How to prepare for a water birth

What is a water birth? 

Can I have a water birth? 

What are the advantages of a water birth?

Are there any disadvantages of a water birth?

Is it safe to have a water birth?

What will my midwife do during a water birth?

Where can I have a water birth?

What should I wear for a water birth?

What pain relief can I have in the water? 

Can I have optimal/delayed cord clamping if I give birth in the water?

How do I deliver the placenta if I have a water birth?

When might I need to get out of the pool?

Can I change my mind about having a water birth?

Do I need to book a water birth in advance?

What should I do if I think I would like a water birth?

Lots of women and birthing people choose to give birth in water. Knowing what to expect can help you feel more prepared. 

What is a water birth?

Water birth is the process of labouring and/or giving birth in water using a deep bath or birthing pool.  

Being in water during labour can help with pain and many people find it more relaxing than being out of water. The water can help to support your weight, making it easier to move around and feel more comfortable and in control during labour. 

Can I have a water birth?

Having a water birth is an option for you if you have had a low-risk pregnancy and your midwife or obstetric doctor thinks it is safe for you and your baby. You can talk to them about it at any of your antenatal appointments.

If you do want a water birth, it’s best to let your midwife know as early as possible. Together you can explore if a water birth might be the right choice for you. They will make sure you have the information you need to decide where to give birth.  

There are some situations where a water birth might be considered risky or unsafe. Each local NHS Trust may have their own guidance, but generally it is not advised for you to have a water birth if: 

• your baby is breech (when your baby's feet or bottom are facing downward in your womb)
• you are having twins or triplets
• your baby is pre-term (under 37 weeks)
• your baby has passed meconium (your baby's first poo) before or during labour
• you have active Herpes
• you have pre-eclampsia (a medical condition that causes high blood pressure during pregnancy)
• you have an infection
• you have a high temperature in labour
• you are bleeding
• your waters have been broken for over 24 hours
• you are on a drip to induce your labour
• you are at high risk of having birth difficulties.

If your baby needs continuous monitoring via CTG machine (an electronic monitor) you may be able to be in the water during labour and/or birth if there is a waterproof CTG machine available.

It is your decision where and how you give birth. However, you will probably be advised not to have a water birth if you have any of the risk factors above. This is because it may be difficult to get you out of the pool safely in an emergency. If you have an infection, you may be at risk of passing it on to your baby in the water.

If you are at high risk of bleeding, being in the pool for the birth can be dangerous because it is difficult to measure how much blood has been lost in the water. You may still be able to labour in the pool then get out for the birth.

If you have swabbed positive for Group B Strep (GBS), you may still be able to use a birthing pool if you have been offered antibiotics.  

Ask your midwife if any of the above apply to you. 

What are the advantages of a water birth?

• The warm water can help to relax, soothe and comfort you.
• The support of the water means you can try different positions and move more freely.
• When upright in the water, gravity will help move the baby down towards the birth canal.
• Being in water can lower your blood pressure and reduce feelings of anxiety, making your body more able to release endorphins, which can help ease pain.
• The water can help to improve back pain and ease the feeling of pressure, especially when you are fully dilated.
• Feeling calm and relaxed may help you to feel more in control during labour.  
• People who have a water birth might need fewer interventions (such as help inducing labour). However, more research is needed before we can be sure about this.  

'I was surprised by how warm it was in the water, and so nice and relaxing! They were able to check the baby’s heartbeat while I was inside the pool. I hadn’t eaten so they even made me some toast and my mum had to feed me while I was in the birth pool.' Jade (read her full story)

Are there any disadvantages of a water birth?

You will not be able to have some pain-relief options. For example, you can’t have any opiates, such as pethidine, for about 2 to 3 hours before you get into the pool, and you can’t have an epidural.

You can't use a Tens machine in the birthing pool as there is a danger of electrocution.

The effect of having a water birth on your baby’s temperature is unclear. But your midwife will check the water temperature regularly to make sure it is not too cold or hot. If your baby’s temperature is low, skin to skin contact with you and warm towels will help.

It is uncertain whether being in water during labour affects the risk or severity of perineal tears or other problems for you or your baby.

You might need to leave the pool if there is a complication.

A birthing pool may not always be available if the hospital or birth centre is busy.  

Is it safe to have a water birth?

Lots of research suggests that labour in water is safe if you have a low risk pregnancy and can use a birthing pool.

There have been very few cases of newborn infection and umbilical cord tears after water birth. These conditions can usually be treated and have only been seen in a very small number of people.  

There isn’t enough research to say if water births are less safe or safer than giving birth out of the water. So far, studies show that the health of babies (including the chance of infection) is similar for babies born in and out of the water.

Talk to your midwife if you have any worries or concerns around about having a water birth. They can explain all your options for giving birth so that you can make the right choice for you.  

Can my baby drown if I give birth in water?

Many women and birthing people wonder whether there is a risk of their baby drowning if they give birth in water, but it is very unlikely to happen.

Babies do not need to breathe when they are in the womb because they get oxygen from the blood that comes from their mum through the placenta.  

