Powerbirth Las Vegas Homebirth Midwife on Waterbirth
This is the ideal tub to be in during the hardest part of labor when water is indeed very soothing. Water relieves pain. I've used water as a pain reliever for the 51 years I've practiced midwifery.
But, the women I help don't usually want to, or need to, get into the water until they are 5-6 cm's dilated.
Notice that I am talking about a bath tub- usually available in every home. It's so much easier to keep the tub water warm and clean than the plastic water birth tubs being promoted today.
In a bath tub, mothers can lean back and relax without floating helplessly in buoyant water, which is NOT a beneficial way to labor, despite the claims being made today.
In the bath tub, moms belly rises out of the water, allowing gravity to aid in the descent and eventually expulsion of her baby (on land). However, her body is covered by warm water everywhere else, relieving the pain of the hard contractions without interfering with gravity.
Water is anti-gravity. If you try pushing a ball down into the bottom of a swimming pool, what happens when you let go of it? Right- it pops up to the top immediately. How exactly does water aid the baby's descent then? Water births increase labor and birth time hours and days longer than normal land births. That's why the mother's belly being out of the water in a bath tub is so great, yet her cervical area is under the nice warm water, helping her relax.
3. Probably THE most important reason for you to birth on dry land is because of how the body is designed to take its first breath at birth. THIS IS IMPORTANT! At the end of labor, the baby has been pushed into the lowest and tightest part of the mother's pelvis. This is when I most often hear decelerations (lowering) of the unborn baby's heart rate. Why does this happen? Well, because the head is being really squished hard at this point and very often the baby's cord is also being squished (compressed), often wrapped tightly around the baby's neck or body. When there is a lowering of heart rate, the baby's brain stimulates the adrenals of the mother, baby, and midwife to get the baby born more quickly. I've seen this happen thousands of times, so it doesn't matter to me if the textbooks mention it, or not- it's a fact- and I respond accordingly by helping the mother birth her baby as quickly as possible by pushing in the best position possible:
As soon as the baby's head is born, there is a momentary pause before the shoulders are released. If I hear a slowing of the baby's heartbeat (I monitor after every contraction at this stage), I instruct the mother to push immediately, whether there is a contraction, or not. When she begins to push, the contraction starts anyway. Time is of the essence for the baby at this point. Shoulder dystocia is not a problem (I'll explain that in another blog) when mom is in this position. As soon as she pushes, the baby is born quickly!
The baby is stimulated to take its first breath when it hits the cold air and when the chest is allowed to expand (on land). This cannot happen in water.
I have used water for 51 years to help women relieve pain in the hardest part of labor. But I use the bathtub. And I do not recommend that women give birth in the water. They always get out when they are 8 centimeters and give birth on the floor. The floor is covered with a clean plastic shower curtain, on top of which I place clean plastic backed bed pads. I bring with me a firm bed pillow so that mom is supported in a semi upright position for birth.
On either side of her are companions who help support her legs in a way that opens her pelvis as much as possible to help the baby come out easier. I posted a picture in an earlier chapter of this position. It really makes birth so much easier for her.
If the baby has shoulder dystocia, it is easy to get the shoulder dislodged from underneath the pubic bone by pressing down on the baby’s head and when the shoulder releases, to lift the baby’s head in an upwards direction to help it get born completely in a swift and safe manner.
It’s very hard to do this in water because water is anti-gravity and way too buoyant. Have you noticed how when you are in a swimming pool and playing with a ball, how hard it is to push the ball to the bottom of the pool? What happens? The ball comes popping up to the surface right away. The same happens during labor if the mother’s belly is totally under water. It delays birth.
When I use the bathtub, the mother is lying back against the curved end of the tub and her belly is sticking out of the water, allowing gravity to help the baby move downward deeper into the pelvis. That doesn’t happen in a water birth. That’s why water births take a longer time for birth to happen. And, if the baby has tight shoulders that won’t release easily, the water makes it even harder for the baby to get born. That is dangerous when the baby’s head is out in the water because if the shoulders don’t come right away, the baby will try to take a breath and likely aspirate water into its lungs.
Water birth advocates don’t always tell you the truth about the dangers that are also possible in water births. Complications do happen more often than you are told.
This is how a good laboring tub should look like, not the plastic kiddie pools they sell today.
But the pregnant mother still needs to get out of it to birth on dry land, in the air.
Babies can aspirate the water and that is a fact. That is dangerous. Just because many babies escape that fate doesn’t mean all of them will, nor do they. Is it worth taking that risk with your baby when all you have to do is get out of the water?
