Women and Birth
Volume 20, Issue 1 , Pages 17-24, March 2007

It's beyond water: Stories of women's experience of using water for labour and birth

  • Robyn M. Maude

      Affiliations

    • Graduate School of Nursing, Midwifery and Health, Victoria University of Wellington, PO Box 600, Wellington 6005, New Zealand
    • Corresponding Author InformationCorresponding author. Tel.: +64 4 3855999x5289/64 4 4769319; fax: +64 4 3855316/64 4 4769315.
    • ,
  • Maralyn J. Foureur

      Affiliations

    • Faculty of Nursing, Midwifery and Health University of Technology Sydney (UTS) Kuring-gai Campus Lindfield NSW 2070, Australia
    • Tel.: +61 2 9514 5708.

Received 1 June 2006; received in revised form 27 October 2006; accepted 27 October 2006.

Article Outline

Summary 

Purpose

This study aimed to give ‘voice’ to women's experiences of using water for labour and birth.

Participants

Five women from a large urban region in New Zealand, who used water for labour and birth, at home and in hospital.

Methods

The study employed an interpretive design using audio-taped conversations as the method of data collection and a thematic analysis of the women's stories.

Findings

Data analysis produced two core categories; ‘Getting to the water’ which revealed the impact of preparing for and anticipating the water; and ‘Getting into the water’ which provided a sanctuary and a release from pain.

Conclusion

The all-encompassing warmth associated with being enveloped in warm water cradled, supported, relaxed, comforted, soothed, sheltered and protected the women; it created a barrier and offered a sense of privacy. Water can be used in any form, even the act of thinking about, preparing for and anticipating the water opened possibilities for these women. The women used water to reduce their fear of pain and of childbirth itself; to cope with pain, not necessarily to remove or diminish pain; and to maintain control over the process of birth. The women indicated that it was not necessary to actually give birth in the water to achieve these benefits. Listening to the stories of women provides us with insights into what is important to them. Women's knowledge contributes an important part of the evidence on which we base our practice.

Keywords: Water labour birth, Experiences, Narrative

 

The demand for water during labour and birth has grown rapidly throughout the developed world. Hall and Holloway1 suggest this may be one reaction against medical control of childbirth. Kitzinger2 suggests that using warm water seeks to change the dynamics of the care of labouring and birthing women, to give control back to them and asserts that it is an approach to childbirth that enables birthing women to have autonomy. The option to use water, along with continuity of caregiver and the availability of private and peaceful surroundings, is one way of supporting women in labour without drugs and other interventions.

The reported benefits of water for labour and birth have been varied. One systematic review, incorporating eight studies (2939 women), concluded that water immersion during the first stage of labour reduces reported maternal pain and the use of analgesia without adverse impact on labour duration, operative delivery or neonatal outcomes.3 However, relying only on measurable/quantifiable outcomes for women who use water for labour and birth may limit our knowledge and understanding of this phenomenon.

Some of the research into water immersion for labour has included surveys of women's satisfaction, but little regard is given to what they have to say about the experience. One randomised controlled trial reported that women were highly satisfied with using water for labour and would use it again in subsequent labours. However, the researchers went on to comment, “Satisfaction is not a reliable indicator of effectiveness”.4 The knowledge that women's voices are largely ignored in the current literature provided the impetus for the research reported here. This study aimed to give ‘voice’ to women's experiences through exploring the stories of five women who used water for labour and birth.

Back to Article Outline

1. Participants and methods 

This interpretive inquiry used story telling and thematic analysis to derive meaning from the experiences of five (Pakeha/New Zealand European) women (Lily, Jane, Linda, Marion and Tanya—pseudonyms) who used water for labour and birth.

The study was conducted between May and September 2001 as a supervised Masters Research project.5 A woman-centred approach was employed. Ethical approval was obtained from the Wellington Regional Ethics Committee.

