Are there any contraindications to labouring in water?
There are several. The most important are as follows:
Presence of a major medical condition such as kidney failure, heart disease, diabetes or hypertension
Abnormal fetal position - such as transverse or oblique lie - which may make successful vaginal delivery improbable.
Lack of or inadequate facilities or absence of an experienced professional (midwife) to monitor the labour or conduct the delivery. Whilst many women can achieve a successful water birth without the direct assistance of a midwife, her presence at the time of the birth is clearly essential in case of any unforeseen difficulty.
What are the most common reasons for women labouring in water leaving the pool?
The most common reasons are:
Maternal distress (mostly because of pain)
Why would maternal request feature so prominent among the reasons for abandoning water birth?
In most cases, it is because the experience does not live up to her expectations. She may find the pain unbearable and the relaxing effect inadequate to overcome this.
As for maternal distress, it is upon the attending midwife to assess and recommend leaving the pool if it becomes obvious that the mother is not coping. This will allow for a more effective method of pain control to be adopted.
Preparing for a water birth
If one is considering a water birth, what are the preparations?
A midwife will have an exhaustive discussion of this method of labour and delivery with the parents-to-be. All questions should be asked and answered.
Importantly, the pregnant mother should be encouraged to spend prolonged periods in warm water before labour, to form her own opinion of the experience. She should remember that, on the day, it will be different, as there will be pain. Also, the process could last six hours, even more.
Nearer term, the usual obstetric assessment will be made to ensure there are none of the factors which will contraindicate labour in water (see above).
At the onset of labour, before entering the pool, a shower is taken and the midwife ensures the rectum is empty. This is done by administering a gentle enema if necessary.
Cardiotocographic (CTG) monitoring will be done for at least thirty minutes prior to entering the pool, to ensure that the baby is fine.
What kind of water is used?
Ordinary tap water is used. Some practitioners advocate salinizing the water, for example by adding sea-water. This is claimed to make the tissues of the birth canal even more supple. This claim is not backed up by evidence.