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How To Use A Birthing Pool

May 21, 2009

 

 

Birthing pools help women to reduce adrenaline levels, adrenaline suppresses the natural hormone 'oxytocin' which is needed to precipitate labour– if labour is long then a birthing pool can be a very good idea. The history of birthing pools actually started with paddling pools.

 

How To Avoid The Use of Drugs

When birth is going well then maybe there is no need to change the strategy by trying to use a birthing pool just because it is there. Dilation can actually progress just by listening to the sound of the water filling the pool. The water environment in general can help a woman to release inhibitions. Many women who do enter a birthing pool during labour could feel the need to get out of the water onto dry land just as the baby is ready to be born. Entering dry land encourages a series of strong contractions.

 

The first breath obviously comes with the contact of the nose and mouth with air.

 

In 1983 the Lancet published a paper on the 100 babies that had been born under water. It concluded that ‘immersion in water is a safe, effective and cheap way to replace drugs in labour’. The NHS pharmacy bill has reduced as a result of birthing pool use and the future generation has been spared the trauma attached to intervention at birth. 

 

But all women contemplating the use of a birthing pool should see it as a possibility and not the objective. 

 

On the 21 August 1999 a turning point in the use of birthing pools occured. A study published in the British Medical Journal (BMJ) by a British epidemiologist(epidemiology: the branch of medicine dealing with the incidence and prevalence of disease in large populations and with detection of the source and cause of epidemics of infectious disease) between April 1994-1996 concluded that 4032 babies born underwater were born within the NHS auspice. There were five perinatal deaths that is babies who died before a week old. But these were not connected to water birth. That is 1.2 per 1000 perinatal deaths. For a while the NHS midwives' protocol was not to let women give birth underwater. But after this research the protocol became much more flexible.

 

Recommendations For Pool Use

1 )Based on immersion in water at body temperature the pool facilities labour during a limited amount of time, that is one and a half hours. 

 

2) The water must be deep enough for there to be an immediate short-term pain relief. Entry into the water lowers the level of stress hormones and makes way for the body to produce more oxytocin. 

 

3) The long term response of entry into the water during labour is that it positively affects the heart. There is a specialised response to the blood flow volume in the body. Any water immersion redistributes the blood volume. When in the water a woman's blood volume in the chest increases which stimulates the heart cells in ‘atria’ (either of the two upper chambers on each side of the heart that receive blood from the veins and in turn force it into the ventricles). A hormone is subsequently released, yes, the heroic ‘oxytocin’. But this only happens when the woman in labour is in the water for up to one and a half hours. The heart is also an endocrine gland (any of various glands, as the thyroid, adrenal, and pituitary glands, that secrete certain substances or hormones directly into the blood or lymph; ductless gland), the hormone of love ‘oxytocin’ is influenced by the heart. However after one and a half hours the oxytocin can be reduced.

 

How To Use The 1 ½ hours As Well As Possible

1) Great importance must be given to the time a woman enters the pool. It is advisable that she does not enter before 5cm dilation. So patience is required however tempting the idea of submersion in water may be. A shower may be used instead (which can stimulate the nipples and oxytocin production) and offer complete privacy.

 

2) Do not to plan a birth underwater. Otherwise you become 'a prisoner of your own project' (Michel Odent).

 

3) The pool should not be too hot or cold. It should never be above 37 degrees C if it is too hot then the temperature of the mother will increase. The temperature of the baby is always 1 degree higher than that of the mother.

 

Epidural Anaesthesia

For your knowledge an epidural anaesthesia (regional anesthesia resulting from injection of an anesthetic into the epidural space of the spinal cord; sensation is lost in the abdominal and genital and pelvic areas; used in childbirth and gynecological surgery) can be a risk factor for foetal distress because the temperature of the woman is disturbed. Sometimes a baby is given antibiotics after the mother has had an epidural forhypothermia (the artificial reduction of body temperature to slow metabolic processes) when there is no infection. It is as a result of the mother's temperature being disturbed. 

 

Ruptured Membranes

Early ruptured membranes does not mean increased risk of infection when using pool. If a woman with ruptured membranes is still dilated the same after 2 hours then this nearly always ends in C Section. Remember: privacy, warmth and unobserved.

