Waterbirth has a long history spanning more than 200 years in written record. The earliest record of a waterbirth in the western world was in France in 1803 when a woman, after 48 hours of labor, was encouraged to enter a bath by her physician (Gondinet, 1804). Fifteen minutes after immersion, the woman delivered a healthy newborn into water without interventions or complications (Bertram, 2000; Gondinet, 1804). In the early 1960s, waterbirth became popular in the Soviet Union where Igor Charkovsky began experimenting with waterbirth and neonatal adaptations to water (Church, 1989). In the early 1980s, intrapartum hydrotherapy spread throughout Europe spearheaded by French obstetrician Michel Odent and Belgian obstetrician Herman Ponette (Bertram, 2000; Mackey, 2001; Odent, 1983; Ponette, 1996).
17 Years 2500 water births without incident
Laura J. Valle, DNP, APRN-CNM
In the United Kingdom, the RCOG and the RCM fully support a woman’s choice of using a birth tub during their labor and delivery if the woman is healthy and the pregnancy is uncomplicated (Alfirevic & Gould, 2006). Further, they endorse maternal choice in childbirth as a human right and believe that the use of waterbirth encourages a woman-centered approach (Harding, Munro & Jokinen, 2012).
My experience as St. Thomas’ Hospital in London was one of exponential growth and knowledge attainment. The midwifery and nursing models of care in the U.K. are quite different than in the U.S. Midwives are the main providers of low risk, normal maternity care and there are no labor and delivery nurses in the maternity units. Rather, the care for women in labor and birth is one-to-one midwifery care with midwifery assistants or midwifery students assisting. Women are able to labor and birth in the pools at St. Thomas’ Hospital. The pools usedwhen I was there were permanently affixed in the middle of the room, oval in nature, and deep. Women reported that the pools provided them with a sense of privacy, security, and warmth during their labors and deliveries. Women using hydrotherapy during their labors and births were able to change position easily, had fewer interventions, and were easily monitored via handheld, waterproof dopplers.
Waterbirth is prevalent in the United Kingdom due in part to their national evidence-based campaign to normalize birth by reducing unnecessary interventions and increasing spontaneous vaginal birth rates (Burns et al., 2012). As part of the Normality for Labour and Births campaign, water immersion in labor and delivery is promoted as one of the top ten tips for women to use as an active birthing position that increases the chance of having a spontaneous vaginal birth while decreasing the chances of having interventions during birth (Royal College of Midwives, 2014). This was supported in Chaichian and colleagues’ (2009) RCT where they found that all of the women experiencing a waterbirth gave birth spontaneously, while only 79.2% of those who had a conventional birth had a normal spontaneous vaginal delivery.
Waterbirth was introduced in the United Kingdom, as well as the United States, in an effort to swing the pendulum back towards normal vaginal birth (Burns, 2001; Rosenthal, 1996). Waterbirth was utilized to reduce the rising, routine use of obstetric interventions; the rising costs of maternity care related to epidural anesthesia use and cesarean sections; and the increasing rates of instrumental and cesarean births (Chaichian, Akhlaghi, Rousta, & Safavi, 2009; Church, 1989; Cluett & Burns, 2009; Rosenthal, 1996). Waterbirth also provides a safe and private space for women to birth gently without invasive interventions (Akhlaghi et al., 2009; Maude & Foureur, 2007). Both the Royal College of Midwives (RCM) and Royal College of Obstetricians and Gynaecologists (RCOG) continue to support the use of water in labor and birth. The RCM and the RCOG published a joint statement in 2006 in support of autonomy, informed choice, and waterbirth (Alfirevic & Gould, 2006). The RCM and RCOG stated that while there is documentation of rare but serious neonatal complications, their review of the overall neonatal waterbirth data is reassuring, and that women “who make an informed choice to give birth in water should be given every opportunity and assistance to do so by attendants who have appropriate experience” (Alfirevic & Gould, 2006, p. 2).
Why Waterbirth is Important
Childbirth is a life-changing event that can have long lasting physical and emotional effects on a woman and her newborn (National Institute for Health and Care Excellence, 2014).