1.1. Data sources and collection 

Audio-taped unstructured interviews lasting between 45 and 85min and occurring 4–21 days after the birth of the baby were employed for data collection. Each woman nominated the day and timing of her interview. Lily chose day 4, Linda day 9, Tanya and Marion day 10 and Jane felt ready to be interviewed 21 days after the birth of her baby.

1.2. Data analysis 

A Giorgi-style method of data analysis was employed. Analysis involved initially listening to audiotapes of interviews and reading of transcripts to get a sense of the whole; then intuiting about, and reflecting on, each transcript; identifying meaning units in each transcript; regrouping and redescribing statements relevant to each meaning unit for each transcript; intuiting about, and reflecting on, each meaning unit across all participants to uncover themes; writing an ‘exemplary narrative’ to illustrate each variant theme and validating (by participants and colleagues) and synthesising statements.6

The exemplary narrative was useful because the transcripts of the conversations contained a significant amount of dialogue that, while it adds to the context of the woman's experience of using water for labour and birth, contributed less to the overall understanding of the meaning the women make of the experience. This made the stories more manageable for thematic analysis and more accessible to the reader. The exemplary narrative was interspersed with each woman's own words to build the picture of the journey.

Two core categories emerged from the narratives and to assist in the interpretation, data was returned to the women for validation of the findings. A journal was maintained to track the decisions, context and processes used in the research.7

1.3. Results and discussion 

The two core categories that emerged from the analysis are named ‘Getting to the water’ which contained six subcategories (specifications; milieu; anticipation; alternatives; difficulties and journey) and ‘Getting into the water’ which contained four subcategories (bliss, release, sanctuary and diligence). Examples of each core category will be presented in the following pages and in accordance with many post modern approaches to research, the discussion of each of the categories and subcategories will include supporting literature placed in relation to the exemplar.

1.4. Getting to the water 

The first category, and its six subcategories, described the where, how and when of using water for labour and birth. The women's stories identified the impact of anticipating when they could enter the water as well as the disruption to the rhythm and flow of their labour caused by difficulties that prevented timely access to the water. The women also commented on features such as where the bath or birth pool was geographically located and its design, suggesting that many of these features also impacted on their feelings of wellbeing in relation to the water.

1.4.1. Specifications 

The depth, shape and size of the bath or pool were important to the way in which women use water during labour and birth, especially in relation to hydrostatic pressure, buoyancy and freedom of movement.8 The women who birthed at home (Tanya and Marion) used portable birth pools consisting of a lightweight plastic frame, which supports a strong and durable polythene pool liner. The pool contains approximately 750l of water and comes to the level of the breasts when the woman is sitting. Linda used a corner spa bath in the delivery suite, and made particular mention of the size of the bath and said that it had provided her with, “plenty of room to move around”.

Freedom to move around while being supported by water has been acknowledged in the literature as beneficial to women during labour. Johnson9 said,

“… it is obvious that a woman in water can move easily and choose to spontaneously vary her posture during labour, which she cannot do in a typical delivery room bed. The posture which a woman finds comfortable is of enormous importance to the physiological effectiveness and emotional satisfaction of labour and birth” (p. 202).

Tanya used an ordinary domestic bath during one of her previous labours. She said, “I just found to be even slightly submerged you needed to lie back really and I didn’t like lying back and you still weren’t totally covered anyway so it just didn’t do it for me basically”. She appreciated the effective relaxation and comfort afforded by the size and depth of the birth pool. Lily preferred a combination of standing and kneeling, using both the shower and the bath. For her the water in the bath was not deep enough because every time she turned over onto her hands and knees her back would get cold because it was out of the water. Because Lily had a lot of back pain, she would have preferred to be able to stand up, leaning forward with hot water directed onto her lower back:

I would have much preferred to almost be standing up in water—like I know that's a lot of water, but [I wanted it] almost … to the upper chest just so it covers at least half way up my back. I would have liked to be surrounded by warmth in the water.

Women have much to contribute to the knowledge of designers and manufacturers of birth pools and managers who are responsible for planning and designing new birthing facilities within institutions.

