©Pregnancy bliss 2008
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Labor in water: When it is time to get into the pool
The optimal time is when the labor is established. This is confirmed by the presence of regular strong contractions as well as a cervical dilatation of at least 4 cm.
Too early an entry may lead to what will be perceived as prolonged labor, which may lead to a forced abandonment of the pool, either for an alternative mode of pain relief or for augmenting labor with an oxytocin (Pitocin) infusion.
A very late entry into the pool will mean that she will not get the intended full benefit of labor in water.
Using the pool in the latent phase of labour
It is true that, for some women, the latent phase of labor can be quite painful. There is nothing wrong in such a situation for the mother to enter the pool at that stage. However, the mother has to be aware of two important facts.
Firstly, that the latent phase of labor can last many hours; sometimes a good 18 hours or more before true labor is established. The uncertainty of the duration of this phase should be made clear.
Secondly, if the latent phase of labor is found to be unbearably painful, it may imply that when actual labor commences, the soothing effect of warm water is unlikely to be sufficient to control the pain.
Does labor in water reduce the possibility of obstetric intervention?
No, it does not. Properly conducted studies indicate that there are no differences in the rate of intervention in the form of instrumental (forceps or ventouse) delivery or caesarean section for women who labor in water compared to those laboring the conventional way. It is essential that a particular option, in this case water birth, is not promoted on falsehood.
Avoiding dehydration if laboring in water
It is true that intravenous infusions cannot be used if labouring in water. However, drinking (but not eating) is allowed so there is no risk of dehydration.
Additional pain relief options in a water birth
Many women find that the relaxing and soothing effect of water is sufficient. However, if additional pain relief is required, many units will allow entonox ("gas and air").
No injectable opiates such as Pethidine or Diamorphine can be administered. If this is deemed necessary, then she has to leave the pool and water birth is abandoned. An epidural in water is contraindicated too.
If Pethidine or Diamorphine had been used in the latent phase, a minimum interval of about four hours has to be ensured before she enters the pool. This is mainly because of the sedating effect of these drugs, a state which is incompatible with a prolonged stay in water, considering the additional relaxing effect of the water itself. The sedating effect of the drugs has to be allowed to wear off completely.