JULIA VANCE: Hi.
My name is Julia.
I'm one of the midwives here at OHSU.
And today, I want to talk a little bit about the use
of water for labor and birth.
I want to talk a little bit about its history,
in general, as well as the history here at OHSU.
And I'm going to cover some of the benefits
that we know about the use of water for labor and birth,
as well as some of the potential risks.
We know that water has been used for comfort and relaxation
for centuries.
The water birth movement started in the 1970s,
mostly in France and Russia.
And at that time, the midwives were
looking for a little bit more gentle way to birth babies
compared to what the common obstetrical practices were.
So they noticed that when babies were
born into a bath of warm water that they
were generally calmer.
They cried less.
And they were a little bit more interactive with their moms
and more willing to breastfeed earlier.
So at OHSU, our water birth journey
began in 1997 when a patient came in and presented
a book to one of the midwives in clinic and said,
this is what I want to do.
I want to have my baby under the water.
So over the next nine months, the midwives
carried that through all the committees and approval
processes that it takes to get something new in a hospital
setting.
And that woman, in fact, was the first water birth here at OHSU.
Since 1997, we've helped over 600 babies
be born into the water.
And many thousands of women use the tub
for pain management and labor.
What do we know about the safety of water birth?
Obviously we can't do random controlled trials
with women who are pregnant and laboring.
So what we can do is we can compare subjective information,
which would be what moms tell us about their labor experiences.
And then we can look back, and we can compare statistics
around Apgar scores, infection rates, and admissions
to the NICU of babies that were born in the water and babies
that were born on land.
And what we do know from the existing research
is that water birth is safe for both mom and baby, that there
are similar Apgar scores, similar infection
rates, and no increased admissions to the NICU
if a baby is born under the water.
OLIVIA KROENING-ROCHE: Before we go too far,
I wanted to explain two distinct uses of the water
during the birthing process, water immersion, and water
birth.
We think that everyone should consider water immersion
during their labor, regardless of whether or not
you plan to actually give birth under water,
because water can be so helpful in managing contraction pain.
Warm water is also really helpful,
because it allows a lot more buoyancy, freedom of movement,
and can help as the baby's moving down through your pelvis
to relieve a lot of that back and hip pressure
that you'll experience.
Remember that your partner is invited
to join you in the water.
So when you're preparing your birth bag,
remember to bring either swimsuit or something
that they would be comfortable wearing in the water.
When we're talking about water immersion,
talking about your abdomen being fully submersed in warm water.
We know that this helps relax the uterine muscle,
improve blood flow to the placenta and the baby,
and really provides a nice sense of comfort and peace
while you're laboring.
We do want to make sure when you get in the water,
it doesn't slow the labor process down,
which can happen if your labor isn't really far advanced.
And this will be a conversation that your midwife will
have with you while you're in labor
so you can decide together when the best
time is to get into the tub.
As midwives, your safety of you and the baby
is really important to us.
And so there's a couple of things we do to safeguard this.
First, we want to make sure that you're
staying really well hydrated.
We have a water bottle we can provide you with.
Or you're welcome to bring your own.
We'll also be monitoring the temperature of the tub really
closely, as well as your and the baby's heart rate
to make sure that everyone's doing really well while you're
in the tub.
If we notice any increases in the temperature or your
and the baby's heart rate, we may
ask you to get out of the tub.
And once that has normalized, we'll
often invite you to get back into the tub.
For a variety of reasons, the number
of people who actually give birth in the water
ends up being relatively low to the amount of people who use
water immersion during labor.
And regardless of whatever your intent is,
we still encourage you to plan to get
in the water for the labor process
regardless of what the ultimate outcome is.
If you do plan to give birth under the water,
we'd like you to watch our companion video for that.
To use the water tub for water immersion during your labor,
you will be having only one baby whose head is coming first,
have a baby that's coping well with labor,
be at least 35 weeks for water immersion
or 37 weeks for water birth, have viewed this video
and discussed your plans with one of our midwives,
received personalized counseling about this option,
and then sign our consent form.
These are some specific situations in which you cannot
use the tub for water immersion or birth in the water--
preeclampsia, which is when you have high blood pressure
with protein in your urine, an active infection,
such as genital herpes, or if you're
positive for hepatitis B, hepatitis C, or HIV,
if we need to monitor your contractions or the baby's
heart rate using an internal monitor,
if there's any difficulty with monitoring the baby's heart
rate with our wireless monitors or dopplers,
or if you have any abnormal blood pressure, heart
rate, temperature, or any other concerning signs for infection.
JULIA VANCE: So hopefully, this video
has given you some more information
about the use of water for your labor and/or birth at OHSU.
We encourage you to take your questions back home
and talk to your support people and people
you're going to have with you in labor.
It might be particularly helpful to share this information
with family members who might be skeptical about the use
of water for birth.
We'll have a resource section available
for you online that you can access at any.
And we want you to bring your individual questions back
to the midwife in the clinic.
If you do choose to use the water tub for your labor
and birth, we will have you sign a consent form
at about 36 weeks.
It covers the benefits and the potential risks of water birth
that we've talked about in this video.
Be sure to bring any individual questions to your clinic
appointments with the midwife.
We're happy to talk about those with you at any time.
And before we go, we also have answered
a few of the most frequently asked questions
for you here in the video.
INTERVIEWER: "I like the idea of the tub,
but I'm not so interested in delivering in the water.
Can I get out for the birth?"
OLIVIA KROENING-ROCHE: Absolutely.
You're welcome to get out of the water at any point.
Many women enjoy utilizing the water for immersion
during labor and may not know until the moment
that you're there whether or not you want to stay in the water
or ultimately get out.
So the midwife and your nurse will assist you
at getting out of the tub at any point.
Also remember that each room has a bathtub and a shower
that you can utilize for other ways
to have warm water help you during the labor process.
INTERVIEWER: "How do you keep the water
warm in the inflatable tubs?"
OLIVIA KROENING-ROCHE: Great question.
We do have a really narrow range that we
like to keep the temperature in the tub
out for the safety of you and the baby.
So often, we'll end up removing some water
and adding more warm water in to keep it at that perfect range.
INTERVIEWER: "What's the fishnet for?"
OLIVIA KROENING-ROCHE: You've probably heard,
and it's true that a lot of women
poop while they're pushing.
And it's totally normal.
We'll use the fishnet to help clean the tub,
keep the tub as clean as possible.
If you do have diarrhea while you're in labor,
we will have to drain the tub and have
you get out of the tub.
So if you're considering using castor oil, keep that in mind.
INTERVIEWER: "Can I be in the water with an epidural?"
OLIVIA KROENING-ROCHE: No, you can't use an epidural
and be in the water at the same time.
INTERVIEWER: "I've heard that there's less
tearing in the water."
OLIVIA KROENING-ROCHE: Yeah, research is unclear
regarding tearing in the water.
When women are having unmedicated births,
they tend to have a lot more control
over the sensation they're feeling as the baby's head is
descending.
So it's possible that they're able to tear
less because they can control as the head is being born.
It's also possible that the warmth of the water
helps increase blood flow to the perineal area, which could also
help decrease tearing.