Laboring and birthing underwater offers many advantages and is becoming more and more popular all over the world. There are many hospitals in England and the United States that are even offering waterbirth, or at the very least laboring in a jacuzzi or birth pool. Several hospitals in Israel are now offering jacuzzis to labor in, but at present birth in water is not allowed. Many homebirth midwives in Israel are offering the option of waterbirth. Some of these midwives own portable pools themselves or rent them out. I have done many waterbirths in my jacuzzi bathtub in my clinic, and own one portable pool that I rent out . This pool was made especially for waterbirth and was bought from The Active Birth Centre in London, England .  I also sell an inflatable pool that is perfect for waterbirth and very reasonable and easy to use.  You can keep it after for your next birth or use it to enjoy with your children.

The advantages of waterbirth are many. Mainly, women tell us that it tremendously helps them cope with the pain of labor and minimizes the burning and stretching feeling during pushing. Water is a very therapeutic agent and immersion in water provides pain relief and increases the bodies natural secretion of endorphins, which are paramount in coping with pain as they are the natural “morphine” of the body. Women say that they feel a sense of weightlessness and feel safer and securer in the water, and their ability to relax is greatly enhanced. When we dim the lights, have soft music in the background, and some candles and nice smelling aromatherapy, and the woman is not disturbed at all, she is able to find her most primitive place and in this most private and intimate and calm environment, she loses her inhibitions and flows with her bodies birth energy. Of course, her partner can go in with her if requested. The birth pool is wonderful as it has a sturdy metal frame that she can grasp for support. It is wide enough that she can adopt a variety of positions, including upright squatting and kneeling, side lying and sitting, and on all fours. It is deep enough to cover her uterus. It is usually about 56 cm. deep. The warm water is so soothing to her lower abdomen and back, just where it hurts. Some say that there is less tearing in water as the warm water helps to relax the perineal muscles. Often births are much quicker when the woman who is in strong active labor with a dilation of at least 4 cm. enters the birth pool. The endorphin release and the relaxation causes a reduction of the stress hormone, adrenaline, and this in turn enhances the flow of oxytocin so that the uterine contractions are stronger and more effective, although pain is perceived as less. If there is access to a jacuzzi, this is also very helpful as the jets can be positioned to massage the lower back or abdomen and provide relief. The problem with most of the jacuzzis in Israel is that they are just bathtub types and are too small to move around in or not deep enough to cover most of the abdomen. It is important for the women to have showered at some time before she enters the bath or pool, to ensure cleanliness. Same with other people who will enter the pool.

Deep immersion seems to be a key factor. If the pool or bath is not deep enough, at least providing water up to breast level and completely covering the belly, then the benefits of the bath may be less noticeable,. The warm water will still provide comfort and the mother will benefit from the upright position, but full immersion promotes more physiological responses, especially a redistribution of blood volume, which stimulates the release of oxytocin and vasopressin.

It is unwise to enter the pool if you are not in active labor and if your dilation is less than 4 cm. as the relaxation of the water can slow down contractions and make the birth longer. Although it is tempting to use the pool, wait until you are at least 4 cm. before you go in for maximum pain relief and enhancing labor progress.

The temperature of the water should be should be warm and comfortable but not too hot, and never above 38, as this could cause dehydration and increased heartbeat in the baby as a response to the heat. It is normal however, to have an increase in the babies heart rate but it should not be consistently over 160 for a long period of time.

The big question in everyone’s mind is: How does the baby start to breathe during a waterbirth? Barbara Harper, an expert in waterbirth explains. Several factors prevent a baby from inhaling water during the birth. Twenty four to forty-eight hours before the onset of spontaneous labor, the fetus experiences a notable increase in the prostaglandin E2 levels from the placenta which causes a slowing down or stopping of the fetal breathing movements, thereby increasing blood flow to vital organs, including the brain. When the baby is born and the prostaglandin level is still high, the baby’s muscles for breathing simply don’t work, thus using the first inhibitory response. A second inhibitory response is the fact that babies are born experiencing acute hypoxia or lack of oxygen. It is a built in response to the birth process. Hypoxia causes apnea and swallowing, not breathing or gasping. If the fetus were experiencing severe and prolonged lack of oxygen, it may then gasp as soon as it was born, possibly inhaling water into the lungs. If this baby was in distress, there would be changes in the fetal heart rate and prolonged bradycardia (low heart rate), which would be a reason to leave the birth pool and possibly transfer to hospital. The temperature is another factor thought by many to inhibit the breathing response while in water. The temperature of the water is so close to maternal temperature that it prevents any detection of change within the newborn, which does not cause him to breathe. Another factor that is vital to the issue of waterbirth and aspiration is the fact that water is a hypotonic solution and lung fluids present in the fetus are hypertonic. Even if water were to travel in below the larynx, it could not pass into the lungs based on the fact that hypertonic solutions are denser and prevent hypotonic solutions from merging or coming into their presence.

The last important inhibitory factor –the dive reflex is associated with the larynx. The larynx is covered all over with chemoreceptors, or taste buds. When a solutions hits the back of the throat and crosses the larynx, the taste buds interpret what substance it is and the glottis automatically closes; the solution is then swallowed, not inhaled. This autonomic reflex is built into all newborns to help them breastfeed, and it is present until about the age of six to eight months when it mysteriously disappears. All these factors combine to prevent a newborn who is born into water from taking a breath until he is lifted up into the air.

What causes the newborn to take his first breath? As soon as the baby senses a change in the environment from the water into the air, a complex chain of chemical, hormonal, and physical responses initiate the baby’s first breath. Water born babies are slower to begin this response because their whole body is exposed to the air at the same time, not just the caput or head as in a dry birth. Many midwives report that water babies stay a little bit bluer longer, but their tone and alertness are just fine. It has even been suggested that water born babies be given the first APGAR scoring at one minute thirty seconds, not at one minute, because of this adjustment.