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Extracted from Mayes Midwifery 14th Edition, Sue Macdonald & Julia Magill-Cuerden (Eds). Baillière Tindall, 2011. Courtesy Elsevier

Therapeutic use of water in childbirth has grown in popularity, and most maternity units now offer a birthing pool. Some women may wish to spend most of their labour and birth in the water pool, others choose to spend short periods, and some women may wish to leave the water for the actual birth of the baby and delivery of the placenta. There is evidence for a number of benefits to labouring in water, particularly a reduced need for pharmacological analgesia, but the midwife should determine the benefits and risks for each woman.

Essential considerations include:

Temperature of the water

  • Too high a temperature will be uncomfortable for the woman and may cause fetal tachycardia
  • Cooler temperatures may induce respiration before the baby has been brought to the surface

Time of entry to water

  • Immersion in water in the early stages of labour may inhibit uterine activity. Some midwives recommend delaying entering the water until the cervix is 4 - 5 cm dilated, although there is little research to support or refute this practice

Infection of mother or baby

  • Infection risk appears to be very low and can be minimised by using disposable bath linings where available, and by thorough cleaning of the bath after use in line with infection control policies.

Water embolism

  • In theory, water may enter the maternal circulation via the placental bed, causing a water embolism. It is recommended that the third stage of labour should be conducted out of the water. Oxytocic drugs (if used) should be given when the woman has left the water.

Perineal trauma

  • The midwife should provide verbal support to enable the woman to control the birth and allow the head and shoulders to emerge slowly, to minimise the risk of perineal trauma.

Monitoring maternal and fetal health

  • Auscultate the fetal heart using an underwater ultrasonic monitor, wireless electronic fetal monitoring or Pinard's stethoscope.
  • Inhalation analgesia is suitable if pain relief is required. Do not leave the woman unattended.
  • If narcotic analgesia is required, the woman should be asked to leave the water, as the drowsiness induced by the drugs may compromise safety.

The baby

The baby should be brought to the surface immediately after birth. The umbilical cord should not be clamped and cut while the baby is still under the water as the sudden reduction in placental-fetal blood flow may initiate respiration, and therefore, inspiration of water. If the umbilical cord needs to be cut prior to the birth of the baby, the woman should be asked to stand with the baby's head clear of the water so that cord may be clamped and cut before the birth of the shoulders.


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