When they are born in water, their body behaves as if they are still in the womb until they take their first breath of air, at which point their lungs open. As a baby comes from water (in the womb) into water (in the birth pool), the lungs are not open and no water can get in.

After your baby is born in the water, you and your midwife will bring them to the surface slowly. Your baby will only be under the water for a short time and won’t take a breath until they are out of the water.  

Your baby is only at risk:

• if their head is brought above the water and brought down again
• if their oxygen supply from the placenta is affected
• if their temperature changes suddenly.

Your midwife will be careful to make sure this does not happen. 

What will my midwife do during a water birth?

Throughout labour, your midwife will monitor you and your baby very often. They will regularly listen to your baby’s heartbeat and monitor your blood pressure, temperature, and pulse. Your midwife will also keep checking the temperature of the water to make sure you are comfortable.

Your midwife will be trained in how to use a birthing pool. Each local NHS Trust may have their own guidance on using the pools. This will include guidance on keeping the birthing pool clean.

Where can I have a water birth?

• At home, with a hired birthing pool.
• In a birth centre.
• On the labour ward.

You can work out together with your midwife where it might be best to have a water birth. Let them know where you would prefer to give birth. They will be able to let you know about the facilities in your local area.  

Find out more about where you can give birth.

What should I wear for a water birth?

Whatever you feel comfortable wearing on your top half is fine, keeping in mind that you will be in what is essentially a large bath. Many people choose to wear a bikini or tankini. Others choose to just wear a bra. You can wear a t-shirt or vest top if you want to be a little more covered. It can be twisted up and tucked into the neck if it’s very long. Some people prefer to be naked.  

It is best to take your bottom half off so that the midwife can see what is happening as you approach birth. However, if you wish to leave your pants on until that stage, that is fine too. 

What pain relief can I have in the water?

Water is sometimes referred to as ‘nature’s epidural’ or ‘aquadural’, because of the support and pressure it gives you. However, if you need a little extra, it is common to use gas and air (Entonox) while you are in the birth pool. The Entonox tubing is waterproof. 

Find out more about pain relief during labour.

Can I have optimal/delayed cord clamping if I give birth in the water?

Delayed cord clamping (DCC) is when your midwife waits 1-5 minutes before cutting the cord after your baby is born. Most birth centres, labour wards and home birth teams will try to do DDC for every birth. 

Waiting until the blood from the placenta has stopped going into your baby can increase your baby’s iron levels and the amount of stem cells they have. This can help with your baby’s growth and immune system. Although many hospitals and birth centres wait to cut the cord anyway, you can add this to your birth plan just in case your hospital does not.

The only reason DCC would not happen is if you or your baby are suddenly unwell just after birth. If the baby is slow to breathe, or you are bleeding more heavily than normal, the midwife may need to cut the cord earlier than usual.

You and your baby’s safety during and after a water birth is very important and this will always take priority. 

Find out more about delayed cord clamping.

How do I deliver the placenta if I have a water birth?

You can deliver the placenta in or out of the water, unless your midwife advises that staying in the pool could be risky for you. Your midwife will keep assessing you to make sure it is safe for you to be in the pool. Do talk to your midwife about your preferences. 

You can be given an oxytocin injection to speed up the delivery of the placenta in the pool. Your thigh or bottom will need to be slightly raised out of the water for this to happen. 

Find out more about the third stage of labour. 

When might I need to get out of the pool?

These are some of the reasons why you might have to come out of the pool during a waterbirth:

• The midwife sees meconium (when the baby does a poo whilst still in the womb).
• You start to bleed heavily from the vagina.
• Your labour becomes abnormal, for example, you have changes in your temperature or blood pressure.
• Your baby’s heart rate changes.
• You need to go to the toilet (you can leave and return).
• Your midwife needs to examine you internally to check your progress.
• Your labour slows down or if your contractions get weaker.
• You want to use different pain relief.
• Your midwife feels it is safer for you or your baby. 

Can I change my mind about having a water birth?

Yes. Even if it is in your birth plan, if you decide you don’t want to get into the pool then you don’t have to. If you get in the birth pool and don’t like it, you can get out again.

Do not be worried about changing your mind. Midwives are happy to support you as long as you and the baby are safe. 

 

'I’m so glad I went for a water birth and would definitely recommend it! If I have another baby in a few years, which I hope to do, I'm really hoping the birthing pool is available for me to use again!' Jade (read her full story)

 

Do I need to book a water birth in advance?

If you think you would like a water birth you should talk to your midwife as early as possible. However, as you don’t know the exact day you will go into labour, you cannot book a birthing pool in advance. This means that if you are planning on having a water birth in a hospital or birthing centre, there is no guarantee that a birthing pool will be free when you go into labour.  

As soon as you go into labour, let your maternity unit know that you would like to use the pool. Your maternity team will always do their best to make sure you have the birth you want.  

What should I do if I think I would like a water birth?

Talk to your midwife as soon as you know you’d like a water birth. They will be able to help answer any questions and you can work together to decide if a water birth is the right choice for you.