By Sharon Muza, BS, CD(DONA), BDT(DONA), LCCE, FACCE, CLE
Many doulas are aware of the benefits of laboring and/or birthing in water. People have long sunk into the sweet relief of the tub and its warm and soothing contents to minimize many a labor pain. There is a lot of research about the safety of waterbirth and you can read waterbirth expert Barbara Harper‘s reviews of the research in Why Pediatricians Fear Waterbirth – Barbara Harper Reviews the Research on Waterbirth Safety and ACOG Releases New Committee Opinion & Acknowledges That Waterbirth is Happening More Often in the US.
Surely, after attending even a handful of labors, most birth doulas will have had at least one client who has chosen to labor in the tub at some point. The birth itself occurring in the water is more common in out of hospital birth centers and home births, but there is the rare hospital that routinely has patients birth in the water. Water typically is a great tool to help reduce labor pain and promote progress. Here are my top ten tips for working with clients who want to use water and be in the tub for some of their labor.
1. Naked or not
Some laboring people are comfortable and choose to be naked while in the tub. Other people are more inclined to wear something while laboring in water. Options for clothing could be a hospital gown, sports bra, bathing suit (top, bottom or both), oversized t-shirt or another clothing item of the laboring person’s choice. If the laboring person is naked, I like to cover them with some bath towels on the chest and belly or back (depending on their position) and keep the towels wet so that they stay nice and warm.
2. Not too hot
It is a good idea to try and get the tub water just around body temperature (99 degrees). If the water is too hot, it can raise both the laboring person’s pulse rate and make the fetal heart rate become elevated as well. That understandably can cause some concern amongst the heath care providers. Keeping the temperature at body temp is a proactive way to avoid potential concerns.
3. A soothing trickle or spray
Many laboring people find it comforting to have support people drizzle or slowly pour water on their belly or back (depending on their position) during the contraction. I like to use a large plastic pitcher from the hospital nourishment room or something else I scavenge to do the pouring. If the shower head is removable and can work as a spray nozzle, it also feels nice to have that sprayed on the laboring person’s belly or back. You can even move it back in forth over the area in time to a rhythm established by the laboring person with their movements or vocalizations.
4. Partner, please don’t go commando!
Prenatally, I remind the partner or support person to bring a swimsuit too, in case they find themselves in the splash zone or tub with the laboring person. If they have forgotten, it is possible to get a set of scrubs from the hospital staff for the partner to wear at the moment. I was with a partner who decided to jump in the tub with the pregnant person without wearing anything which was a bit awkward. It was a homebirth, but I would have preferred a swimsuit nonetheless. Your mileage may vary.
5. Hydrate and then hydrate some more
Being in the tub can quickly dehydrate a laboring person. I like to pick up the pace on offering drinks to my client while in the tub. I offer lots of sips of a yummy electrolyte beverage and encourage them to keep up with their hydration levels. Putting the beverage in a bottle with a sports cap helps make it easy to drink no matter what position the pregnant person is in.
6. Don’t forget to pee…in the tub
Going to the bathroom frequently is always a good idea in labor and that doesn’t change when in the tub. I like to discuss how urine is sterile and there might be a little bit of urine and A LOT of tub water. I encourage my clients to urinate in the tub while they are in their to make sure the contractions remain effective and the baby can move down. Most people are happy to do so, but if it really bothers them, have them get out every 30-60 minutes to use the toilet.
7. Pillow talk
No hospital is too excited about the pillows going in the tub with your client. Taking a blanket or large bath sheet and rolling it up to tuck behind their head makes for a comfortable item that can make it easier on the laboring person’s neck and back. This can also be used to kneel on when they are on hands and knees in the tub too. I like to take the shower curtain and stash it on top of the curtain rod too, to keep it out of the way.
8. I sit on the toilet
When they are available and able, I like to set up my client and their partner close to each other when the pregnant person is in the tub. A birth ball works great for a partner next to the tub. I tend to hang close by though for support, suggestions, position changes and more. I find that taking a clean towel and placing it over the toilet gives me a place to sit during the labor, while still being in the bathroom with my client and doing my doula deeds. It gives me a place to sit without making a small space even more crowded.
9. Keep an eye on the contractions
The tub can speed things up or slow things down. I try to keep an eye on the contraction pattern to sense if anything changes. If the laboring person needs a rest, the tub may provide some space between contractions for a quick snooze. On the other hand, the tub sometimes kicks things into high gear and off we go, having a baby. Either of those options may be fine for the laboring person, but it is good to be aware when it might be time for something different if the hope is to get things to pick up, but that hasn’t happened in the tub.
10. Listen up
If the birth is happening in the tub, I help my client to listen for the doctor or midwife’s instructions. Sometimes the health care provider may need the birthing person to change positions, stand up, get out or another instruction for the safety of the birther, the baby or the situation. This could be during the labor, the actual birth or immediately postpartum. One such example might be concern about postpartum hemorrhage and the provider may want the new dyad to be out of the water to better assess and manage blood loss. I am ready to help my client to adjust or change positions if necessary. Being in the tub makes it just a bit more difficult to shift position, and sometimes there is a new baby who needs to stay above the waterline too!
Do it in the water!
Laboring in the water can be a great relief from some of the pain of labor contractions. Birthing in the water can be pretty special too. When a doula is prepared to support their client in the tub just as easily as on land, it can go much smoother and be more enjoyable for everyone. Doulas should plan to be prepared for the tub scene with these ten useful tips for helping clients in the tub. After reading these, is there anything else you would want to add? Please share your personal suggestions in the comments section below.
Thanks for the great tips Sharon! One of the things I always take on when I have a client in the tub is making sure I have cold wash cloths for her forehead and neck to help regulate her body temperature. I like to have a bowl of ice water with wash cloths in it so I can switch them out quickly.
I find that a cheap bath pillow is an excellent addition in supporting the mom’s head or neck and it has the added benefit of not getting soggy or chilly.
This is awesome! Sharing!
Despite the widespread belief that it is, urine is not actually sterile! If mama is planning a water birth (or isn’t, but baby comes faster than expected), I’d be encouraging her to pee in the toilet in order to keep that water as clean as possible. https://www.sciencenews.org/blog/gory-details/urine-not-sterile-and-neither-rest-you
Thanks for sharing that Tanya! I now want to look into this a bit more to learn about this possibility.
This is so interesting… I was taught in health-occupations-related coursework (many, many years ago) that urine is sterile as it exits the body, but is not considered so once it is “out,” because bacteria present in the external environment can grow in urine. But it would seem that is also not true. We’ve learned a lot about the microbiome since I was in those classes, but this never occurred to me and of course it makes a lot of sense that there are bacteria absolutely everywhere. Thanks for sharing!!