FAQs for Professionals

As couples become more informed of their options, they are assuming more responsibility for their own birth experience. Hospitals are more cooperative today than ever before as many doctors, midwives and nurses want to make birth more “mother/baby” friendly.

Hospitals are corporations with set policies, but those policies can be amended, changed or new policies put into place. Knowing how and who to approach within the hospital is one of the keys to success. The sooner you start the process, the more opportunity there will be to use water immersion for both labor and birth in a hospital.

Begin your inquiries early and be persistent. Consult with your maternity care provider, first, and assess their experience, knowledge and if they have taken any courses or read research articles about labor and birth in water. Enlist their support for your birth care plan. State that you have chosen to use water as a comfort measure and would like to have a waterbirth if it is appropriate at the time of birth. The birth in water is not, yet, the biggest issue. Setting up the circumstances to allow a waterbirth always come first. That usually means the ability to bring a portable tub into the hospital. If your provider refuses to even consider using water for labor or birth, find a new provider. Nurse-midwives in hospital practices are usually open to accommodating your desires for an undisturbed birth.

The next person to enlist is the nurse manager of labor and delivery at the hospital. The manager is the most influential person to assist in all the policy changes that need to happen. You can call the hospital directly and ask to speak to the nurse manager. If she is able to talk to you, make an appointment. Before your appointment gather all supporting material and have the consent and cooperation of your provider, first. That’s the first question the nurse manager will ask: “have you spoken to your doctor/midwife?” Put together a packet of materials which includes a letter from your provider, a sample policy and some research articles. (It might be a good idea to bring a food item or self-care gift like bath products.) You can give her a list of resources, including our website. Once there is an agreement that a policy needs to be put into place, she will coordinate all the necessary meetings with department heads who all need to agree to a system wide policy change. This process can take up to six months, but sometimes it happens more quickly.

Your job during the implementation of the policy is to continue to advocate for change. You can to talk to other mothers who are pregnant around the same time, or those considering getting pregnant and educate them with the research on water labor and birth that you have done. You might also contact a local birth center or home birth midwife to educate yourself more about childbirth options in your local community.

Discuss other options for comfort management with your partner, your provider and know which of those options are available if the policy does not change quickly enough. Showers, walking, rocking, doulas, dancing, music, soft lights can all be done with or without the availability of a soaking tub. Ask for all those at the same time you are advocating to use a birth pool.

If your hospital offers waterbirth as an option, there is usually no extra cost. Sometimes a hospital will charge a fee for the use of a portable birth pool. You can also purchase your own birth pool for home or hospital use through many different sources. We recommend Waterbirth Solutions.com. The cost for a complete portable birth pool kit is now under $250. Midwives will often provide a birth pool for a small rental fee or they may refer you to a local doula or rental company who provide a number of birth pools for hire within the community.

Some insurance companies do reimburse for the expense of the pool rental or purchase. Parents who have been successful in receiving a reimbursement have asked their provider to write a prescription for the birth pool or to make an order in the chart. Insurance companies view the use of the tub as a “pain management” treatment and are more likely to cover the cost if there is a code associated with the order. If the hospital has permanent birth pool equipment, there is no reason to inform your insurance company that you have had a waterbirth. It doesn’t matter if the baby was born in the bath or on the bed – it is still a vaginal birth.

It has been suggested that the bath be used as a “trial of water” for at least one hour and allow the mother to judge its effectiveness. Midwives report that some women can go from 1 cm to complete dilation within the first hour or two of immersion. Research studies have demonstrated that water is an effective tool to assist irregular contractions to become more consistent or to use water immersion instead of Pitocin for a stalled labor. This reaction is due to an increase in Oxytocin levels and a reduction of stress hormones.

