Prepare Your Mind
Examine your motivations, incentives, and expectations. Ask yourself why you have decided on a waterbirth. Is it something you are doing for yourself, or because someone else expects you to? Are you strongly drawn to the idea of labor and birth in water? Can you picture yourself in that situation, feeling comfortable and confident?
It is best to remain flexible and let go of rigid expectations that you must birth your baby in any certain way. Examine how you might feel if, for whatever reason, your baby is not born in water, and try to find a way to be comfortable with that possibility. Plan and prepare for the waterbirth you want, and also allow yourself the luxury of making your final decision, about whether or not to be in the tub, at the time of birth. That way everyone stays flexible and knows that you plan to follow your instincts and do whatever feels really right to you.
Get in touch with your birth fears and work on diminishing them by gathering information and educating yourself as much as possible. Most important, develop and trust your intuition. Always remember that a woman's body knows how to deliver a baby and that millions of years of evolution are on your side!
Some women are not comfortable with nudity. Since they may associate being in a bath with being nude, they may not feel at ease in the tub even though they might want a waterbirth. This situation need not be a barrier to having a waterbirth, since its very easy for a modest mom to just slip into an oversized t-shirt or nightgown before she enters the tub.
The tub should be big enough to sit in comfortably and deep enough for the water to come up to armpit level, so you can get a comfortable amount of buoyancy.
Make sure that your tap adaptor fits the faucet you will be using. Clean the tub with a non-abrasive cleaner, and then use a 10% solution of bleach and rinse very thoroughly.
Consider purchasing two hoses, of different colors, one for filling and one for emptying the water. Remember that the water rises by 1" to 2" for each person who gets into the tub and allow for this as you are filling the tub. Fill the tub to 9 inches from the top, then add more water as needed, being careful to avoid spillover.
Do a test run by timing how long it takes to fill the tub, so that you already know this when your labor starts. Depending on how quickly you are progressing and how quickly the tub fills, you may want to start filling the tub when labor begins.
SPECIAL NOTICE regarding tubs:
Very recently I have been contacted by a tub maker who believes that the whirlpool style tubs that have internal pipes (which produce the pulsating water jets) are not a good choice for waterbirth because, he states, the internal pipes cannot be reached to be adequately cleaned. I am looking into this and will post further information as I learn more about this issue. In the meantime, the best and safest choice of tub is probably one that has no internal pipes.
The water should be clean: if it is pure enough to drink, it is pure enough to give birth in. The water temperature should be between 95-101 degrees F, depending on your preference. Adjust the temperature to what feels most comfortable to you. If the water is too cold, you will lose body heat as you try to keep warm and you may end up tense and shivering. If the water is too hot, you may feel drowsy and overheated.
The Birthing Room
The floor should be strong enough to support the weight of the tub when it's full. The room should be large enough for the midwife to set up her equipment.
What to Eat and Drink
Drink to thirst. Ask your partner to remind you to drink at least a half pint of water every couple of hours to avoid dehydration, which can result in fatigue and a poorly functioning uterus. Eating and drinking during labor has been shown to reduce the total length of labor by as much as 90 minutes. Eat light, easily digestible food.
When To Get Into the Tub
Wait until you have a strong desire to be in the water. It's best to wait until your contractions are strongly established. Some recommend waiting until you are at least 5 cm dilated, since you want to save the pain relieving effect for the time when you need it most - at transition.
If labor slows down when you are outside the water, try getting into the tub, since that might stimulate labor. If your progress slows down while you are in the tub, get out and move around a bit, to stimulate labor. Often it is the CHANGE of environment that gets labor moving again. Once labor is on track again, you can get back into the tub if you feel like it.
What About Debris in the Water?
Use a fish net to remove any mucus, blood clots, feces, or vomit from the water as soon as possible. But don't spend lots of energy worrying about this. Remember that Dr. Rosenthal says "The solution to pollution is dilution."
Experiment with a variety of different positions while in the tub. Try kneeling, squatting, sitting, or lying outstretched. Some women prefer to have their partner in the tub with them to hold them and act as an anchor, others prefer to be in the water alone.
How Long Should the Baby Stay Under Water?
Discuss this with your birth attendants ahead of time. Many people feel comfortable with the time that it takes for the mother to reach down and pick up the baby herself (called rapid emersion). Any longer than that is not necessary. Although some people prefer slow emersion, remember that the great benefits of waterbirth are achieved as soon as the infant comes into the warm water.
How Does the Baby Breathe?
The baby begins to breathe after its face comes out of the water and its skin and cord come into contact with the cooler air. Until then, the baby receives oxygen through the umbilical cord, as it has done throughout the nine months of pregnancy.
What About the Placenta?
Some mothers want to stay in the tub after the birth and bond with the baby. Because of this, they may also choose to deliver their placentas in the tub. This should be discussed with your birth attendant ahead of time, since some are not comfortable with this approach. If the placenta is slow to come, then get out of the tub!
Will Mother Get an Infection From the Water?
Dr. Michael Rosenthal reports that there have been no incidences of infection in close to1000 births that he has attended. This may be due to the fact that in labor and delivery the action is moving down and out, not up and in. The concentration of bacteria in and around the vagina is actually diluted by the water.
(Daniels, 1986; Lichy, 1993; Harper, 1994)
Thanks to Andrea Eastman of the
Gentle Birth Alternatives Home Page for her help compiling this section.