Waterbirth has been shown to increase levels of satisfaction with childbirth and the overall birthing experience (Akhlaghi et al., 2009; Cluett & Burns, 2009). This higher rate of satisfaction has been attributed to women feeling more in control of their body and the birth process while in water (Aird, Luckas, Buckett, & Bousfield, 1997; Akhlaghi et al., 2009; Richmond, 2003). Women were also more satisfied with their birth experiences when their feelings and concerns were listened to, their autonomy was respected, and they had control of the decision making surrounding their birth choices (Akhlaghi et al., 2009; Wu & Chung, 2003).
In Brown (1998), a birthing tub was installed within their maternity unit in England in response to women wanting to have a choice in how they birthed, and desiring control over their own birth process. Women who feel in control of their childbirth experience demonstrate long-term satisfaction beyond childbirth and mothering, including feelings of accomplishment and enhanced self-esteem (Green, Coupland, & Kitzinger, 1990; Simkin, 1991). Women also tend to have more positive psychological outcomes in the postpartum period when they feel in control of themselves and their environment (Green, Coupland, & Kitzinger, 1991). A woman’s satisfaction with her childbirth experience has the ability to contribute to long-term health and well-being and is a pivotal event that a woman will remember for the rest of her life (Ferguson, Browne, Taylor, & Davis, 2016; Simkin, 1991).
After working in London, I returned to the United States to complete my Master in Science in Nursing to become a nurse-midwife. Whilst my waterbirth knowledge and experience advanced in Europe, I returned to the U.S. after almost four years to find that no progress had been made at my hospital, or surrounding hospitals, to provide waterbirth as an option for women. In fact, the only option for a waterbirth where I lived was for a woman to have a homebirth.
My passion for women centered care, women’s choice in labor, women’s autonomy, and shared decision making have propelled me to finish a Doctor of Nursing Practice degree and to pursue a PhD exploring shared decision making in maternity care. In my research I have found that waterbirth is a safe and viable option for women to exercise control over their birthing experience and experience autonomous choice in mode of delivery. While there is a paucity of level two evidence or randomized controlled trials, large observational studies have shown that waterbirths in low risk women who are attended by trained and experienced professionals are as safe as conventional births with no increased risk to neonates (Bodner et al., 2002; Brown 1998; Davies et al., 2015; Demirel et al., 2013).
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Aird, I. A., Luckas, M. J., Buckett, W. M., & Bousfield, P. (1997). Effects of intrapartum hydrotherapy on labour related parameters. Aust N Z J Obstet Gynaecol, 37(2), 137-142.
Akhlaghi, A., Kasiri, H., Nikzad, E. S., Chaichian, S., Fekrat, M., & Mehdizadeh, A. (2009).
Comparison of waterbirth with conventional vaginal delivery: A non-randomized controlled trial from Iran. Paper presented at the European OB & GYN Conference, Tel Aviv, Israel.
Alfirevic, Z., & Gould, D. (2006). Royal College of Obstetricians and Gynaecologisits and the Royal College of Midwives Joint Statement No. 1: Immersion in water during labor and birth.
Retrieved from https://www.rcm.org.uk/sites/default/files/rcog_rcm_birth_in_water.pdf
Bertram, L. (2000). Choosing waterbirth: Reclaiming the sacred power of birth. Charlottesville, VA: Hampton Roads Publishing Company, Inc.
Bodner, K., Bodner-Adler, B., Wierrani, F., Mayerhofer, K., Fousek, C., Niedermayr, A., & Grunberger, W. (2002). Effects of water birth on maternal and neonatal outcomes. Wien Klin Wochenschr, 114(10-11), 391-395.
British House of Commons. (1992). Health Committee. Maternity services. Second report. London: HMSO.
Brown, L. (1998). The tide has turned: Audit of water birth. British Journal of Midwifery, 6(4), 236-243.
Burns, E. (2001). Waterbirth. MIDIRS Midwifery Digest, 11(Supplement 2), S10-S13.
Burns, E. E., Boulton, M. G., Cluett, E., Cornelius, V. R., & Smith, L. A. (2012). Characteristics, interventions, and outcomes of women who used a birthing pool: a prospective observational study. Birth, 39(3), 192-202. doi:10.1111/j.1523-536X.2012.00548.x
Chaichian, S., Akhlaghi, A., Rousta, F., & Safavi, M. (2009). Experience of water birth delivery in Iran. Arch Iran Med, 12(5), 468-471.
