Humans have an integral relationship with the element of water. It runs through our veins, we are born of it, and it is necessary for our survival. We are drawn to it for escape, adventure, release, and cleansing. As a woman is preparing to give birth, water is a means of release from the weight of her growing belly, and the means to ease her aching muscles. Water is a great coping tool in labor, whether through a shower or tub. (For the sake of this paper we will only be mentioning the use of a tub.) The use of water in labor can aide in pain management by increasing relaxation, decreasing strain on muscles, and creating freedom of movement.
The mother’s ability to relax her muscles during labor can affect the length of labor and the intensity of contractions. The more a mother fights and tenses her muscles the worse contractions may feel. Especially in active labor, the mother may need as many coping strategies as possible. The birthing tub offers a great respite, and a simple way to relax. The birthing tub is often called, "The midwife’s epidural”, for its effectiveness (Drichta, Owen p. 257). The warmth of the water helps to ease the pain felt from contractions, relaxing muscles of the pelvic floor and back, and creates a mental space that creates privacy (Drichta p. 258). It is recommended to maintain water temperature at 96-98 degrees. Using higher temperatures could cause increased blood pressure, dehydration and lethargy (Drichta p. 258). The bath is also deeply engrained as a place of mental release in daily routines. Our bathtubs are typically places of retreat to relax, and the mental association during labor holds true.
Labor is a physically demanding process. From hours of walking, lunging, squatting, intense contractions, and the possibility of little sleep can make for a grueling marathon on the mother’s muscles. The warmth of the tub eases both the pain of the contractions and the work of her remaining muscles (Drichta p. 257). Being in a large tub that covers her belly, the mother is buoyant and freed from the gravity of dry land. Her pelvic muscles are relaxed and her cervix will continue to dilate, often with more ease as she relaxes. A mother that is able to relax and mentally release her tension, will have an easier time laboring than a mother that is fighting each contraction.
Being weightless allows the mom to assume positions that could be too taxing on land, such as deep squats using the side of the pool, that will help baby to descend and turn. She's able to easily move from one position to the next in response to her labor, while remaining warm and relaxed. The ease of movement allows the mother to find her own rhythm and coping responses that she would not have had if she was limited to a bed. Her ability to move through labor gives the mother more control and autonomy during the birth. She's able to push in the position that suits her, catch her own baby, and bring baby to chest without outside help or others manipulating her body. She has full confidence and control.
Relaxation, decreased strain on muscles and freedom of movement are gained for the birthing mother with the use of water during labor. The three work together as a pain management strategy, addressing both mental and physical tension that could hinder a birth. The birthing tub is used at its greatest advantage during late stage active labor throughtransition. It is recommended that for every hour spent in the tub, the mother spends at least thirty minutes out of the tub. This is to ensure that contractions do not slow down, as can sometimes happen. Often contractions may just feel less intense, but are still actively working. According to Water BirthInternational, “Getting back in the water after thirty minutes will reactivate the chemical and hormonal process, including a sudden and often marked increase in oxytocin.” (Harper p. 2) As with other labors, hydration is of the utmost importance. Keep a drink with a straw nearby so the mother can drink at will. The birth can be completed in the water as well, depending on location (some hospitals only allow laboring in the tub) and as long as the labor is not having any complications (ex:meconium, shoulder dystocia).
Drichta, Jane E., CPM and Owen, Jodilyn, CPM. The Essential Homebirth Guide for Families Planning or Considering Birthing at Home. 2003. Simon and Schuster.
Harper, Barbara. "Guidelines for Safe Waterbirth.”Waterbirth International. p. 2