A Midwife's Perspective: Labor and Birth in the Water

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Jill Cohen

© 2001 Midwifery Today, Inc. All rights reserved.

The benefits of water

It was late in the evening. I sat staring into the fire, waiting as I often do for the phone to ring. Midwives frequently have a sixth sense about birth, and on this particular evening, my senses proved true—at 10:30pm the phone indeed rang. At first all I heard was the echo of deep breaths and water running. I knew this was labor. Water and labor fit hand-in-hand for most laboring women. The shower or bath warms, secludes and relaxes a woman so she can open more easily at her own pace. It creates a womb-like environment in which a woman can feel safe. It may not take the pain away, but it enables a woman to cope through her intense sensations, relaxed and with least resistance, creating more comfort. Water forms a warm, wet buffer around her, keeping outside forces and interventions at bay. Yet if the woman should need assistance or monitoring it can be accomplished easily in her watery environment.

I waited for the contraction to pass as I listened intently for the mystery woman on the other end of the phone to finally identify herself. I could tell by the echo that she was in her bathroom, and could tell by the sound of running water that she was in the bath. The tempo of her breath told me I would be heading over soon... as soon as I could ascertain who she was! After her breathing slowed and she paused to collect herself, I heard her giggle a "Sorry!" I knew right away it was my dear friend Hazel. This was her fourth child—I was out the door!

Laboring in the water

I walked in to find her children sound asleep and her partner sitting at the edge of their large tub, a glass of cold water and bendable straw in hand to help keep Hazel well-hydrated. Before she could utter a word, another contraction arrived and she went deep into herself. Because water can speed labor along once the woman is over 5 centimeters dilated, and I guessed that Hazel was at least that, I busied myself preparing her birthing room. I then settled into the bathroom with my water Doppler and monitored our little friend. All was well. Hazel needed to pee, so she got out and onto the toilet. Another big contraction, wide eyes and pop went the bag of waters. They were clear and smelled sweetly of baby. It was time to decide where this child would be born.

Without hesitation, Hazel chose the tub. As soon as she was situated, I heard the familiar sound of relief I hear so often when women sink into warm water. It is music to a midwife's ears, as is the steady heart rate of a baby about to be born. Hazel pushed with the next contraction as she pulled her legs back and sang that magical birth song, low and deep. With that push we saw the baby's head. Two more pushes and the head was born.

As we waited for the next contraction, we had time to see this little child and appreciate the peacefulness of his/or her entrance. Water is vital to life—we cannot live without it. Its ability to nourish, nurture, propagate and promote life fits so well in the birthing world. I believe that because babies come from a watery environment, when they are born into water it feels familiar to them. Under normal circumstances, babies will not breathe until they hit air. When they emerge into water their house gets bigger, but they still think they are in the womb. This little one was wide-eyed and waiting. It is always amazing to see such peaceful passage.
Within a few moments, another contraction came and the baby was gently born. Hazel instinctively reached down and brought her baby to the surface. There was no need to suction—this little boy flexed, stretched, yawned and pinked up without even crying.

Misperceptions

Misunderstandings abound about the use of water in birth, such as risk of infection, risk to the baby, and lack of ability to monitor effectively. There is now much research-based evidence to indicate that with proper preparation and protocol the risks are no more than for air birth. So for those women and practitioners who choose water to facilitate birth, go for it! But first, be informed: Investigate what standards should be used. Plan what kind of tub you will use, where to put it, and find your water source. Remember that water is a different medium to work with. Familiarize yourself with it; think about its potentials; imagine its relation to birth. Merge with it and feel its effects.

For me, the rewards of using water in labor and birth is summed up in that magic sound of relief in a woman's moan as she enters the warm water, and the magic moment as baby comes forth with that peaceful look that tells me the passage has been safe and gentle.

Jill Cohen lives and practices midwifery in the Eugene, Oregon area. She is senior editor of The Birthkit and associate editor of Midwifery Today, where this commentary originally appeared.