Water immersion during labor

Water immersion during labor has become more popular over the years, and I occasionally have mothers-to-be ask about this practice. Does Clements University Hospital have tubs in Labor and Delivery? Can – or should – they bring a rental tub with them? What are the benefits?

The American Congress of Obstetricians and Gynecologists (ACOG) updated its recommendations on this very topic recently. Let’s review what we know – and recommend – about safely using water immersion.

Water immersion versus water birth

Let’s be very clear about what we are talking about. Water immersion is not the same as a water birth.

There are two stages of labor: The first is when you are experiencing contractions, and the second is when you are pushing and the baby is actually born. In this post, I only want to talk about water immersion early in labor.

Right now, ACOG recommends delivery not take place in water. There simply isn’t enough data to fully understand the risks and benefits of going through the second stage of labor and delivery in water.

Erring on the side of caution, I would also suggest women not have their babies in pools or tubs.

Benefits of water immersion

There may, however, be some benefits to sitting in a tub of warm water during the first stage of labor.

First, water immersion might provide some pain relief. Studies have found women who relax in a warm tub or shallow pool during the early stage of labor tend to use epidural analgesia slightly less than those who do not.

This makes sense – think about how nice it is to sit in a warm tub after a day of strenuous work or exercise!

Second, women who use water immersion tend to have a shorter length of labor – by about 32 minutes.

Who is (and is not) a candidate for water immersion in labor?

While less pain and shorter labor are nice benefits, water immersion is not for everyone. For some, water immersion can make it difficult or impossible for labor to happen safely.

You may qualify for water immersion if:

• Your baby doesn’t need constant monitoring during labor. We can’t use continuous monitoring – either external or internal – in the water.
  
• You’ve reached a gestational age of at least 37 weeks. Women in preterm labor do not qualify because their babies need to be monitored continuously, and preterm deliveries tend to be rapid. We absolutely do not want these babies born in the tub accidentally.
  

You may not qualify for water immersion if:

• You have an epidural in place or if you have had any medications that are sedating.
  
• You have a bloodborne infection like hepatitis or HIV. In that case, getting into the water may increase the risk of exposing your baby or health care team to the infection.
  
• You have any medical or obstetric complications.
  

Keep in mind, your doctors and nurses are just trying to make sure you get the appropriate care that will result in the best possible outcomes. We can accommodate water immersion only if we are confident doing so will be safe for both you and your baby.

Options for using a tub during labor

Some hospitals actually have tubs built into their labor and delivery (L&D) suites. Ask if your hospital has tubs available and what kind. You can never be too careful – there have been cases of neonatal infections related to waterborne illnesses.

I have to admit my personal concerns about tubs with whirlpool jets. The water in those tubs circulates through internal plumbing, and I worry about the ability to completely drain and sanitize the entire tub, including the jets. It is much easier to clean all the surfaces in a tub that simply fills and empties.

If your hospital doesn’t have its own tubs, it may be possible to bring a portable rental tub to the L&D unit where you plan to deliver.

These tubs are inflatable and can be set up on a section of the floor. These tubs avoid infection by using a new plastic liner within the tub – similar to what many nail salons do for pedicures.

But – L&D rooms in hospitals are highly planned spaces. Inflatable tubs work only if there is enough room for both the tub and all the resources needed to care for both mother and baby.

I have resisted using portable inflatable tubs at William P. Clements Jr. University Hospital because of space limitations. As your physician, I have to consider:

• Whether the tub’s presence is an obstacle should providers need to rapidly enter the room and provide care to a mom or baby with a problem
  
• If the tub will be in the way should we need to quickly push the L&D bed (with mom on it) to the OR for a C-section or other procedure
  
• How the tub is filled and drained, and who is responsible for those activities and whether any water on the floor poses a slip and fall risk for patients or guests
  

Your comfort level

There are also a couple additional questions you might want to consider when considering water immersion during the first part of labor:

• How comfortable are you climbing in and out of the tub at home in the third trimester? Some women feel awkward, and the thought of climbing in and out of the tub while having contractions may be a little daunting.
  
• Do you plan to have visitors in your room during your stay in L&D? Women typically prefer to be nude in the tub, but if it is sitting in the middle of the room you may feel a little exposed. This may or may not be an issue, depending on your degree of modesty.
  

For the right patient, water immersion can enhance the birth experience. I encourage you to talk to your physician if this is something you think will be right for you and your family.

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