Today the number of women getting epidurals is 60-70% (some say it’s 80%) and the number of women giving birth by cesarean is 32%. There are very few women giving birth without medications in the hospitals and who are not being induced. So, I do understand why water births have become so popular.
It’s okay to labor in the water, but wise not to get into the tub too early. It’s also important to hire a midwife or other caregiver who knows how to monitor the baby’s heart during labor. That is very important because it will tell you how your unborn child is handling the contractions. It is also very important that you hire a midwife who knows how to check cervical dilation when you want to know how you are progressing. It is also important for you to bear down/push/grunt when your body gives you the signal- do it without fear because it is a natural urge. I have written about it in depth in the previous chapters in this book. And again, I must reiterate- get out of the tub when it is time to give birth.
European Midwives are amongst the best trained midwives in the world. They only accept students into their midwifery training programs who have the highest grades from school.
With that being said, I recently ran across an article by Gail Hart called The Cultural Differences in Waterbirth Practices.
American midwives are unaware that Europeans do water births differently from American midwives. Many European midwives are upset at that difference and would like us to change how we do water births. (I agree with them).
The Temperature of the Water is too hot. According to Gail, she says “As a result, some water-born babies seem a bit slow to come around. They just don’t seem interested in breathing for a while.”
Some believe that this slow transition is normal in water babies— (It’s not normal in land babies) and many propose using a modified Apgar for water born babies because they are “just slower to start.”
The Europeans believe this U.S. temperature is not “physiologic” and that the mothers are “enervated”- drained of energy. They believe that babies are born “non-vigorous” because of the relaxant effect of the heat. They also believe that the overly warm water interferes with the signals the baby should be receiving during second stage, which will trigger him to breathe when he is fully exposed to air. They say that cooler water on the scalp plays the same role as air on the scalp during crowning. The Europeans believe that water in second stage or birth should be at a comfortable “swimming pool temperature,” not at “bath temperature” or “body temperature.” They recommend tepid-to-cool water and are a bit horrified that U.S. births take place at bath temperature.
Recommended Transition from Water to Air according to Europeans:
The other major difference in waterbirth teaching is that most United States midwives and mothers remove the baby from the water very rapidly after birth and bring the whole baby out of the water. European practitioners recommend letting the baby “acclimatize” under the water for a moment—a few seconds to as long as 10 or 15 seconds. They also strongly insist that the baby be lifted slowly from the water.
Transition is different for water and air—unless baby is brought up slowly.
What causes a baby to breathe? It is not emergence from the womb; it is emergence into air, which permits oxygen to contact the skin, sending signals to the placenta, which then raises the CO2 level. The rise in CO2 is the trigger to begin to breathe.
The baby in a land birth gets those signals to breathe, with a drop in oxygen and rise in CO2, all the way down the birth canal as soon as scalp is close to the opening of the vagina- the whole time the head is emerging and then during the moments or minutes it takes for release of the shoulders and the birth of the body. A baby being born is well into the transition process.
A baby who is born in water does not get this signal. The baby born in water has a higher oxygen blood level (yes, this is proven fact) and thus has a lower CO2 level. These babies have not been getting exposure to air on their skin on the way down the birth canal or after head immersion in the water and will not be exposed until they emerge from the water and into the air.
Europeans recommend lifting the baby from the water face first. They also encourage moms to hold babies with just the face emerged for a while before lifting them fully from the water.
We can get a faster transition if we mimic air birth by bringing the baby into exposure to air in stages: First, bring the face out of the water and wait there … then the rest of the head and wait there … and when baby is responsive and breathing, then bring the rest of the body out of the water???????????????????? My question again- Why not just get out of the water for birth, then you don’t have to mimic anything!
Gail says, “This is very different from what we do. (Most of us “snatch” the kids up as fast as we can get our hands on them! Baby is held by mom—often facing her chest—with the baby’s entire body exposed to air in almost a split second, rather than the gradual process we see during a land birth.)”
I say if a mom snatches her baby up that fast, her common sense and intuition knows her baby shouldn’t be born underwater.
The Europeans are correct. The babies are born more vigorous: Awake, alert, responsive, and fully ready to breathe when you birth in water the European way. But so are babies born on land.
The great thing about bathtubs is that the mother can have the water as hot as she wants it during labor, knowing her baby will never be hurt by the heat because her belly sticks out of the water when she leans back against the tub and only her lower abdomen and her back are submerged in the relaxing hot water. AND when she gets out of the tub when she feels birth is near, the baby will be born safely on land.