Church, L. K. (1989). Water birth: one birthing center’s observations. J Nurse Midwifery, 34(4), 165-170.
Cluett, E. R., & Burns, E. (2009). Immersion in water in labour and birth. Cochrane Database Syst Rev(2), CD000111. doi:10.1002/14651858.CD000111.pub3
Davies, R., Davis, D., Pearce, M., & Wong, N. (2015). The effect of waterbirth on neonatal mortality and morbidity: a systematic review protocol. The JBI Database of Systematic Reviews and Implementation Reports, 13(10), 180-231. doi:10.11124/jbisrir-2015-2105
Demirel, G., Moraloglu, O., Celik, I. H., Erdeve, O., Mollamahmutoglu, L., Oguz, S. S., . . . Dilmen, U. (2013). The effects of water birth on neonatal outcomes: a five-year result of a referral tertiary centre. Eur Rev Med Pharmacol Sci, 17(10), 1395-1398.
Gondinet, M. (1804). Convulsions epileptiques. In M. Baumes (Ed.), Annales de la société de médecine-pratique de Montpellier pour l’an XII. Montpellier, France: Jean-Germain Tournel.
Ferguson, S., Browne, J., Taylor, J., & Davis, D. (2016). Sense of coherence and womens birthing outcomes: A longitudinal survey. Midwifery, 34, 158-165. doi:10.1016/j.midw.2015.11.017
Green, J. M., Coupland, V. A., & Kitzinger, J. V. (1990). Expectations, experiences, and psychological outcomes of childbirth: a prospective study of 825 women. Birth, 17(1), 15-24.
Harding, C., Munro, J., & Jokinen, M. (2012). Evidence based guidelines for midwifery-led care in labour: Immersion in water for labour and birth The Royal College of Midwives. Retrieved from https://www.rcm.org.uk/sites/default/files/Immersion in Water for Labour and Birth_0.pdf.
Johnson, P. (1996). Birth under water–to breathe or not to breathe. Br J Obstet Gynaecol, 103(3), 202-208.
Mackey, M. M. (2001). Use of water in labor and birth. Clin Obstet Gynecol, 44(4), 733-749.
Maude, R. M., & Foureur, M. J. (2007). It’s beyond water: stories of women’s experience of using water for labour and birth. Women Birth, 20(1), 17-24. doi:10.1016/j.wombi.2006.10.005
National Institute for Health and Care Excellence. (2014). Intrpartum care: Care of healthy women and their babies during childbirth. NICE clinical guideline 109. Retrieved from guidance.nice.org.uk/cg190.
Nutter, E., Meyer, S., Shaw-Battista, J., & Marowitz, A. (2014a). Waterbirth: An integrative analysis of peer-reviewed literature. J Midwifery Womens Health, 59(3), 286-319. doi:10.1111/jmwh.12194
Odent, M. (1983). Birth under water. Lancet, 2(8365-66), 1476-1477.
Ponette, H. (1996). Water-births: My experience of 1600 water-births, including breeches and twins. Issued from the study center for perinatal epidemiology. Acquarius, 1-9.
Richmond, H. (2003). Women’s experience of waterbirth. Pract Midwife, 6(3), 26-31.
Rosenthal, J. (1996). The use of water immersion in labour at the Family Birthing Center of Upland (California). In B. Beech (Ed.), Water birth unplugged: Proceedings of the first International Water Birth Conference (pp. 92-95). Cheshire, England: Books for Midwives Press.
Simkin, P. (1991). Just another day in a woman’s life? Women’s long-term perceptions of their first birth experience. Part I. Birth, 18(4), 203-210.
Turner, J. R., & Turner, T. G. (2000). Birth in the 21st century: Notes from a visit to the new aquatic maternity centre, Ostend, Belgium. Midwifery Today, 54, 19-20.
Wu, C. J., & Chung, U. L. (2003). The decision-making experience of mothers selecting waterbirth. J Nurs Res, 11(4), 261-268.