Women have been giving birth in deep water for millennia. Traditionally, for instance, the Pirahas women in the Brazillian Jungle practice waterbirth in the river, the water as high as their waist, as it is seen by them as being cleaner and healthier than land birth ( Emmet 2008). The theory of the semi-aquatic age of humanity is a fascinating reflection on our adaptations to living in and around the coast.
However, in our modern era of birth, what draws women and their attendants to use water during birth, and what are the benefits to which midwives can point to support this?
In Dianne Garland’s seminal handbook for waterbirth, “Revisiting Waterbirth: An Attitude to Care”, and in her lectures worldwide, Dianne talks of 4 key areas of benefit for women. It is important to note that these are benefits of deep water emersion where the water is deep enough to have the whole uterus immersed, as opposed to a regular depth bath, which may not cover the entire belly, or a shower, where the woman is not immersed.
Physiologically, water has many benefits for birth. Firstly, the hydrostatic property of water reduces body weight by 75%. So, for a heavily pregnant woman who might feel like a beached whale on land, she feels able to move freely to find a comfortable position for labour and birth. Needless to say, due to the nature of pools and baths, most of these positions are upright postures that facilitate an easy birth. We think this makes waterbirth an even more important consideration for overweight woman whose movements may otherwise be more restricted but for whom medical interventions are carry more risk; and also for women with a previous C-Section where for instance water buoyancy takes the weight/strain from the scar.
Michel Odent raises two further physiological benefits for immersion in deep water:
- That immersion in warm water changes the oxygen exchange in the muscles making muscles more effective. As I always tell women, this means that they get more for the effort of each contraction. This effect lasts 1-2 hours, and thereafter it fades unless the woman leaves the water for a while and returns.
- From the observation of the immediate pain relieving effect of immersion in warm water, the effect is so fast that it is theorised “that an action on the ‘gates’ is plausible through skin stimulation’. As the Gate control theory of pain has been refined, we are better able to understand ‘how skin nerves transmitting heat can override the transmission of aching pains from the visceral region” (Odent 2015: 103). The impact of these effects are so profound on a woman in labour that Barbara Harper (Waterbirth International) warns inexperienced practitioners that labour maybe progressing far faster than the calm and comfortable appearance of the woman may indicate.
Hormonal Benefits of Water
Dr Sarah Buckley talks about the symphony of hormones at birth, and their complexity and balance are such that very little of substance can be summed up in this short article. However, we know that many forms of pain relief, particularly pharmaceutical drugs, interfere with the symphony of hormones affecting progress in labour and feelings and sensations after birth, and some drugs cross the placenta with profoundly negative effects on birth and lactation. Water is an intervention that works with the hormones of birth rather than interfering with them, reducing the inhibitive effects of adrenaline and promoting the production of oxytocin and endorphins. As we have touched on above, the gateway theory of pain has been used to explain the effects of water on a labouring woman. Women feeding back to us about their experience of water birth talk of the pain relieving effect being about 50%, however, many women describe the experience of getting out of the water to go to the toilet and finding the land contraction so unbearable that they have literally run and then leapt into the pool to ensure the next contraction is in water! It must be emphasised here, that the hormonal benefits do not work in isolation, the whole environment needs to work: low lighting, quietness, privacy, compassionate sensitive support.
The Psychological Benefits of Water
Women talk about water as providing privacy, control, the sensation of being wrapped in cotton wool. Midwives observe women regressing into themselves, entering a ‘labour land’, a calm place when they are able to sustain themselves amidst the powerful sensations of birth. In our modern medicalised environments, women often feel that they lose control of their bodies and privacy. People feel that they can enter the room without permission, and often touch intimate body parts and interfere in movement and choices. Some women see being in a birthing bath/pool as providing a safe space which gives them more control over how and when they are touched, and water gives them a kind of clothing. This can be really important for some women.* Particularly if the room is gently lit and noise is minimal, water changes the perception of light and sound, distorting it, and enhancing the ability of women to regress into themselves. Regression is an important feature of a healthy and easy birth. Michel Odent and Sarah Buckley emphasise the importance of the reduction of neo cortex activity for labour to progress normally and in our highly stimulated environments, immersion in water, and the way it distorts sound and light, enables women to withdraw more easily. Once again, the importance of the overall environment and the role of the woman’s carers most be noted.
The Spiritual Benefits of Water
Many of us now live in highly secularised cultures, however, water has been a keystone of spiritual belief and ritual across the world linked to death and birth, creation and chaos, and the passage though significant life events. For many, there seems to be a deep and often unconscious connection with water, and women can be drawn to it. As a spiritual person, I personally was aware that there was a deep and profound connection that I found through water to a self/a soul that gave me the strength to birth beautifully (I cannot describe it in words which is the very nature of deep spirituality) and which had a profound and lasting effect on my life and my sense of purpose. Dianne Garland, although not professing to be a spiritual person, talks about the importance of this aspect of water to women and birth, discussing ‘the water goddess affect’, the deep belief in water’s ‘healing properties’ (maybe without awareness), of ‘swimming with dolphins’ and the work of Ray, Odent and Wielder regarding ‘spiritual regression’ or ‘spiritual zoning out’. She goes on to say that it reminds us that “water is a healer: we are nourished in it, born into it, return there to relax and exercise; we are made up of water and drink it to survive.” (Garland 2011:62)
So why waterbirth? At a clinical level immersion in deep water is a safe and effective method facilitating an easy birth and providing pain relief. But in the experience of women and in the observation of their carers there is a deeper psychological and spiritual impact in which women are able to accept, initiate and transform the major physical, emotional and life event they are passing through. As always in these circumstances, waterbirth is part of a package, its full benefits require a conducive environment of quiet, privacy, low lighting and compassionate sensitive care.
* Eg. JA McKenna and G Symon In Water VBAC: Exploring the frontiers of women’s autonomy (2013) interviews with 8 women about the VBAC in water experience. Also
H. Richmond; ‘Women’s experience of waterbirth’ Practising Midwife 6(2) (2003)
Dianne Garland: Revisiting Waterbirth an Attitude to Care (now revised and updated May 2017)
Michel Odent: Do we need Midwives? (2015)
Michel Odent: Water and Sexuality (1990)
Sarah Buckley: Gentle Birth, Gentle Mothering (2009)
Daniel Everett: Don’t sleep there are snakes (2008)
S Ray: Ideal Birth (1986)
I Wielder: Inward Jouney- Outward Bound (1999)
Royal College of Obstetricians and Gynaecologists: Patient Information: Why your weight matters in pregnancy and after birth (2011)
NICE Guidance: Weight management before, during and after pregnancy Public health guideline [PH27]: July 2010
https://evidencebasedbirth.com/waterbirth/ Written as a response to the ACOG statement on waterbirth it is nevertheless packed with evidence and research references on safety and benefits.