My Three Birth Stories And The Use Of Birthing Pools
In 1995 my first son was born under the water in a birthing pool, a super deluxe birthing pool. I do not recall anyone instructing me on the best way to use a birthing pool even though I had paid for independent midwives. My waters broke quite spontaneously at midnight and I found myself entering full blown labour immediately. It took some time for Rachel and Aileen, my two lovely midwives, to arrive but after an hour when they arrived they told me that my son was ready to be born. Prior to their arrival, not knowing what was happening to me and feeling a complete ninny for not being able to deal with what I thought must be pre-labour, I had deliberately not entered the tantalising pool, believing I needed to save it for when it really got bad, even though I could not imagine anything worse than what I had endured. In that hour I sat on the toilet. In hindsight I feel this helped my baby move its head through the cervix speedily (take note). My midwives were surprised to find that my son was ready to be born so quickly and they could feel my fatigue, I had just run a marathon in a hour; they advised me to enter the pool and use it to soothe me and slow down the contractions for the second stage (when the baby traverses down the birth canal). In my second stage, my contractions did miraculously slow down in the water and it was a long leisurely experience by comparison to the first stage. Two and a half hours later my son's head began to crown in the water and within moments he was swooped out of the water to take his first gasp of air. When he was born he was very calm and it felt lovely to caress him in the warm water. I also stayed in the pool until my placenta was ready to be delivered naturally, when I stood up, about another 45 minutes. Up until this time my new baby son spread his limbs and stretched his fingers and toes and lay on his back while I supported his head, he was still attached to the placenta so he could not go very far. It was a very dreamy, watery experience and it felt so clean and unmessy having everything contained in the water. I also believe that the water softened my pernieum so I experienced no tearing. 

In 1997 my second son was also born in the water in another super deluxe birthing pool. His labour and birth were a very different experience. Throughout my six and a half hour labour he seemed 'stuck'. I had instructed my midwives not to tell me if my baby was posterior (the baby's back against the mother's back) but I had a feeling as my labour progressed that he might be. It didn't help that Rachel had told me all though my pregnancy that given my speedy first stage with my first son that I may give birth within an hour with my second. In many ways when my labour began, this is what I came to expect would happen, so I was exhausted when I entered the fourth hour. Be aware of the power of other's words. My midwives sensed my frustration, and Rachel was very tired as she had just come from another birth and she advised me to enter the pool as I needed a change of scene. Having entered the pool, I felt everything slow down and I also began to shiver. I did not know at the time but my adrenaline was rising and my oxytocin was being suppressed by its rise. It felt like I was in the pool for far too long. I remember asking Rachel to leave and asking for her assistant Kim to come in. Kim was a very matter of fact person, although she was an independent midwife I was never sure she liked her job. I had actually asked Rachel not to bring her to my birth. However, Kim was just what I needed at that moment. I asked her not to molly coddle me and give me straight answers, I requested that she give me an internal examination (which I swore I would never have during labour). Kim did something miraculous, she told me that my baby's head was just slightly caught on my cervix and that she had made a little adjustment. Even though I did not feel the urge to push, I saw daylight from behind the curtains and knew that in any moment my first son would be waking. I pushed so hard and my son was born under the water, threaded through my legs as he had a very short cord and brought to the surface. On this occasion I could not wait to get out of the pool, instead I was requested to remain in it and after forty-five minutes I was so cold that I requested my son's cord be cut to encourage release of the placenta, of course my rise in adrenaline as a result of my shivering was slowing down the release of the placenta. Eventually I stood up in the pool and delivered my placenta. I asked Kim what she did to make my baby arrive, she told me she had done nothing at all, I just needed to believe that she had made some kind of adjustment so that is what she told me she had done (the power of the placebo). I am eternally grateful to her for this. I also did not tear again, a result of immersion in the warm water I believe. 

My third son was born in one hour but not in a birthing pool. At fifty minutes into my labour I did get into my much smaller pool because I was at the peak of first stage (when my baby's head was passing through the cervix). However, Michel Odent (natural birth pioneer) came running downstairs to tell me that if I get out of the pool onto dry land my baby would be born in ten minutes. I thought about this once he had disappeared upstairs again, the pool was so warm and inviting and felt like just what I needed to deal with the pain. But I went with what he advised and within ten minutes my son was born explosively, his whole head came out in one contraction, a true foetal ejection reflex. Here I experienced just how powerful dry land could be, especially if just as the baby is about to be born you are supported by someone under your arms so that you can lean back into them and allow the baby to literally just slip out. Again my perineum remained intact, even though my third son was a pound and a half heavier than my first son. The water played no part in this as I was only in it for a minute but obviously my perineum had no scar tissue and was by now used to the stretching effects of birth. I asked Michel Odent if I could get in the pool to deliver the placenta as it always made me feel so relaxed and clean. He did not want me to and he had trouble explaining why to me and instead encouraged me to lie down on the wooden floor with my baby. Very uncomfortable. It was a messy old business giving birth to the placenta on dry land. It definitely feels cleaner in the water, but I learnt there is a minor risk associated with this.

 

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