Waterbirth: Just a Fad?
World-renowned social anthropologist and birth activist Sheila Kitzinger is a strong advocate for waterbirth. A voice for the ability for every woman to choose, Sheila believes that waterbirth should be an option in mainstream maternity care. In this piece, Sheila outlines some of the myths surrounding the birth method, and provides evidence that, in fact, waterbirth is a safe, effective and empowering birthing option.
Waterbirth is often discussed as if it were a novelty – and a dangerous one at that. It has been assumed to be something that “dropouts” and “weirdoes” choose, or that it is just a recent, passing phenomenon. In truth, waterbirthing is a safe and widespread practice among hospitals in the UK and Western Europe – including Switzerland, Italy, Spain, Portugal, Malta, Denmark, Norway and Finland. Furthermore, most practices aren’t as new as we think (the Ostend Aquanatal Centre in Belgium has been going strong since the late 80s), and waterbirth practices are here to stay.
A Swiss study reveals that when using a pool women require less analgesia, have a lower incidence of perineal trauma, and reduced blood loss at delivery. NICE (National Institute for Health and Care Excellence) concludes that waterbirth ‘provides the safest form of pain relief’.
There is evidence that being in water improves uterine contractility and speeds dilatation. So, a waterbirthing woman is less exposed to interventions, including artificial augmentation of uterine activity, and is more likely to feel happy about her birth experience afterwards. Yet that may not only be due to the water. Labouring women who give birth in water have more one-to-one care from a midwife they have come to know. This, combined with a relaxed environment in which the pool is used, contributes to the positive results. More first time mothers have spontaneous births in a freestanding midwifery center or at home than those in hospital.
In the UK, the NHS (National Health Service) states that women should be able to use a pool if they wish, and recommends one be available for every thousand women. This option has become part of mainstream maternity care, and approximately 75% of all hospitals in the UK have installed birthing tubs. Many community midwives are eager to raise the homebirth rate, and portable pools, designed to be used by just one woman (to avoid cross-infection), are selling well.
Complicated waterbirthing pools are not necessary. Chairs, stools and other contraptions restrict movement, and when a woman is immobilized she is more likely to need obstetric intervention. Francoise Freedman of Birthlight in Cambridge suggests using a pool at home to explore yoga movements during pregnancy. These include hip-openers, kneeling stretches, and those to prevent and ease back pain, and others for ribcage expansion and pelvic floor toning. The warm water acting as a cushion also makes a comfortable space to practice perineal massage.
Midwives keen on home birth and waterbirth were once seen as dissidents and mavericks. This has changed now – so much that in the UK, it is common to encourage women to choose to labour, and perhaps give birth, in water and in their own home. Pregnant women and midwives are being empowered now.
Every midwife-run and staffed birth center for low risk women offers pools, and midwives are beginning to develop the skills to use them. There is a feast of research from which midwives can learn more. Ethel Burns, Waterbirth Practitioner, Research Midwife and Midwifery Teacher, and I have drawn up recommendations for practice in a paper available from Oxford Brookes University (read it here).
Sheila Kitzinger is a social anthropologist of birth and an advocate of home births. She believes that women have the right to decide the place of birth and kind of care they prefer, and to make an informed choice, based on research and their own values. Women suffering post-traumatic stress after birth ring her for help, and to find the confidence to deal with it. She works with mothers and babies in prison and asylum centers. She lectures all over the world and her books are published in 23 languages. Visit her at: http://www.sheilakitzinger.com.