1.4.2. Milieu 

The setting in which the bath or birth pool is located has significance for women. The women birthing in hospitals used birth pools that were placed by hospital planners and designers into positions that are often dictated by extraneous factors. Linda appreciated the opportunity to use a deep bath in an adjoining bathroom. In the delivery room the delivery bed dominated the centre of the room and therefore became the focal point:

The room itself—I mean it had the basic hospital bed; it had the ‘lazyboy’ [reclining chair] and another chair beside the bed with all the hospital equipment around it. I mean they are nice rooms, nicely painted rooms and so forth but they’re still hospital rooms. The hospital bed, I think it's the bed more than anything that puts everybody off because it looks like a hospital bed, it's so cold and impersonal whereas the bath itself, I mean the bath—you can feel a little bit more at home, you didn’t feel like you were in a hospital room you felt like you could have been at home just having a bath sort of thing, relaxing.

Lily and Jane used purpose built, low intervention birth rooms designed using Lepori's10 concept of having an open central space allowing the women freedom of movement. This space provides access to a range of options that encourage active birth, such as bars and rails on the walls, and includes easy access to water immersion. The creation of such spaces is supported by research comparing home-like versus conventional institutional settings which has found lower rates of intrapartum analgesia/anaesthesia, fetal heart rate abnormalities, augmented labours and immobility during labour. The research has also reported greater satisfaction with care.11

1.4.3. Anticipation 

The importance of anticipating the use of the bath or birth pool should not be underestimated. The power of anticipation is reflected in the stories of Marion and Tanya both of whom experienced delays in being able to sink into a deep pool of warm water.

Tanya eagerly anticipated entering the birth pool as she watched it fill and waited for the water to reach ‘the right temperature’. While waiting for the pool to be ready, she was very aware of the need to be in the water. “I was focused on being in the pool, that's where I wanted to be …”. She attributed the speeding up of her labour (Tanya gave birth 45min after entering the birth pool at 4cm dilatation) to the anticipation of the warmth of the water and the knowledge that she needed to change what she had been previously doing:

I didn’t get into the pool until 8:00 at night, but I was ready to get in before that … the pool wasn’t ready for me. I was just really dying to get in … I just knew I really wanted to be in there … if I hadn’t got into that pool, I could have gone many more hours; it would have taken a lot longer.

Marion's house was very busy when she found herself in early labour, 2 weeks before her due date. Her Granddad's funeral was scheduled for later that day, and there were many people at the house. Planning for the birth was incomplete and she had not yet picked up the birth pool from the supplier. Marion remained in latent labour during this time. When asked what she thought was going on with her labour Marion replied:

… there was so much going on during the day. I think that a lot of it was [that] there was so much happening it kind of slowed down a lot … some of it was that I knew that everything wasn’t ready yet, everything wasn’t there that I needed, so I kind of just slowed down and waited ….

Later in the day when everyone had left and the birth pool arrived, Marion's labour became more established and she took control.

Odent12 reported that women's labours can progress rapidly just by anticipating and watching the pool fill. He claimed that the mere sight of the water and the sound of it filling the pool are sometimes sufficient stimuli to release inhibitions. Experienced midwives’ judicious use of this phase might help women enter the pool at just the right time, which in turn may promote cervical dilatation.13

1.4.4. Alternatives 

All the women in this study used water in other forms in early labour prior to accessing the birth pool when labour was well established. This included laying in the bath at home, standing under the shower or having water poured from a container over their back. Marion went into her bath to get some relief from niggling contractions on three occasions:

I decided I was going to have a bath because that would just relax me, that would settle it all down and I’d be able to go to sleep and I’d be fine and it would all go away. So I did that, went and had a nice bath.

The distinction that Marion made between using her bath and going into the birth pool was clear since both were available in her house. The bath was a method used to soothe the discomfort of the early contractions, whereas the birth pool was for when she was in active labour and for giving birth.

Both Jane and Lily used the shower at home during early labour. Jane found the running water soothing:

It was just enough to make it bearable. I found the shower I had … in the early stages … quite refreshing and it made me feel better. It didn’t really take the edge off the pain I don’t think—it just made me feel better in myself.

