Water births: what options are available at home or in hospital?

Water births have been said to have numerous benefits for both mum and baby, but what are your options in Ireland?

What are my water birth options in Ireland? Water birthing is an alternative to more 'traditional' delivery that many mamas-to-be are interested in. Giving birth in water has been hailed as 'a natural epidural' and is said to have multiple advantages for both mum and baby, saving time, pain and unnecessary trauma. Currently, Dublin's Coombe Women and Infants University Hospital is the only maternity hospital equipped with a specifically-designed birthing pool, and the only hospital offering the option of a water birth in the Republic. Since the Coombe introduced water births (in May 2014), hundreds of women have used the pool for labour and more than one hundred women have had a full water birth. If you are planning a home-birth you will be required to supply your own birthing pool, unless your Self Employed Community Midwife has one they can lend you. Hospital home-birth services, such as the Holles Street, Waterford, and Wexford Domino Schemes can provide a pool for you to labour in, but not give birth - again, you will need to supply your own pool in these instances. If you are using a private service home-birth provider, such as Neighbourhood Midwives in Dundalk, birthing pools and all accessories are included with all home-birth packages. Water births are only indicated for 'low risk' labours and should be supervised by a specialist (midwife or gynaecologist). Although many expectant mums plan a delivery in water, complications during labour can mean a sudden change in the best-laid plans, with the priority always being the health and safety of the mother and unborn baby. What are the advantages of giving birth in water? Water births can help women to achieve more active control and participation in the labour process. Women can choose when to enter or leave the birthing pool, and enjoy a somewhat more relaxed and serene environment. The water's temperature of 37 degrees (the temperature of the human body) decreases the production of adrenaline, relaxes muscles during childbirth, and promotes dilation without pain. Labouring mums are also made more comfortable by maintaining a vertical position in the pool, since this is the most natural posture to give birth in because it helps and facilitates baby's entry into the world. And it's not just mums who benefit from a water birth, as baby also has time to adjust to their new environment and situation more peacefully. Underwater delivery favours the baby's transition from amniotic fluid to the outside world, with some advocates claiming it can even make for a happier more contented baby during the first year. Are water births safe? Last year, researchers from Oregon State University in the US examined outcome data from more than 6,500 midwife-attended water births and found that newborns born in water were no more likely to experience low Apgar scores, require transfer to the hospital after birth or be hospitalised in their first six weeks of life, than newborns who were not born in water. The results - believed to be the largest study of water births to date and the first to examine the practice in the United States - were published in the Journal of Midwifery and Women's Health. Lead author, Marit Bovbjerg, says the findings suggest that water birth is a reasonably safe, low-intervention option for women who face a low risk of complications during the birthing process. However, Bovbjerg notes that the research did reveal an 11 percent increase in perineal tearing amongst mums who gave birth in water:

"For some women, that potential risk of tearing might be worth taking if they feel they will benefit from other aspects of a water birth, such as improved pain management. There is no one correct choice. The risks and benefits of different birthing options should be weighed carefully by each individual."

[caption id="attachment_270130" align="aligncenter" width="1440"] Marit Bovbjerg, of Oregon State University, who conducted a large-scale study into the outcomes of water-births.[/caption] For the large-scale study, researchers analysed birthing outcome data collected from 2004 to 2009 by the Midwives Alliance of North America Statistics Project, commonly referred to as MANA Stats. Most of the nearly 17,000 women in the study were attended by certified professional midwives, who provided detailed reports on their cases from their medical records. More than 6,500 women in the database gave birth in water, either at home or in a birthing centre. The outcomes in those births were compared to the outcomes for non-water births. However, the study compared only births at home or in a birthing centre and not those in hospitals. Despite the fact that the researchers' findings are consistent with outcomes reported in other water birth studies, the team say they are contrary to the opinion of both the American College of Obstetricians and Gynaecologists and the American Academy of Paediatrics Committee:

"Those groups support labouring in water, but caution against giving birth while immersed. Our findings suggest that water birth is a reasonably safe option for low-risk women, especially when the risks associated with pharmacologic pain management, like epidural anesthesia, are considered."

Although similar research from this side of the pond is a little older, a 2009 review of 3,243 women found no evidence of increased adverse effects to baby or mum as a result of labouring in water or from water birth. Based on such findings, including the fact that immersion in water during the first stage of labour significantly reduces women’s perception of pain and the use of epidural, the Royal College of Midwives have stated that water birth should be an option in low-risk pregnancies:

"All healthy women with uncomplicated pregnancies at term should have the option of water birth available to them and should be able to proceed to a water birth if they wish."