Water birth and home birth

Water birth is the process of giving birth in water using a birthing pool.

You can labour in water and leave to give birth if you wish. Being in water during labour is shown to help with pain as well as being more relaxing and soothing than being out of water. The water can help to support your weight, making it easier to move around and feel more in control during labour.

What are the advantages of water birth?

• The warm water can help to relax, soothe and comfort you.
• The support of the water means you can try different positions and move more freely.
• When upright in the water, gravity will help move the baby down towards the birth canal.
• Being in water can lower your blood pressure and reduce feelings of anxiety, making your body more able to release endorphins, which can help ease pain.
• The water can help to improve back pain and the feeling of pressure, especially when you are fully dilated.
• Being in the pool during labour and birth can be a “cosy” experience, making you feel safe.

If you have a straightforward pregnancy, and both you and the baby are well, you might choose to give birth at home.

Giving birth is generally safe wherever you choose to have your baby.

If you give birth at home, you’ll be supported by a midwife who will be with you while you’re in labour. If you need any help or your labour is not progressing as well as it should, your midwife will make arrangements for you to go to hospital.

You have lots of decisions to make during pregnancy, in labour and when you have had your baby. In order to make informed decisions about your care you can use a decision making tool like the BRAIN tool.

B Benefits. What are the benefits?

R Risks. What are the risks and considerations?

A Alternatives. What are the alternatives, and what are the risks and benefits of those?

I Intuition / information. How do you feel? Do you need more information?

N Nothing / not now. Do I need to decide now? What if I do nothing?

Sometimes a doctor or midwife may need to make a cut in the area between the vagina and anus (perineum) during childbirth. This is called an episiotomy.

An episiotomy makes the opening of the vagina a bit wider, allowing the baby to come through it more easily.

Sometimes a woman’s perineum may tear as their baby comes out. In some births, an episiotomy can help to prevent a severe tear or speed up delivery if the baby needs to be born quickly.

If your doctor or midwife feels you need an episiotomy when you’re in labour, they will discuss this with you. In England, episiotomies are not done routinely.

Up to 9 in 10 first-time mothers who have a vaginal birth will have some sort of tear, graze or episiotomy.

The National Institute for Health and Care Excellence recommends that an episiotomy might be done if:

• the baby is in distress and needs to be born quickly, or
• there is a need for forceps or vacuum (ventouse), or
• there is a risk of a tear to the anus

Around 1 in 7 deliveries in England involves an episiotomy.

If you have a tear or an episiotomy, you’ll probably need stitches to repair it. Dissolvable stitches are used, so you will not need to return to hospital to have them removed.

Massaging the perineum in the last few weeks of pregnancy can reduce the chances of having an episiotomy and perineal trauma during birth.

The type and frequency of massage varies across research studies. Most involve inserting 1 or 2 fingers into the vagina and applying downward or sweeping pressure towards the perineum.

The most benefit was in women who repeated this every day.

An important part of maternity care is listening to your baby’s heart rate throughout your labour. This enables us to monitor your baby’s wellbeing and can help to identify if there are any problems developing.

At all times you will be given information that allows you to make an informed choice about all aspects of your care.

Your community midwife will have a conversation with you about monitoring your baby in labour as part of your antenatal care and document your discussions and decisions in your personalised care plan. This conversation will take into account your pregnancy, your well-being and your birth preferences.

Most babies come through labour without any problems, but there are a few babies who run into difficulties. The best way of finding out which babies are having trouble is to listen to every baby’s heartbeat regularly throughout labour.

There are no current guidelines to suggest when your midwife should listen to your baby’s heartbeat during pregnancy, however it is possible to hear it from approximately 16 weeks.

From 24 weeks, your midwife will ask you about your baby’s movements every time you see them and, if there are any concerns, they will ask to assess you and your baby. This may result in a visit to the Maternity unit at the hospital.

How do we listen?

If you are healthy and have had a problem free pregnancy, your midwife will ask to listen to your baby’s heartbeat using a Pinard stethoscope or a hand-held doppler.

Intermittent Auscultation

When you are in labour, the midwife will ask to listen to your baby’s heartbeat at least every 15 minutes, immediately following a contraction, and more frequently as labour advances. This method of monitoring is called intermittent auscultation. The advantage of this method is that it enables you to move around freely and can be used in water.

It is important that the midwife starts listening to your baby’s heart beat just as your contraction is going away, and they will need to count the heartbeat for a full minute.

It is helpful if you know about this as your midwife may ask you to change position to make this easier.

The midwife will need to count your baby’s heart beat for a full 60 seconds every time they listen in.

If your midwife notices a change in the baby’s heart rate that suggests your baby might not be coping well, they will tell you and they may recommend continuous monitoring.

The midwife will ask to manually feel your pulse on your wrist every hour during the first stage of labour and if you are still having intermittent auscultation during the second stage, they will ask to feel your pulse every 5 minutes. This helps your midwife be sure that it is definitely your baby’s heartbeat that is being picked up and not yours.

Continuous electronic fetal monitoring (CTG)

This type of monitoring produces a continuous ‘trace’ of the baby’s heart rate throughout your labour and is referred to as a cardiotocograph or CTG.

The CTG monitor has 2 sensors that are strapped around your abdomen, one to monitor the frequency of your contractions and the other to monitor your baby’s heart rate.

Continuous monitoring can limit your ability to move around, however it is still possible to mobilise, or to change your position to standing or sitting on a birthing ball.

A wireless monitor may be available. This allows you to move more freely.

Risk assessment is an ongoing process and the recommended method of fetal monitoring may change throughout labour. If there are no identified risk factors for fetal compromise, there is a risk of increased interventions with continuous CTG monitoring compared with intermittent auscultation, which may outweigh the benefits.

Advice given by the midwife or obstetrician on the method of fetal heart rate monitoring will take into account the whole clinical picture.

When performing CTG monitoring your midwife may find it difficult to get a clear trace on the graph (particularly when you are pushing or mobilising). If this happens, they may ask permission to monitor your baby with a fetal scalp electrode (FSE). If this method of monitoring is recommended during your labour your midwife or doctor at the time will discuss this with you and support you to make an informed choice.

Things to remember

• A normal CTG trace indicates that the baby is coping well with labour
• Changes to your baby’s heart rate pattern during labour are common and are not always worrying
• Sometimes these changes can show which babies are having trouble coping with the stress of labour.
• If your midwife has concerns with the CTG they will ask your permission to invite a senior midwife and/or doctor to be involved in your care and they will make an assessment to find out if there is an identifiable cause that can be corrected.
• Such causes include an infection developing which can be treated with antibiotics or if there are other signs that your baby may be distressed such as the baby opens their bowels inside (passes meconium).
• This will be all be considered along with how your labour is progressing to make a personalised plan of care for you and your baby taking into account your preferences.