While Lily enjoyed the localised heat on her lower back:

… I really wanted to hop into the shower, I wanted heat, and I needed heat. So I hopped in the shower—and had it on quite warmish and then every time a contraction would come I would turn it on really hot and turn around and brace myself against the wall and just have it on my lower back, really, really hot.

Linda recalled the soothing effect of having warm water poured over her back during contractions. She said, “S [midwife] was scooping up [the water] with a container and tipping it over my back and that felt warm and really nice, it was like very relaxing and soothing”.

The women's stories revealed that water can be used in any form, from the shallow water of a bath, perhaps in the phase of latent labour, to the deep water of a birth pool during active labour. The shower also provided comfort and relief. The shower head could be directed onto a specific part of the body to soothe the pain while also enabling the woman to control the temperature she desired. Calmness and relaxation could also be promoted by using a bowl to pour water over the woman in the bath or pool.

1.4.5. Difficulties 

Both women who planned to give birth at home experienced some difficulties with the portable birth pools they hired. The difficulties included a lack of availability of the equipment and getting the water temperature correct, the latter being the focus of the following excerpt from one of the women's stories.

For Tanya, getting the water temperature ‘right’ played a significant part in the course of her labour. In line with thinking of the time, she had understood the recommended water temperature to be 35–37°C for the first stage of labour.14 However, when Tanya was ready to get into the pool it was noted on the thermometer that the water was too hot:

We had the pool all heated up. In fact we thought it was too hot, so someone turned it off at some stage. And then we discovered later that it was hot at the top and cold at the bottom. Somebody had to stir it up!

Issues related to water immersion and fetal hyperthermia have been debated9, 15, 16 and recommendations were made to regularly monitor both the maternal and water temperature. However recent research has demonstrated that women self-regulate their body temperature according to changes in the water temperature. This mechanism is now understood to be far superior to any water temperature guideline and research has now concluded that there is no reason for practitioners to adhere to protocols that recommend keeping the water at a set temperature, other than for the mother's physical comfort.17

1.4.6. Journey 

The impact of the decision to relocate to the hospital from home during labour and the actual trip to the hospital can be very disruptive in that it can disrupt the rhythm and flow of the labour. Some women experience feelings of loss of control and an altered ability to cope once they made the decision to transfer. Jane and Lily's stories of their journeys to hospital provide contrasting perceptions of the experience.

Jane had planned a hospital birth and was very keen to use the water for labour. She lived only 10min away from the hospital but had to climb quite a few steps up to the road to her car. Her labour was progressing fast and when examined, her cervix was 6cm dilated. Soon after making the decision to go to the hospital her membranes ruptured, intensifying the contractions. Jane's thoughts at this time were, “I had to try and make it up those stairs and that was a bit of a drama in the middle of contractions”. Her contractions were coming about every 2min and she had to stop walking up the steps each time another contraction started. Consequently, it took a while to make it to the top of the steps to the waiting car. Jane was very anxious to get to the hospital and described the trip was a bit of a drama. She said, “I felt out of control when I didn’t know if we were going to get there”. In one study, staying in control emerged as a core category. “Indeed, personal control appeared to have an effect on the participant's view of the experience as well as her ability to manage pain, release inhibitions and to have the confidence to exercise choice”.1

In contrast, Lily was unfazed by her trip to the hospital, about 15min drive away. She described her trip to the hospital as, “more comical than it was actually stressful”. Lily's partner did not drive, so they had arranged for a friend to drive them to the hospital in Lily's car. She was giving the driver directions to the hospital in between contractions, kneeling over the back seat and facing the wrong direction. Lily ponders on the initial slowing down of her contractions and wonders if this is related to the trip to the hospital. She says, “I was waiting for it. I’d heard that when you go to the hospital it could really stop you from progressing”.

