimetres (24 in) deep, large enough to accommodate two people and make it difficult for interference during the birthing process. [29] Modern birth pools are somewhat smaller, with a diameter between 110–150 cm (43–59 in) and at least 50 cm (20 in), preferably 56 cm (22 in), of water. [30]
Midwifery is the health science and health profession that deals with pregnancy, childbirth, and the postpartum period, in addition to the sexual and reproductive health of women throughout their lives. In many countries, midwifery is a medical profession. A professional in midwifery is known as a midwife.
Caesarean section, also known as C-section, cesarean, or caesarean delivery, is the surgical procedure by which one or more babies are delivered through an incision in the mother's abdomen. It is often performed because vaginal delivery would put the mother or child at risk. Reasons for the operation include obstructed labor, twin pregnancy, high blood pressure in the mother, breech birth, shoulder presentation, and problems with the placenta or umbilical cord. A caesarean delivery may be performed based upon the shape of the mother's pelvis or history of a previous C-section. A trial of vaginal birth after C-section may be possible. The World Health Organization recommends that caesarean section be performed only when medically necessary.
Childbirth, also known as labour, parturition and delivery, is the completion of pregnancy where one or more babies exits the internal environment of the mother via vaginal delivery or caesarean section. In 2019, there were about 140.11 million human births globally. In developed countries, most deliveries occur in hospitals, while in developing countries most are home births.
A doula is a non-medical professional who provides guidance for the service of others and who supports another person through a significant health-related experience, such as childbirth, miscarriage, induced abortion or stillbirth, as well as non-reproductive experiences such as dying. A doula might also provide support to the client's partner, family, and friends.
A birthing center is a healthcare facility, staffed by nurse midwives, midwives and/or obstetricians, for mothers in labor, who may be assisted by doulas and coaches. The midwives monitor the labor, and well-being of the mother and the baby during birth. Doulas can assist the midwives and make the birth easier. Should additional medical assistance be required, the mother can be transferred to a hospital. This transfer is more likely if an epidural is needed, there is meconium staining, it is a prolonged labor, or the newborn needs intensive care. Some hospitals have birth centers as an alternative to the usual high tech maternity wards.
A home birth is a birth that takes place in a residence rather than in a hospital or a birthing center. They may be attended by a midwife, or lay attendant with experience in managing home births. Home birth was, until the advent of modern medicine, the de facto method of delivery. The term was coined in the middle of the 19th century as births began to take place in hospitals.
Natural childbirth is childbirth without routine medical interventions, particularly anesthesia. Natural childbirth arose in opposition to the techno-medical model of childbirth that has recently gained popularity in industrialized societies. Natural childbirth attempts to minimize medical intervention, particularly the use of anesthetic medications and surgical interventions such as episiotomies, forceps and ventouse deliveries and caesarean sections. Natural childbirth may occur during a physician or midwife attended hospital birth, a midwife attended homebirth, or an unassisted birth. The term "natural childbirth" was coined by obstetrician Grantly Dick-Read upon publication of his book Natural Childbirth in the 1930s, which was followed by the 1942 Childbirth Without Fear.
Unassisted childbirth (UC) refers to the process of intentionally giving birth without the assistance of a medical birth attendant. It may also be known as freebirth, DIY (do-it-yourself) birth, unhindered birth, and unassisted home birth. Unassisted childbirth is by definition a planned process, and is thus distinct from unassisted birth due to reasons of emergency, lack of access to a skilled birth attendant, or other. It is also different from homebirth, although most UCs also happen within the home.
Michel Odent is a French obstetrician and childbirth specialist.
In case of a previous caesarean section a subsequent pregnancy can be planned beforehand to be delivered by either of the following two main methods:
Postpartum bleeding or postpartum hemorrhage (PPH) is often defined as the loss of more than 500 ml or 1,000 ml of blood following childbirth. Some have added the requirement that there also be signs or symptoms of low blood volume for the condition to exist. Signs and symptoms may initially include: an increased heart rate, feeling faint upon standing, and an increased breathing rate. As more blood is lost, the patient may feel cold, blood pressure may drop, and they may become restless or unconscious. In severe cases circulatory collapse, disseminated intravascular coagulation and death can occur. The condition can occur up to twelve weeks following delivery in the secondary form. The most common cause is poor contraction of the uterus following childbirth. Not all of the placenta being delivered, a tear of the uterus, or poor blood clotting are other possible causes. It occurs more commonly in those who already have a low amount of red blood, are Asian, have a larger fetus or more than one fetus, are obese or are older than 40 years of age. It also occurs more commonly following caesarean sections, those in whom medications are used to start labor, those requiring the use of a vacuum or forceps, and those who have an episiotomy.
Queen Charlotte's and Chelsea Hospital is one of the oldest maternity hospitals in Europe, founded in 1739 in London. Until October 2000, it occupied a site at 339–351 Goldhawk Road, Hammersmith, but is now located between East Acton and White City, adjacent to the Hammersmith Hospital. It is managed by the Imperial College Healthcare NHS Trust.
Childbirth positions are the physical postures that the pregnant mother may assume during the process of childbirth. They may also be referred to as delivery positions or labor positions.
Obstetrical forceps are a medical instrument used in childbirth. Their use can serve as an alternative to the ventouse method.
A perineal tear is a laceration of the skin and other soft tissue structures which, in women, separate the vagina from the anus. Perineal tears mainly occur in women as a result of vaginal childbirth, which strains the perineum. It is the most common form of obstetric injury. Tears vary widely in severity. The majority are superficial and may require no treatment, but severe tears can cause significant bleeding, long-term pain or dysfunction. A perineal tear is distinct from an episiotomy, in which the perineum is intentionally incised to facilitate delivery. Episiotomy, a very rapid birth, or large fetal size can lead to more severe tears which may require surgical intervention.
Issues and practices related to childbirth in Sri Lanka are influenced by the sociocultural composition, political history and violence within the country.
Trinidad and Tobago is the southernmost country of the West Indies; as of 2013, its adjusted maternal mortality rate is 84 deaths per 100 000 women; the rate is adjusted for underreporting and misclassification by the World Health Organization. The contraceptive rate, that is the percentage of women in union aged 15–49 years currently using contraception, is 42.5%. The fertility rate is 1.8 children per woman. Fourteen weeks of maternity leave with allowances is provided by the government; women typically choose to take this leave after the birth rather than before, to spend time with the newborn.
A midwife is a health professional who cares for mothers and newborns around childbirth, a specialization known as midwifery.
Obstetric anesthesia or obstetric anesthesiology, also known as ob-gyn anesthesia or ob-gyn anesthesiology, is a sub-specialty of anesthesiology that provides peripartum pain relief (analgesia) for labor and anesthesia for cesarean deliveries ('C-sections').
Pain management during childbirth is the partial treatment and a way of reducing any pain that a woman may experience during labor and delivery. The amount of pain a woman feels during labor depends partly on the size and position of her baby, the size of her pelvis, her emotions, the strength of the contractions, and her outlook. Tension increases pain during labor. Virtually all women worry about how they will cope with the pain of labor and delivery. Childbirth is different for each woman and predicting the amount of pain experienced during birth and delivery can not be certain.
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