Understanding Water Immersion and Water Birth

The purpose of this ‘class’ is to provide guidelines for safe use of water therapy for labor and birth

Our Goal – Healthy Mother and Healthy Baby

DeKalb Medical believes and supports one birth at a time. Each of our providers works individually with his/her patients to ensure each expectant mother understands potential risks and safety guidelines and how they will address them during the birthing process. It is crucial that mothers understand all risks and safety recommendations in order to make informed consent about any procedure.

Instructions for Online Class • Read through all the slides

– You are responsible for the information covered in the Online Class

– If you have questions about any of the information contact your OB healthcare provider

• Water Birth requires – – OB Provider approval (not all OB Providers support Water Birth) and

– Authenticated Water Birth certificate - the last slide will provide you with information on how to receive your authenticated certificate

• Water immersion for labor – OB Provider approval – most OB Providers will support water immersion for

labor comfort

– Does not require an authenticated Water Birth certificate

Definitions

Water Immersion

• Mother sits in water that covers belly and comes to breast level

• Promotes hormonal changes that enhance a more rapid labor

– Water Immersion for 30 minutes releases more oxytocin (hormone that causes labor contractions)

Water Birth

• Baby is born underwater and immediately brought to the surface

Research

ACOG, AAP and ACNM associations all agree - water immersion for the first stage of labor may have many benefits to the laboring woman

ACOG – American College of OB GYN

AAP – American Academy of Pediatrics

ACNM – American College Nurse Midwives

ACOG and AAP believe there is insufficient data to draw conclusions regarding water birth

Due to the lack of data, both ACOG and AAP recommend that birth occur ‘on land’ and not in water

Benefits for Mother

• Warmth and comfort

• Ease of movement

• Increased relaxation

• Natural effleurage (water provides a massage like motion)

• May provide more effective labor

• May provide some pain relief in labor and/or birth

• Supports the perineum

Benefits for Baby • A more natural transition

• Warm, familiar environment

• Often less traumatic birth

• Less light

Disadvantages and Risks

• Challenges with monitoring fetal well being and labor progress

• Difficult for support person to provide counter-pressure or massage

• Risk of fetal aspiration (baby breathing in water)

• Risk of infection

• Increased risk of hypothermia (low temperature) for baby

• Slippery baby

• Possible delays in assessing and interceding with labor complications

Eligibility Requirements • Water Immersion or Water Birth requires approval from mother’s

OB GYN or CNM (certified nurse midwife)

• For Water Birth – – Provide an authenticated water birth class certificate upon arrival to Labor and

Delivery

– Signed water birth consent from mother’s healthcare provider

• Low risk pregnancy

• One Baby pregnancy – head down

• Greater than 37 weeks gestation

• BMI < 40 (Body Mass Index)

Eligibility Requirements - continued

• No history of previous Cesarean Birth or extensive surgery on the uterus

• Mother’s vital signs are within normal limits

• Baseline fetal monitoring with a Category 1 tracing – Normal baseline heart rate between 120 – 160 beats per minute

– No deceleration (slowing) of fetal heart rate

• No excessive bleeding (normal bloody show is OK)

Eligibility Requirements- continued • Mother must be able to enter and exit the tub with minimal

assistance

• Mother agrees to exit tub if advised to do so by their RN, CNM or OB

• Eligibility is also determined by: – How mother’s labor is progressing,

– Availability of trained providers,

– Availability of equipment,

– Number of patients requesting water immersion and

– Mother’s OB or CNM must be “in-house” before mother can enter the tub

Contraindications

• Less than 36 6/7 weeks pregnant

• BMI > 40 at time of delivery

• Inadequate baby heart tracing or signs of baby in distress

• Mother with fever of >100.4F or any suspected infection

• Excessive vaginal bleeding

Contraindications- continued • Any communicable blood or skin infection

– HIV, Hepatitis B

– Any open or draining wound or skin lesions (active herpes)

• Mother has a health issue (heart disease, etc.)

• Epidural / Spinal anesthesia

• IV pain medicine – exit tub for 3 hours, then return if not drowsy

Special Circumstances Mothers with the following conditions are eligible for water immersion only during the first stage of labor and must exit the tub for the second stage of labor (delivery)

• Gestational Diabetes

• Suspected macrosomia (big baby)

• Twin gestation

• History of shoulder dystocia (baby’s shoulders get stuck inside mother’s body after baby’s head is delivered)

Special Circumstances - continued

• Meconium – Thick meconium –

• First stage of labor - baby must be monitored for 20 minutes of every hour

• Second stage of labor – must exit water and give birth in bed

– Thin meconium – first and second stages of labor may use water immersion and water birth

• Pitocin – May be used with mother in the tub

– Does require continuous monitoring

Guidelines Before Water Immersion

• Must have OB provider order and signed informed consent

• Mother and Baby Assessment including – Mother’s vital signs

– Baseline Category 1 fetal heart tracing – initial monitoring is minimum of 20 minutes

– Reviewing of Prenatal Records

– Lab work as ordered by OB or CNM

Care During Water Immersion • OB or CNM must be “in-house” before mother can enter the tub

• Mother – – Hourly blood pressure and pulse check

– Encouraged to drink fluids to stay hydrated

– Frequent emptying of bladder

– Vaginal exams as ordered by provider to evaluate labor progress to assure adequate time to exit the tub

• Water temperature checked hourly (range 92 – 99 F)

• A responsible adult must be in the room at all times while the mother is in the tub

Care During Water Immersion (continued)

• Baby - periodic intermittent monitoring using portable doptone or telemetry monitor – Frequency of intermittent monitoring is determined by mother’s OB or CNM

– If abnormal or suspicious, mother will exit the tub and move to bed for continuous monitoring

– Mother may return to tub if “good” heart tracing is seen

Water Birth

• All water birth deliveries are to be attended by an OB or CNM on staff at DeKalb Medical

– If the mother’s OB or CNM are not available, the mother may receive the benefits of laboring in water, however, mother will not be able to deliver in water

• Doulas are not licensed medical professionals; thus, the opinion of the doula will not determine interventions or water birth eligibility

Completing the On-Line Class

• Please print and sign/date the certification.

• Bring the certificate when you come to the hospital in labor; you must have your signed certificate to be able to experience water immersion and/or deliver in water.

If you have any questions or problems,

please call 404.501.9355.

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