The contrast between Lily and Jane is interesting. Lily had said at our earlier meeting that she would have quite liked a home birth, but because Lily and her partner were only renting the place where they lived, they did not feel like it was their home. However for Jane, getting to the hospital was paramount and she became apprehensive when she thought her labour was progressing too fast to make it in time. This was despite the fact that her midwife regularly attends women birthing at home and that she lived very close to the hospital.

1.5. Getting into the water 

The next section describes the second core category, and its four subcategories (bliss, release, sanctuary and diligence). The first two subcategories (bliss and release) are very closely related. One explains the feelings and pleasurable sensations afforded by water and the other explains the relationship between water immersion and the release from pain. The women's stories illuminate what happened once they made it into the water and reveals the meaning they made of the experience.

The women were generally not able to articulate exactly what it was that being immersed in water ‘did’ for them. Linda's response to the question, “what was the water like, what did the water feel like?” demonstrates this difficulty. She says:

It was … just the warmth and that felt really nice, it was like—very relaxing. It was – I don’t know – it was, yeah … cause I was scared as well which didn’t help, and so therefore, I wasn’t relaxed but with S (her midwife) tipping the water over my back and that, it was just the warmth and everything else, it was soothing, yeah it's quite hard to describe actually.

1.5.1. Bliss 

Lily used the word bliss to describe the sensations of the relaxing, soothing, comforting and the all-encompassing warming effect engendered by being in the water. It fits well with similar words used by the other women when they described being in the water. Lily said,

It was just bliss actually, it felt really nice … It just felt really, really, really, wonderful, it relaxed me a lot, as soon as I got in the bath I was totally relaxed and it was yeah—I don’t know how, it just felt really nice, it felt like the right place to be.

Marion said, “I think a lot of it was the warm, like I really needed to be warm, so I had that whole enclosed warmth and yeah, the support of the water, yeah, it was my space”. This aspect of warmth is reflected in Linda's words describing being immersed in the warm water of the bath as:

Almost like being in a water bed … is a good way of explaining, like on a cold night when you get into a waterbed or an electric blanket … and it's warm and it sort of like goes through you and warms you up, that's what it was like sitting in that bath.

For Linda the bath provided a means of coping with labour and dealing with her fear. She experienced an ongoing conflict between the relaxing effect of the water, a sense of nervousness and fear that would not leave her:

I was extremely nervous, very nervous, but once I got into the bath I sort of relaxed, you know the heat of the water and so forth, that was really good to relax—to sort of relax and let it all happen … it was almost like soothing … I mean I was still nervous and I was still scared but it was nice and relaxing.

While the women had difficulty articulating what water did for them, it is clear their stories support the notion that water does provide a temporal stabilising effect described by Cammu et al.4 A natural balance between pain and relaxation was achieved.

Bliss (as in a trance state) was talked about by two of the women in terms of an altered state of consciousness while relaxing in the bath or birth pool. After having ‘niggles’ all day Marion decided to have a bath before going to bed early at around 9p.m. She enjoyed the support the water afforded her body and says that she was able to completely relax in between the contractions while in the water. “I think I was basically asleep in the water between times”.

A similar altered state was evident in Lily's account:

I almost fell asleep in between. I just let my head loll on the side. I would just lie it against the side of the bath and I’d just about go to sleep. I was so relaxed in between, it was really nice and it was nice to keep warm. I think I was basically asleep in the water between times.

Odent12 claims to have observed that water seems to help labouring women reach a certain state of consciousness where they become indifferent to what is going on around them. Odent continued to explore the biochemical and physiological effects of warm water immersion and concluded, “when a parturient enters a bath at body temperature, there is immediate pain relief. This pain relief is probably associated with a reduced level of endorphins and catecholamines (there is a tendency to fall asleep in a comfortable tub)”.13

1.5.2. Release 

The focus of this subcategory is how women perceive labour pain and any pain relieving properties associated with being immersed in water. Much of the research to date has attempted to quantify the absolute effect of pain relief afforded to the woman by water immersion during labour and birth, however, the women's stories reveal that being immersed in warm water did not necessarily take the pain away, but rather their perception of pain is impacted by the water. What water immersion did appear to do was provide a release from the pain.

