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Using Water During Labor and Birth

          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).



                                                     Works Cited

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



Pregnant in Sumatra

Being pregnant brought lots of joy and excitement to my life. Living in Sumatra with my Indonesian husband while pregnant brought some worry and fear as well. Fear of a serious medical complication in a developing country, fear of being far from my own mom and loving family members, fear of not being able to stick to my guns about what I wanted and knew was best for my pregnancy and son’s birth in a completely different culture and environment. In spite of the fear and the unknown, I tried to focus on the positive and the potential for amazing things to happen.

My mom shipped What to Expect When You’re Expecting and Ina May Gaskin’s Guide to Breastfeeding halfway across the world and I scoured the internet for what American mommies were doing so that I could try and blend as best as I could the two distinct cultures that my baby would be born into.

I loved the way many Indonesian moms practice attachment parenting simply because there is no alternative. Who would leave their infant in another room of the house to sleep? A centipede or snake could bite it! Or a tiger could attack! (Just kidding….mostly). Also, most houses simply don’t have another room in the house to make into a nursery nor do they have money to buy a crib. So we bought a baby hammock instead of a crib. Car seat? More babies are used to riding on motor bikes. Diapers? The hot, humid weather plus the cost mean that these are usually a luxury item that not all babies wear but that are becoming more common now especially in cities. Slings and baby carriers? Indonesian moms have been strapping their babies to ‘em in Batik sarongs and going about their day since forever. Breastfeeding? Again, a lot of women in villages usually do not work outside of the house nor are they able to spend money on formula so nursing is the best option for them. Natural childbirth? My mother-in-law delivered six children in her house with a midwife. No pitocin or epidurals available! Cry it out? I am not exaggerating when I say that the entire Indonesian family will do anything – anything – to comfort a baby at the first whimper or sign of discontent. While times are also changing here and all mother and baby stories are different, these were the impressions of labor and infant care that I witnessed and saw as common.


34 Weeks

Thankfully, I had an incredibly easy and manageable nine months with just one bout of morning sickness. My baby boy grew and kicked while I practiced yoga, deep breathing, Kegels, everything I could think of to stay calm, relaxed and prepared in order to envision a healthy, natural birth. My mantra was “I am a flower, I am a fountain.” I would say it every time I worried that my body would not open to push the baby out or that my breasts would not produce milk to nurture him.

Throughout my pregnancy, I had deep concerns about being pressured into a C-section here as the modern hospital where I received prenatal care seemed to have so many. I received an ultrasound at every monthly visit, which seemed so unusual and unnecessary. I was told I had low amniotic fluid and should take strange medicine not approved by the FDA along with placental extract thought to prevent miscarriage. All the medicine my OB-GYN tried to get me to take was discarded and I trusted my gut and stuck with my prenatal vitamin. I asked if I could try different labor positions and he was totally against it saying that I needed to stay attached to a monitor. While I stayed with this doctor, part of me wished I was in the middle of our house in the village with a bidan (trained midwife) so that I could avoid all of the interventions. But I knew that my family in America and my husband here trusted the hospital and wanted the security and safety assumed to be had there.

My due date was March 19th, 2015. The doctor wanted to induce the very night of my due date without waiting at all (this after being told earlier in my pregnancy inexplicably that my due date was 4 days earlier than the one previously given). I refused and went home resolved to wait a week before going back to the doctor. I walked around the neighborhood endlessly, ate all kinds of spicy food like curries and sambal (chili sauce - unavoidable in Indonesia!), and did squats and meditation. I began doubting myself and of course just wanted what was best for the baby. I knew that his movement could slow down as the time approached but I went to the doctor on the night of March 25th to check that everything was ok. They admitted me, hooked me up to the monitor and it felt like there was no going back. I wanted to move and walk like I read about. I wanted to get on all fours and stretch. I wanted to go in the water and take a bath. I was repeatedly told in a language not my own that I could not. I was scared and if not for my husband’s presence and support, I would have felt hopeless and entirely alone. I had brought prayer cards and a rosary and listened to Christian music on my phone while praying that he was safe and all would be well. They started me on a pitocin drip after an invasive internal examination from the doctor. I experienced mild pressure but no contractions all night and tried to rest.

The morning of the 26th, they increased the pitocin and the contractions came fast and strong. They felt erratic and unstoppable with no rhythm. I had been offered no pain medicine and was forced to stay in bed with no ability to change positions. I was even ridiculously told to keep my legs closed! At one point during the four hours of endless contractions with absolutely no progress or relief, a complete stranger, the mom of another laboring woman from the room across the hall, came into my room to stare at me as a strange foreign woman and talk to my mother-in-law. I wanted to scream “Get out!” but settled on telling my husband that I was in no way comfortable with random people in my room.

In the end, at noon after not even dilating one centimeter on the pitocin, the doctor suggested that I go for a C-section, which I firmly believe was his desired route all along. But by that time, I could not handle the rigid rules, the pain or the hopelessness of the situation anymore and just sought relief and the certainty that I would meet my baby boy soon. The five minutes in the Operating Room leading up to the procedure was the sweetest and most meaningful time of the whole labor. My husband bravely came into the room with me (something that I think not many Indonesian husbands do!) and we talked about seeing our son. He smoothed my hair, held my hand, kissed my cheek and I could not believe how calm and reassured I felt after the trauma of the night and morning before.


Sweetest Moment

Upon waking from a nap after the procedure, I had found my voice and my conviction that baby was not allowed to be far from me or receive any unnecessary treatment. I found it difficult to speak up for myself but had absolutely no qualms about speaking up for my son. My postpartum experience was extraordinary and even better than I could have anticipated. As soon as he was brought to me, he nursed and we were skin-to-skin. I breathed and soaked in every moment. We shared a surprisingly spacious and luxurious family room; he did not go to the nursery except for his bath and hospital photos. When I felt he had been gone too long, I immediately called for him to be brought back. The nurses and my experienced mother-in-law helped him latch and brought him to my bed every time they thought he was hungry. He received no supplementary sugar water, formula or pacifier as per my express instructions. When I had slightly high blood pressure and seemed tired, the nurses suggested he stay in the nursery but I refused to let them take him away and he slept by me instead. The second day in the hospital during my recovery, they brought a complimentary massage therapist to give me an hour massage. Absolutely heavenly! I was fed such nutritious fish, veggies, rice, broth, porridge and fruit. By the time we were released from the hospital, I was confidently nursing him.

We brought him home and I had the whole “it takes a village” experience with my in-laws staying with us to cook and clean. Our sweet baby boy slept between my husband and I, and I nursed and changed wet diapers in bed throughout the night – as we still do! And he takes his naps in his hammock. The all-in-one changing table, bassinet and play pen is still collecting dust in storage.


Baby in a Hammock

Although the birth experience was incredibly different than expected and I did not have a doula with me, Jessica’s constant support and advice via messages and care packages kept me sane, grounded and feeling more in control and knowledgeable. I can’t even imagine how helpful she would have been if she were actually by my side!


Indonesian-style Baby Wearing

By: Kristin Abt