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

Kay: Jill, what made you decide to become a nurse midwife?

Jill:   It was truly a God-directed thing for me. I’ve always enjoyed caring for people. After high school, several things fell into place for me to go nursing school. During my last year, I had the chance to shadow a midwife for a week. It was really awesome to see the relationship she had built with those women. That experience stuck with me.

After I graduated, I worked as a medical/surgical nurse at a hospital for a short time before transferring to maternity services. I really enjoyed it, but I knew I wanted to help women not just when they’re in the hospital. I wanted to see them day in and day out — to build relationships and help guide them in making good decisions, while caring for themselves and their families. That’s why I went back to nursing school to become a certified nurse midwife. I wanted to be in a position to empower women.

Kay:  Is midwifery care becoming more popular these days?

Jill:  I think women are learning that pregnancy and childbirth are normal, healthy processes for which a woman’s body is well-designed. Yet each woman’s experience is unique. Some women are interested in water birth. Others prefer having a birth ball, shower, or rocking chair close by. And many simply want all of their relatives by their bedside. More and more mothers-to-be are having babies their way, with the help of a midwife who is there to do as much or as little as the woman wants.

Kay: Midwifery has been around for centuries, yet there are misperceptions about it. What ones do you encounter most often?

Jill:   I wish the general public knew that nurse midwives do not only deliver babies at home. They also deliver babies at the hospital and in birth centers. Most people are surprised to find out I work at a health center and deliver babies at a hospital.

Kay: What other misperceptions come to mind?

Jill:   Midwifery care is a safe option for women, especially for those who want to be cared for by someone who views birth as a natural process.

CNMs are nurses first. I went through four years of training to become a nurse, then went back to school for extra training focused specifically on labor and delivery, before and after childbirth care and OB/GYN. We are certified by the American Midwifery Certification Board. At HealthNet, we are credentialed by the hospital and work side-by-side with OB/GYNs. We view things more naturally, but when we need to intervene for the health of the mom or baby, we will.

Kay: There’s been a lot of talk in the news about the national Caesarean section rate being on the uptick, and how that may not be the best thing. What are your thoughts about it?

Jill:   In the 1960s, the national c-section rate was approximately 5%. These days, it hovers around 30%. I feel like we as midwives are helping to reverse that trend.

A woman’s due date is really just an estimation. In general, we wait until 10 days past the due date to induce labor. In most cases there needs to be a medical reason to induce sooner. When a woman goes into labor on her own, the labor usually goes more quickly and smoothly. Often times when you introduce medicines to speed up the process the woman’s body isn’t ready yet or the baby is not able to tolerate it well. Anytime you give the body the chance to do it on its own, it will go a lot better than trying to force it.

Kay:  You are expecting your second baby soon. Did being a nurse midwife change your outlook on your own birth experience?

Jill:   Absolutely! It really made me look at my own pregnancy and labor very differently. I had my first child naturally. He was a big baby too — 9 lbs. 3 oz.! I like being able to share appropriately from my personal experience to encourage moms who are considering natural childbirth.

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HealthNet Midwifery Services is the largest midwifery practice in the state, assisting in the birth of more than 2,400 babies each year at IU Health Methodist. The program’s 24 nurse midwives work with the OB/GYN physicians on staff to provide prenatal care, postpartum care, well-woman care, family planning and more for women at HealthNet’s six community health centers and one OB/GYN care center. The program celebrates its 20^th year this year.

Lisa Glazik has been working for HealthNet for over 6 years.  She started out working in different centers during the week but now she is stationed at the hospital downton.  And, from one quick phone call she made me happy to boast about HealthNet’s Midwives!

Willie: Lisa, why did you become a Nurse Midwife?

Lisa: I was always interested in women’s health.  When I had the chance to start shadowing other nurses in OB programs while at Illinois, I noticed that they were missing out on a BIG piece of a woman’s pregnancy, THE BIRTH! To spend almost an entire pregnancy with a patient and to not be in the room for that special moment made me feel as if I’d be missing on some closure in the process.

Willie: What is the most satisfying part of your job?

Lisa: Being a part of that special moment.  Seeing the culmination of teaching a mother about pregnancy, what to expect and healthy lifestyle choices is very rewarding.

Willie: What is the biggest challenge you face when dealing with a patient?

Lisa: When someone comes to us uneducated about healthy lifestyle choices, it makes it really hard to get them to make new ones.  Change is hard for EVERYONE, but learning about the changes that need to be made can be even harder.  It is a challenge to get the new information to sink in when a patient already has set habits.  But it is awesome to see them succeed!

Willie: What do you all do to celebrate National Midwifery Week?

Lisa: The fall brings a slower period, so we usually plan a retreat day for ALL of us to get together, relax, but also learn from what has been happening all year.  This year, however, we couldn’t plan it until November. 

I like Midwifery Week, though, because I get a lot of questions directed my way about what exactly a midwife does.  I enjoy educating others, even some IN health care, and dispelling some of the old stereotypes that some may have about midwives.

Willie: If you could sum up your goal, in one sentence, to make sure a pregnancy is a success, what would it be?

Lisa: I would tell the mother-to-be, “Your birth experience is YOURS, I am here to give you THAT experience in the best way possible with a healthy mom and a healthy child as an end result.”

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To learn more about Nurse Midwives at HealthNet, stay tuned to our Twitter feed and Facebook page to get statistics and tidbits all week!