The thing for me with the water wasn’t that it relieved the pain because I don’t know how much it did because I don’t know how the pain would have been without it; the thing for me with the water was I completely relaxed in between time … (Marion).

Many women are keen to avoid pharmacological pain relief but are unsure about their ability to go through a labour without some help. Linda made a link between the relaxing effect of the water, the speed of the labour and her ability to avoid pharmacological pain relief:

I think it was a quick labour as well which probably helped. It [the water] was enough to make me relax enough to not even think about [the pain]—I mean I didn’t even think about taking drugs or gas or anything like that.

The explanation for this relaxing effect (and the accompanying release from pain) is related to the soothing warmth of the water, the support of the body and the pleasurable sensation of water, which stimulates the closing of the gate for pain at the level of the dorsal horn, and supports the notion that water provides women with a temporal stabilising effect possibly mediated through the improved ability to relax in between contractions.4 Jane's comments provided more support for this notion when she said, “It [the water] made me feel better. It didn’t really take the edge off the pain I don’t think; it just made me feel better in myself”.

Church18 also proposed this when she reported that water immersion decreases anxiety in the woman and that this works to reduce adrenaline levels, thus encouraging natural oxytocins and endorphins to flow uninhibited. A natural balance of pain and relaxation is achieved, and labour progresses normally.

For women who want to avoid pharmacological pain relief and for midwives who support these women, judicious use of water immersion may offer the means to achieve this.

1.5.3. Sanctuary 

Being immersed in warm water during labour and birth provided the women a safe haven and created a barrier between themselves and their caregiver and supporters. For some women water immersion helped to create a sense of privacy. Marion described how the pool enabled to her to maintain control of her labour by creating a barrier between herself and her supporters. This is reminiscent of the woman who maintained control by sinking her ears under the water so that she could not hear the midwife telling her what to do.1 Marion used the pool as a barrier by moving to the far side where no one could touch her:

Every time I had a contraction I’d move so that they could press my back and everything so I could get that as well and that really helped but as soon as it was finished I’d be back, and away from them as well, they couldn’t reach me—when I didn’t need them, there was no way they could have touched me because I was over the other side of the pool, we had the pool in the far corner of the bedroom so that it was here and everything else was over there and the bed's on this side and yeah so every time [I had a contraction] I was over in the far corner where they couldn’t [touch me]—I was no-where near anyone else.

When asked why this was important to her and what was happening for her and she replied:

… when I needed them I’d go and get them and when I didn’t, I needed the space to be on my own so I could relax and focus—I turned everything off and kind of went in … I did actually focus on the baby.

Marion described the pool as a protective place for her, a little cocoon:

It was my space. Every time S (the midwife) made me stand up … so she could listen to the heart rate and stuff it was like, as soon as she was finished, I was back down in the water so I could get away from all that stuff that was going on. I think the water was more about being able to block everything out in between and being able to completely relax and be kind of ‘in there’—I was really aware of everything that was going on the entire time.

1.5.4. Diligence 

This subcategory explored the role of the midwife and how the shared philosophies of the woman and her midwife play a critical part in defining how and where the care is provided. A belief in the importance of supporting physiological birth provides the midwife with a sense of watchfulness, consideration, kindness and courtesy that encourages a partnership with women to support their childbirth choices.

Linda lived alone, and though she had a sister close by and a friend coming from another city to be with her in labour, she appreciated the support and information sharing of her midwife. Linda was very clear about not wanting to have any pharmacological pain relief and it was her midwife's ‘usual’ practice to use minimal intervention and support ‘normal’ birthing. Linda said:

I trust S (the midwife) … she said to me it's probably an easier way than giving birth on the bed.” S … said … try water … when we went over the labour ways … she said to me when I … go into labour one of the things she's going to tell me to do is get into a bath, just for relaxing sensations, just to ease the contractions, make you feel a bit better about it all. It was S that said you can try a water birth if you want to, she says it's a lot more relaxing, it's a lot easier and it's a gentler way to bring baby into the world.