I make it clear to pregnant parents that I do not participate in water births. In my opinion, as I have already stated, they are dangerous for the baby. I have had several women who I have attended before as a midwife, tell me they want a water birth this time, even though they know my feelings about it. So, okay, they are my friends and I want to help them have the kind of birth they want. But I also know what to watch for and monitor the baby carefully. If necessary, I will intervene to save the baby. They have no objections to that, obviously, as we all want a good outcome for both mother and baby!
One of these pregnant women, set up a birth pool in her bedroom. She had already had one successful land birth with her first baby, but pain seemed to be what she wanted to avoid with this second baby. The only problem was her husband couldn’t keep the pool water warm enough. He and a helper rushed back and forth from the kitchen hauling huge pots of boiling water to the bedroom to keep the pool water hot enough. It seemed ludicrous to me that they seemed oblivious to the bathtub right off the bedroom where all they had to do was turn on the faucet and fill it with water whatever temperature was most comfortable for his pregnant wife. But the water birth fad seemed to have taken over their common sense.
So, I just watched her and monitored the baby’s heartbeat. When she asked me to check her cervical dilation after two hours of this scenario, I told her she was still 4 centimeters, which she had been when she first got in the tub.
Now she was really discouraged, freezing cold because her husband couldn’t keep up with boiling the water, and tired. I suggested her husband fill up the bathtub with nice warm water, and asked her if she didn’t want to get into it now?
Of course, she said yes. Once in the tub, she leaned back against the slanted side and relaxed. I suggested she spread her thighs apart and lift her legs up with the next contraction if she felt like it, and to bear down a little bit with the contraction if she had the urge to.
She was only in the bathtub for 45 minutes, or so, and wanted to get out and wanted me to check her again because her contractions were coming close together and were very strong. I had already set up the birth area on the floor as I always do and that is where she let me check how far dilated she had gotten in the tub.
She was now five centimeters dilated and her cervix was as thin as paper. Birth was near! She, however, started hollering, saying she wanted to go to the hospital because the contractions were now coming one after the other and she did not like the pain.
I told her she could go in if she wanted to, but the baby would be born in the car if she left now. But as I predicted, with the next contraction, she went from 5 centimeters dilation to literally pushing the baby out before I could even get on a glove.
Her husband came running into the bedroom with their older son, who he had been tending to, and was totally surprised, but happy, that the baby was here. So was my client. She couldn’t believe she gave birth to him that fast. They were both happy that they didn’t end up in the hospital.
I have had a couple of other pregnant women repeat a similar scenario with their birth pools. They are a waste of time, in my opinion. Get in your bathtub for the hard part of labor and get out when it’s time for birth!
One lady was planning a hospital birth because her husband was afraid of a home birth, so she hired me to labor sit with her and tell her when she should head for the hospital, not wanting to go in too soon.
When she got to four centimeters, I told her that she should leave now or she wouldn’t make it in time.
She didn’t want to go in yet and as long as her husband didn’t say anything, she was happy to stay at home. So she went and jumped into their jacuzzi pool in the back yard and literally within minutes, her baby’s head was born under water.
I wasn’t prepared for a water birth but had no choice but to jump into the pool with all my clothes on because that baby was not coming out any further. His shoulders were stuck and as hard as I tried to get them to release, the water was anti-gravity and they wouldn’t dislodge even with my effort.
I yelled for her husband to jump in the pool and help me lift his wife out onto the side of the jacuzzi- onto the hard cement, which he did very quickly. As soon as we laid her down on her back, with a little downward pressure on the baby’s head, he came right out.
She was happy she had her home birth and the husband was happy both mom and baby were fine.
One more mom whose other children I had all delivered was pregnant with her last baby. She wanted a water birth this time in her spa like huge tub. So, okay with me until she was in the water for a much longer time than she had been in labor with the other children.
I said nothing to her when labor dragged on, waiting for her to tell me when she was tired and ready to get on dry land next to her spa, where I had already set up the usual birth area I used for exams and for birth.
She finally said, “I can’t stand anymore of this. Will you check me?”
She got out of the water and laid back on the area on the floor where I had set up my equipment. I checked her dilation- she was 7 centimeters. As I was checking her dilation, she had a contraction that was very strong- she went straight to full dilation and the baby came right out with very little pushing effort on her part.
Water is great for pain relief, but birthing the baby in water is not natural and never will be. No other primates give birth underwater.