Giving Birth in Water Q&A

Before giving birth in water, or planning a waterbirth, you may have many questions about what it entails.  This is especially true if waterbirth isn't widely practiced in your area.  Below is a Q&A of some of the most common questions you may have when considering a birth in water:

• What supplies do I need for a waterbirth?
• How much does it cost to have a waterbirth?
• Why doesn't the baby breathe under water?
• How long is the baby underneath the water?
• Is waterbirth possible at a hospital or birth center?
• Why is waterbirth not available in more hospitals?

What supplies do I need for giving birth in water?

For a home waterbirth, you will need a birth pool, which can either be purchased or rented, a hose to fill the pool, a liner for the pool if it is rented, and blankets, towels, shower curtain liners or chux pads to protect the floor.  If your hospital has birthing pools, then all supplies should be readily available. If not, then you should talk to your care provider about bringing your own. If you will be having a homebirth, you may purchase a birth kit with the necessary supplies online.

How much does it cost to have a waterbirth?

That will depend on whether you plan to purchase or rent a birth pool.  The cost to purchase or rent a birthing pool typically runs between $118-375 plus shipping.  However, it's possible that your insurance company may  reimburse the pool rental or purchase fee.   If you are self-employed or itemize deductions, you may be able to deduct the cost as a medical expense.   If you choose a birth center or hospital that has their own equipment, there is no need to contact your insurance company.

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Why doesn't the baby breathe under water?

A combination of 4 different factors stop the baby from taking a first breath while still underneath the water:

• A hormone secreted by the placenta, Prostaglandin E2, causes the baby's breathing movements to slow before, during, and right after labor.  While these levels stay high, the baby is prevented from breathing.  All the baby's oxygen will continue to be supplied by the placenta, not the lungs.
• Babies will not gasp or try to breathe as long as the umbilical cord is not clamped nor cut and is still pulsing regularly.  All babies are born with slightly low levels of oxygen which causes them to swallow, not inhale.
• The baby's lungs contain a hypertonic solution which is dense while water is a hypotonic solution.  If water were to move past the protective larynx, the lung fluids would not allow it to pass since they prevent hypotonic solutions like water from mixing or pushing past them.
• The larynx, or voice box, provides an important protective function called the Dive Reflex. The surfaces of the larynx in the throat are layered with taste buds (chemoreceptors).  In fact, it has five times as many as the entire tongue surface.  When a substance enters the mouth and passes the level of the larynx, the body determines what path it should follow and the glottis, or airway opening, is covered to prevent foreign particles from entering the lungs.  So, if water were to enter the baby's mouth, it would then reflexively swallow rather than inhaling.

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How long is baby in the water after giving birth?

This will depend on a few factors.  After giving birth in water, sometimes the baby's body is wrapped in the umbilical cord and it will take a few seconds to bring the baby to a good position to take it from the water.  In the majority of waterbirths, the baby is caught by the mother and immediately pulled to her chest.  In the US, care providers usually take the baby from the water in less than 10 seconds. The baby does not need to stay underneath the water for any period of time nor is there a great need to rush to get the baby out. The best practice is to safely remove the baby from the water and place it skin-to-skin with the mother's chest quickly but without rushing to do so.

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Is waterbirth possible at a hospital/birth center?

This will depend on your care provider, pregnancy, and hospital or birth center policy.  Hospitals are becoming more waterbirth-friendly but some still have outdated policies in place that restrict waterbirth or place so many limitations on duration, supervision and other such restrictions that make it nearly impossible to have a waterbirth, even if they are fully equipped with birthing pools and equipment.  Still others will allow labouring in the tub but require pushing in a bed.   Birth centers tend to be much more supportive of waterbirth and have more lenient policies that make it easier to bring your own tub if one is not available.

The best course of action is to discuss waterbirth with your care provider well in advance of your anticipated due date.  Discuss your specific situation and desire for waterbirth.  Be sure to ask if you can bring your own tub should one not be available.  You may need to be persistent in that some care providers are unaware of the benefits of giving birth in water.  Once they become aware of the benefits, they may become much more open or supportive.

Why is water birth not available in more hospitals?

The National Institute for Health and Clinical Excellence (NICE) in the United Kingdom issued guidelines that giving birth in water is the most effective non-pharmaceutical form of pain relief for childbirth which has no negative side effects and should be offered to all women giving birth. 

Despite the overwhelming evidence of the benefits of giving birth in water, few hospitals offer birth pools, citing liability, financial constraints and staffing issues as barriers.  However, widespread access to giving birth in water would provide the potential to cut maternity care costs considerably for mothers and insurance companies in that it reduces the number of mothers who request epidural anesthesia, which runs upwards of $1500 in the United States.

Another reason for lack of access to waterbirth is that in modern maternity care, doctors and obstetricians receive no training in the use of water for birth. Although slow in coming, more hospitals are seeing the benefits of waterbirth and recognizing the benefits of allowing women to make their own choices for birthing.  Also, the increase in the number of birthing centers, which usually offer greater access to birth pools, is allowing more women the benefit of water for birth.

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Page Last Modified by Catherine Beier, MS, CBE