There are four main factors that prevent the baby from inhaling water at the time of birth:

1. The fetus moves the muscles of the chest wall during pregnancy about 40% of the time. Close to the time of labor, the Prostaglandin E2 levels from the placenta rise, which cause a slowing down or stopping of those fetal breathing movements. As the baby is born, the Prostaglandin levels remain high, disabling the baby’s muscles for breathing. The muscles simply don’t work, thus engaging the first inhibitory response.
2. All babies are born experiencing mild hypoxia or low oxygen levels. Hypoxia causes apnea (absence of breathing) and swallowing, not breathing or gasping. The first reflex after a baby is born is to swallow, not breath. The swallowing will allow the fluids that are in the mouth to enter to stomach.
3. Fetal lungs are already filled with fluid. That fluid is there to protect the lungs, and keep the spaces open that will eventually exchange carbon dioxide and oxygen. It is very difficult, if not improbable, for fluids from the birth tub to pass into those spaces that are already filled with fluid. One physiologist states that “the viscosity of the fluid naturally occurring in the lungs is so thick that it would be nearly impossible for any other fluids to enter.” The blood supply to the lungs is also very low during pregnancy and birth. This causes a high pressure within the lungs, thus keeping everything out.
4. The mammalian diving reflex is an inhibitory factor that is present at birth in all humans as well as all mammals. It lasts in humans up to six to eight months. When the face comes into contact with water, the glottis at the back of the throat automatically closes and prevents water from entering the lungs. Any solution that enters the throat is swallowed, not inhaled. This allows babies to also breastfeed without aspiring the fluid into the lungs.

For a more complete description, please read Barbara Harper’s “Birth, Bath and Beyond: The Science and Safety of Birth in Water.”

Remember that physiologically, the placenta is still supporting the baby with oxygen throughout the birth and immediately afterwards. It can never be predicted when the placenta will begin to separate causing the flow of oxygen to stop. The umbilical cord pulsating is not a guarantee that the baby is receiving enough oxygen. The safe approach is to remove the baby, without hurrying, and gently place him upright onto the mother’s chest or hold the baby, suspended with the head out of the water, until the mother reaches down to lift the baby up. Waiting for the mother to return to her conscious brain after her birth journey, allows her to becomes fully present with an overwhelming desire to meet her new baby.

We recommend waterbirthsolutions.com for all waterbirth pools and supplies for parents, waterbirth professionals and institutions. We have worked with them for years and you’ll find their expertise and service second to none.

This is quoted from Evidence Based Birth, by Rebecca Dekker, RN, PhD:

“In 2014, Schafer reviewed all published cases of waterbirth umbilical cord tearing. An umbilical cord tear is also called umbilical cord “snap,” “rupture,”or “avulsion.” Based on their review, they estimated that there are about 3.1 umbilical cord snaps per 1,000 waterbirths. Out of all the cases of umbilical cord snap, about 23% lead to NICU admission, 13% lead to the need for a newborn blood transfusion, and there have been no reports of any long-term harmful effects. Burns et al. (2012) reported 20 umbilical cord snaps in a study with 5,192 waterbirths and 3,732 land births where women left the tub before giving birth. Eighteen out of these twenty snaps occurred during waterbirth. Unfortunately we cannot compare the overall numbers of umbilical cord snap between waterbirths and land births, because other than the Burns et al. (2012) study, there have been no studies that describe how frequently umbilical cord snaps happen on land.”

My conclusion, after interviewing some of the researchers, is that umbilical cord rupture at birth is generally caused by rushing the baby out of the water very quickly. This is precisely why I recommend a slower delivery with a pause to look for cord entanglement and resolving that, insuring that there is enough cord to slowly raise the baby up out of the water and to wait for a few seconds (with the baby’s head out of the water) before lifting the baby or having the mother lift the baby up onto her chest. The safe approach to preventing umbilical cord snapping during a waterbirth is to allow the baby to do the majority of the work of second stage with the mother breathing through the contraction and only bearing down in the last moments. If she bears down continuously, and expells the baby forcefully, that increases the risk of what I describe as “torpedo babies,” who have the increased risk of also snapping their cords if those babies are entangled. Slow the second stage down, bring the baby up slowly and untangle a baby in the water–if there is an entanglement–before raising them up to the surface.

The majority of the babies who have encountered cord rupture do just fine, but a few are put in NICU for observation and even fewer need transfusion. The ideal for every baby is delayed cord clamping, but it is not always possible. Just consider a cord snap an early cord clamping, which is easily preventable by slowing the birth down just a bit.