Having a water birth and using a birth pool

A water birth is when you give birth to your baby in a birth pool. Water can also be used to help you stay mobile and provide pain relief throughout labour, and this is referred to as 'using water in labour'. Read on and watch our video to find out more about water births, using water in labour, and whether or not it’s right for you.

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How can I use water in labour?

Many women use water during their labour, and this can include getting into a shower, a bath or a specially designed birth pool to help you cope with the pain of contractions. About 30% of women giving birth in England plan to use water or a birth pool for coping with pain during labour, according to a survey by the Care Quality Commission (CQC) in 2013.

Comparatively, staying in the water to actually give birth is not as common. The CQC survey found that only 6% of women gave birth in a birth pool.

What are the benefits of using water in labour?

Being immersed in water during labour can be relaxing and has pain-relief benefits, as explained by midwife Pauline Cooke in this video:


Because the water supports your weight, it can be easier to move around and get into comfortable positions. Being enclosed and surrounded by water in a birth pool can also give you a sense of privacy, which in itself may help labour to progress.

Being in a birth pool is a good way of reducing pain in labour: research involving more than 3,000 women found that those using a birth pool during labour are less likely to need an epidural. Because of this, the national guidelines in England recommend immersion in water as a way of coping with pain in labour. National guidance does not actively encourage women to actually give birth in water, however, because of the lack of robust statistical evidence available about the benefits.

Water birth: the benefits

Some women report an increased feeling of birth satisfaction after giving birth in water. Water births might also be easier than being on dry land as the water provides support, allowing you to get into upright positions that are beneficial for labour.

Depending on your circumstances, such as the position of your baby, you might also be less likely to tear your perineum, the area between the opening to the birth canal and the back passage. Some women feel that having a water birth provides their baby with a more gentle transition to the start of his or her life, although no one can be sure how babies feel during labour.

Water birth: the problems

Using water in labour is not always suitable for everyone. In some circumstances, women will need closer monitoring or interventions that are not necessarily possible in a birth pool. For example, sometimes when women are induced, their baby needs to be monitored more closely using electric sensors, and these cannot be used in a birth pool.

It's worth noting that a birth pool may not be available in the unit you're giving birth in. Use our Birth Choice tool to find out which of your local units provide birth pools.

Is it safe to use water in labour or have a water birth?

There's no evidence to suggest that there are any adverse effects of using water in labour, and national guidelines from the National Institute for Health and Care Excellence (NICE) recommend it. Giving birth to your baby in water also appears to be safe but it's not actively encouraged or discouraged in national guidance because of the lack of robust statistical evidence available.

There can be a small risk of the baby overheating. This can be prevented by keeping the temperature of the water at around 37˚C, so it’s the same as your body temperature.

Which methods of pain relief can I use in a birth pool?

Being in a birth pool limits your other pain-relief options. Although water is recommended as a form of pain relief itself, many women may want more pain relief options than this alone. Entonox, or gas and air, is a mixture of oxygen and nitrous oxide that you can inhale through a mouthpiece when you're in a birth pool - find out more about gas and air. Some women also turn to non-medical methods to cope with pain in labour, such as massage and breathing techniques; these can all be used in a birth pool.

You won’t be able to use the following forms of pain relief in water:

  • Tens machine: Because these machines transmit mild electrical impulses, they cannot be used in water.
  • Epidural: When a local anaesthetic is injected into a part of your spine it can mean that the lower part of your body becomes weak, so it’s unsafe to be in a birth pool.
  • Opioid drugs: Drugs such as pethidine can make you feel drowsy and therefore unsafe in water.

Can I use a birth pool wherever I give birth?

Water is more likely to be used by women who plan to give birth in a freestanding (standalone) birth centre or at home than by women who plan to give birth in a labour ward. This was one of the findings of the Birthplace Study of 2011, which looked at what happened to more than 64,000 low-risk mothers giving birth in England. The table below shows the percentage of first-time mothers at low risk of complications who used water for pain relief, according to their planned birth environment.

Similarly, the study found that for low-risk women who have already had a baby, there are big differences in how likely they are to use water in labour depending on where they have planned to give birth, as the table below shows.

Birth pools are not available everywhere, as explained by a midwife in our video, so you should decide whether or not you might want to use one before you choose where you’d like to give birth. Use our Birth Choice tool to find out whether or not your chosen unit offers birth pools.

Remember if there’s only one birth pool available, it may already be in use by another woman when you need to use it. It’s also worth considering that units with more birth pools are likely to have midwives who are more experienced at supporting women using water, and this might be important to you.

If you plan to have a home birth, you'll have to either hire out or buy your own inflatable birth pool. Public Health England is advising people not to use heated birth pools that are filled before labour begins and where the temperature is maintained by a heater and a pump. This is because of concerns about the 'legionella' bug, which can cause Legionnaires' disease, and which was found in some of these particular birth pools. Most birthing pools rented for use at home are filled from domestic hot water when you go into labour, and there is no concern about using these pools. So if you’re planning a home birth using a pool that you’ll fill only when you go into labour, there’s no need to be concerned. Similarly, if you’re planning a birth in an NHS birth centre or maternity unit, this alert does not apply. If you have any concerns about the pool you were hoping to use, contact your midwife.

If you are at a higher risk of complications and are keen to use water in labour, find out more about negotiating your care.

water in labour

Deciding where to give birth?

Watch our videos of nine mums talking about why they decided to give birth in a birth centre, on a labour ward or at home, and what their experiences were like.

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References

These are the sources of information used in this article:

Birthplace in England Collaborative Group, Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study, BMJ 2011;343:d7400 (2011)

Care Quality Commission, Women’s experiences of maternity care in England: Key findings from the 2013 NHS trust survey (2013)

Cluett ER, Burns E, Immersion in water in labour and birth, Cochrane Database of Systematic Reviews 2009, Issue 2. Art. No.: CD000111. DOI: 10.1002/14651858.CD000111.pub3. (2009)

National Collaborating Centre for Women's and Children's Health, Intrapartum care: care of healthy women and their babies during childbirth. NICE Clinical Guideline 190,London: National Institute for Health and Clinical Excellence (2014)

Understand your maternity options

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