Linda said that her friend was very nervous and pacing up and down in the room. However, her midwife sat quietly by the pool and slowly ran water down over her back. The soothing water and the presence of her midwife enabled her to relax even though she was scared.

We were going through contractions and I was extremely nervous, very nervous, but once I got into the bath I sort of relaxed. I was still nervous and I was still scared but it was nice and relaxing … I think it was a combination of the water and S [midwife].

Continuous supportive presence with women during labour has been shown to have a positive impact on outcomes by reducing the likelihood of medication for pain relief, a caesarean section or a forceps delivery.1, 19, 20 For the women in this study, to be able to labour and birth in water meant that they were required to form a relationship with a midwife who was philosophically, emotionally and physically in tune with them and would support their choices. There is a need for partnership and teamwork between women and midwives. This empowering relationship enables women to maintain control of their birth. The following photograph of Tanya, her baby and her midwife provides a visual representation of the partnership relationship that facilitated Tanya's water birth at home (Fig. 1).

Back to Article Outline

2. Limitations of the study 

The small scale of this project (five participants) means that the findings are not generalisable to the wider population of birthing women, although the sample size in qualitative inquiry is adequate if it produces new and richly textured understandings of experiences.21 Our own extensive clinical experience suggests these findings are credible. However transferability is only apparent if the themes and their descriptions resonate22 with others in clinical practices which support women using water for labour and birth.

These findings may not apply to women from all cultural backgrounds since only Pakeha/NZ European women were included. This was to be sensitive and respectful of the spiritual importance of Maori birthing and to honour Maori women's stories as unique to them and their culture.

A further limitation may relate to the timing of the interviews. Raphael-Leff 1991 cited in Hall and Holloway, 1998, suggested that the optimum time for women to want to discuss their experience of giving birth appeared to be 2 or 3 days after the event. This avoided possible transient feelings of elation and the labile emotions associated with the postnatal period.1 However on speaking to the women in this study it was considered to be more appropriate to wait for the women to decide when they felt ready. It is worthwhile to consider whether the variation in time between the use of water and the conversations may have influenced women's recall of the experience. All of the women felt they had good recall of their births and the events surrounding them, however, there were too few participants to detect any consistent variation in their stories.

2.1. Future research 

There is a need for further research in this area. Similar research conducted with women from the same and different locations will enable comparisons to be made with this study adding to the credibility and dependability of these findings. Valuable contributions to knowledge of the use of water for labour and birth could be made for example, through research that included an exploration of the effects of a shared (midwife and woman) philosophy about the use of water and the impact on outcomes; examining the use of water for labour and birth with women from other cultures and exploring women's experience of the notion of ‘safety’ in the birthing environment and the use of water.

Back to Article Outline

3. Conclusion 

The women all clearly described being in the bath or pool as ‘their own space’, one that offered shelter and protection from unwanted interference or intervention, as well as isolation and insulation from everything else going on around them, allowing them freedom of movement, comfort, relaxation and the ability to focus. The enveloping effect of the water wrapped the women in warmth and provided a sense of privacy, whilst enabling them to deal with their pain without the need for pharmacological pain relief.

Research supports the notion that continuous support by caregivers, who are philosophically, emotionally and physically in tune with women, has a positive impact on the outcomes for women in childbirth. This empowering relationship enables women to maintain control of their birth. Using water for labour and birth is one way in which the midwife and woman achieve this.19

The findings of this inquiry have broadened our understanding of the meaning women make of the experience of using water for labour and birth, and have demonstrated that the efficacy of water immersion goes beyond measurable outcomes. Both ‘Getting to the water’ and ‘Getting into the water’ are much more than the simple acts they may appear. Being in water during labour and birth is not the end product; it is not the water by itself that makes a difference. It's beyond water. It is a shared philosophy and belief in birth as a normal life event that supports women to use water for labour and birth. It is also the planning, preparation and education and the anticipation of using water for labour and birth. One way in which midwives may harness this anticipatory effect is by having the water running into the birth pool or bath when the woman arrives at the hospital or birth centre so it is the first thing she sees and hears. The safe and judicious use of water for labour and birth creates an environment that promotes relaxation, privacy and a release from pain that enables and empowers women to maintain control.

