One option is the use of water during labor and birth.  I personally chose to have a waterbirth with my first child.

It was the most exhilarating experience I have ever had in my life.

I felt so empowered and strong! I would have had a waterbirth with my second child, but alas she came out so fast that I didn’t have time to make it to the tub, let alone a bed!  Several of the nurse-midwives in our practice have also chosen waterbirth for the birth of their babies.

What is waterbirth?  Water birth is the birth of a newborn under water.

What is hydrotherapy (also called water immersion)? Hydrotherapy in labor is the immersion of the laboring mother in water, often used in an effort to delay or prevent use of pain medicine either through an IV or with an epidural. Hydrotherapy can be accomplished in a tub or a shower to help the woman relax and cope with labor pains.

How long have women been delivering their babies in water?   Waterbirth has been around for centuries. The first documented waterbirth was in France in 1805. From the years of 1985 to 1999 over 150,000 waterbirths occurred around the world.  More research is underway across the nation to help better understand how many women have waterbirths in the US.

Are there benefits to using the tub for labor and birth?  Studies have shown that women feel more buoyant, better able to relax or feel calm, and some women feel less fear and stress. Other studies have compared the use of pain medicine between water and land births, and have found water birth moms use less pain medicine. More research is being done to better understand the benefits of hydrotherapy and waterbirth. 

Is waterbirth safe?  Thousands of waterbirths have been studied over the years, and researchers found waterbirth to be as safe as land birth. The studies compared waterbirth to land birth and concluded, “There is no evidence of increased adverse effects to the fetus/neonate or woman from laboring in water or water birth” (Cluett & Burns, p.2, 2009).  Pain medication use, length of labor, vaginal tears, infections of the mom and baby, and patient satisfaction were some of the areas studied.  

What are the reasons I would not be able to use the tub for labor and delivery?  In our delivering facility, we have a policy on hydrotherapy and waterbirth.  Use of the tub is for women with healthy, normal, and full term pregnancies with normal labor patterns. Contraindications (reasons you would not be able to use the tub) include: suspected infection, maternal fever, active genital herpes, untreated skin infection or open wound, abnormal tracing of the baby’s heart rate, too much vaginal bleeding, recent pain medicine use, any positive Hepatitis or HIV results, morbid obesity (BMI >40), less than 37 weeks gestational age, and having less than 4 prenatal visits.

How warm is the water?  The water temperature in the tub is warm and is similar to your own body temperature. Women can get warm in the tub, which is why staying hydrated during your labor is important.

Are the tubs clean? Our tubs are cleaned following strict recommendations from the tub manufacturer, and have been approved by the Indiana State Board of Health. Hospital personnel responsible for cleaning the tubs follow these strict guidelines, receive initial training, and complete competency check offs.

What if I have a bowel movement while I am in the tub? Many women have bowel movements during labor and especially during the pushing stage of birth whether or not they are in the tub or on land. Women who use hydrotherapy and waterbirth are mobile, and can get out of the tub to use the restroom.  If you have a bowel movement in the tub, the stool is removed from the water. If the water is very messy you can get out of the tub, and it can be drained and refilled.

Where can I go to have a waterbirth? The Indiana University Maternity Center at Methodist Hospital offers both hydrotherapy and waterbirth. All of our nurse-midwives practice at Methodist Hospital, and are well trained in helping you safely give birth in water.  We have been safely offering waterbirth at Methodist Hospital for nearly 15 years. At this time, we are the only hospital offering hydrotherapy and waterbirth in Indianapolis.

For more information about HealthNet’s Midwifery Services, please click here.

Post by Carrie Bonsack, CNM, MS

Paige McDaniel, Certified Nurse Midwife

In honor of National Midwifery Week, we met up with Paige McDaniel, one of HealthNet’s many excellent midwives! Paige recently traveled to Liberia, West Africa to conduct a needs assessment and help nursing staff in Liberia update protocols. Check out Paige’s incredible story about her trip to West Africa and delivering twin baby boys!

Q: Tell us about your recent trip to Liberia, West Africa?

A: I was in Monrovia, the capitol of Liberia for two weeks at the beginning of September with my faculty advisor from IU’s School of Nursing, getting started on the required Inquiry Project for my DNP program. I hope to transition my career into global midwifery education and development, and for this project, I plan to implement a midwifery education intervention around the issue of postpartum hemorrhage management. Liberia has one of the highest maternal mortality rates in the world because of bleeding during and after childbirth, so the need is very great.

Q: Walk us through a day in your shoes in Liberia.

A: For this first trip, I was working under my advisor as part of her larger USAID-funded grant to develop nursing and midwifery education in Liberia. My purpose on this visit was to conduct a clinical practice needs assessment pilot study to assess the clinical knowledge of the hospital nurses and midwives, and help the nursing staff there begin to refine outdated institutional protocols and identify clinical areas where new protocols need to be developed. I was not there as a patient provider per se, and much of my time was spent working with nursing and midwifery leadership at the country’s only tertiary facility, John F Kennedy Memorial Hospital. Specifically, I worked with midwife and nurse leaders to develop modules to assess staff competencies in three clinical areas, including a simulation involving postpartum hemorrhage for the hospital midwives.

Q: What was the most satisfying part about your trip?

A: I think the most satisfying part of my time in Monrovia was simply the relationships I built with the nurses and midwives at the hospital, as well as other Liberians I was privileged to meet. The country recently emerged from a brutal, 13 year Civil War so in addition to having to completely rebuild the country’s infrastructure, many people are still quite reserved and often guarded. Everyone I met was always welcoming and hospitable, but by the end of the two weeks, I knew that I had made some genuine friendships.  I will be back in Monrovia a few more times for this project, so truly getting to know some of the people there was very important to me.

Incidentally, I also had the surprise pleasure delivering twin boys as I was pulled into the delivery room one day during my first week by one of the midwives! This is something many CNMs practicing in the United States don’t have the opportunity to do, so I very much enjoyed this professional “first”! 

Q: What is the one thing you wish you could tell others about being a midwife?

A: Being a midwife is absolutely the most rewarding profession that I can imagine for myself. Regardless if I ultimately find myself in direct clinical care “catching babies”, educating a new generation of midwives in the classroom, or working in public policy to help strengthen health care for women and children, I will be forever honored to stand next to my sister midwives as we engage in the work of our hearts.

For more information on HealthNet midwives, please click here or call a location near you.