The main aim of this study was to make a contribution to midwifery knowledge about the use of water for labour and birth from the perspective of women. When midwives review the literature on water birth we hope they will consider evidence from both quantitative and qualitative paradigms. As midwives, we must make every attempt to honour women's knowledge of themselves. Women's self knowledge is evidence for practice.

Back to Article Outline

Acknowledgements 

To the women who generously shared their stories and photographs, we owe a huge debt of gratitude. This research received financial support from New Zealand College of Midwives, Wellington region and Domino Midwives Wellington.

Back to Article Outline

References 

  1. Hall S, Holloway I. Staying in control: women's experiences of labour in water. Midwifery. 1998;14:30–36
  2. Kitzinger S. Introduction. In:  Beech BA editors. Water birth unplugged proceedings of the first international water birth conference. Cheshire: Books for Midwives Press; 1996;
  3. Cluett E, Nikodem V, McCandlish R, Burns E. Immersion in water in pregnancy, labour and birth (Cochrane Review). vol. 2. The Cochrane Library; 2004;
  4. Cammu H, Clasen K, Van Wettere L, Derde M-P. To bathe or not to bathe’ during the first stage of labor. Acta Obstet Gynecol Scand. 1994;73:468–472
  5. Maude R. It's beyond water: stories of women's experience of using water for labour and birth. Unpublished MA (Appl.) midwifery thesis. New Zealand: Victoria University of Wellington; 2003.
  6. Crotty M. Phenomenology and nursing research. Melbourne: Churchill Livingstone; 1996;
  7. Koch T. Story telling: is it really research?. J Adv Nurs. 1998;28(6):1182–1190
  8. Richmond H. Theories surrounding waterbirth. Practising Midwife. 2003;6(2):10–13
  9. Johnson P. Birth under water—to breathe or not to breathe. Br J Obstet Gynaecol. 1996;103:202–208
  10. Lepori B. Freedom of movement in birth places. Children's Environ. 1994;11(2):81–87
  11. Hodnett E. Home-like versus conventional institutional settings for birth (Cochrane Review). In: The Cochrane Library, Issue 4. Oxford: Update Software; 1999.
  12. Odent M. Birth under water. Lancet. 1983;24(31):1476–1477
  13. Odent M. Can water immersion stop labour?. J Nurse-Midwifery. 1997;42(5):414–416
  14. Burns E, Kitzinger S. Midwifery guidelines for use of water in labour. OCHRAD, Oxford: Brookes University; 1996;
  15. Rosevear S, Fox R, Stirrat G. Birthing pools and the fetus. Lancet. 1993;324
  16. Charles CF, et al. Hyperthermia risk from warm water immersion. Br J Midwifery. 1980;6(3):152–156
  17. Geissbuehler V, Eberhard J, Lebrecht A. Waterbirth: water temperature and bathing time—mother knows best!. J Perinat Med. 2002;30:371–378
  18. Church L. Water birth: one birthing centre's observations. J Nurse-Midwifery. 1989;34(4):165–170
  19. Hodnett E. Caregiver support for women during childbirth (Cochrane Review). In: The Cochrane Library, Issue 4. Oxford: Update Software; 1999.
  20. Rush J, Burlock S, Lambert K, Loosely-Millman , Hutchison B, Enkin M. The effects of whirlpool baths in labour: a randomised-contolled trial. Birth. 1996;23(3):136–143
  21. Sandelowski M. Telling stories: narrative approaches in qualitative research. IMAGE. 1991;23(3):161–166
  22. Conle C. Narrative inquiry: research tool and medium for professional development. Eur J Teach Educ. 2000;23(1):49

PII: S1871-5192(06)00110-7

doi:10.1016/j.wombi.2006.10.005

Women and Birth
Volume 20, Issue 1 , Pages 17-24, March 2007

Article Tools

* Image Usage & Resolution