Yesterday I participated in my first every Facebook live event! Emily with MyBirth and I sat down to chat about water birth in general. It was a little awkward at first, but I calmed down after awhile. Really, it was pretty fun, and I want to do it again. Who knew? If you have any thoughts about topics you’d like to see us cover, let us know in comments here or on facebook!
I wanted to follow up with a little blog article about water birth at home with us. Water birth at a birth center is pretty simple - someone fills up the tub, you get in, you have your baby, you get out. Done. You don’t have to think about it much, which is grand. But, for those of us having babies at home, we have to do a little more planning and prep. I hope my notes below will be helpful to you!
Although people do give birth in these Fishy Pools (I did with baby 1 and 2!)
and, especially with Nancy Giglio, these horse troughs
at River City Midwifery, we have two options for water birth (without having to buy a tub).
Option 1: use your own tub.
There are some big advantages to using your own tub:
1) No set up. For people who have quick labors this is really important. It can take an hour or so to connect a hose, inflate and fill a birth tub. A built in tub has one step – turning the water on. I have attended many births next to a half inflated tub. It happens a lot!
2) Easy to drain. It’s great to be able to drain the tub a little if you want to breastfeed, or drain a lot and refill if it gets cool. With an inflatable tub we have to bail water. This is amusing for onlookers, and a decent workout, but pulling a plug has its advantages.
3) Cost. Even though we lend out tubs free of charge to folks, there are some costs associated with using a portable tub including a liner, hose and hose adapter. A built-in tub skips these costs.
4) Space. Sometimes there isn't a good spot for an inflatable tub or maybe your house has brand new wall to wall white silk carpet. There are lots of reasons your particular home might not be ideal for a portable tub.
Considerations for your home tub are:
1) Depth. A depth of at least 18 inches to overflow is best. To say that most tubs are not this deep is an understatement. If you have a garden tub from the 90s like this
you are probably eager to replace it, but it is your best bet at tub depth. Ideally your tub would be deep enough to allow you to give birth hands and knees without your bottom being above the waterline. Take a bath and see what birthing positions are possible in your tub, keeping in mind that the baby has to be born entirely under or entirely out of water. No in and out. Sometimes overflow valves can be unscrewed and flipped around, giving you an extra inch or two. If you don't care about giving birth in the water, or think giving birth squatting or laying down will be okay for you, then thats fine. I have attended several births in shallow regular tubs. In those cases, the woman was pretty small and all gave birth semi-sitting. Old clawfoot tubs have great depth but are rather narrow. Just make sure you are comfortable before labor.
2) Access. Your midwives need to be able to access you and baby during the birth in case of an emergency. Ideally, access would be on all 4 sides but one short and one long side is okay too. Corner tubs work okay usually. Also, a very tiny bathroom is a challenge for your team. Feel free to send your team pictures of your tub and bathroom if you have any doubts.
3) Comfort. Sometimes built-in tubs are just not comfortable. They might be okay for leaning back and having a soak, but are uncomfortable to move around in, hurt your knees or are hard to get out of. Sometimes the lips are really thin, which is uncomfortable to lean over. Take as many deep practice baths as you need to to be sure.
Sometimes people ask about using their hot tub. A hot tub, with the temperature turned down to 99 degrees, is fine for labor but probably not birth - they are really hard to get clean and clean afterward. Sometimes people labor in their swimming pools or rivers and lakes! If you haven’t seen the famous (-ly strange) Black Sea birth videos, well….. here you go. For the record, we do not recommend giving birth in the Chesapeake Bay.
Option 2: a blow up tub
Blow up tubs have some advantages over built in home tubs.
1) Depth. Our tubs are made for water birth and are deep. We have two different styles of tubs that we lend to clients – one is 25 inches deep, the other is 27 inches. Super deep and safe for babies to emerge, well.... fully emerged.
2) Comfort. Blow up tubs have firm but wide and cushioned side walls. They are really comfortable to lean over in labor. This is how most people, given the option, end up laboring and birthing in a tub. Additionally, the bottoms are inflated which is easier on knees and bottoms than hard whatever built in tubs are made from.
3) Access. Usually we can find a spot in your home where the midwife can access the tub from 3 or 4 sides.
4) Location. You can put the tub wherever you want. As long as you find a hose long enough to reach it, it can go wherever you please. Including outside if you like.
5) Pictures. The translucence of inflatable tubs can make pictures easier or allow you to place them in areas with better lighting/background. Some people put (battery powered!) LED lights in between the liner and the tub which look really pretty.
We have two Birth Tub options, pictured below, taken from more or less the same angle/time/place (our waiting room!)
1) La Bassine.
This tub is smaller and more oval than the BPIAB. It is great for people who like to feel tucked in. It is more translucent that the BPIAB. Filled, it is 400 pounds lighter than the BPIAB. If you are worried about the strength of your floors, this is a better choice. (though, no one has ever had a tub fall through the ceiling that we have heard of. Ever.)
2) The Birth Pool in a Box (BPIAB)
This tub is much bigger and 2 inches deeper than La Bassine. This does make a difference for people who are really tall. If you are 6’0”+ we will bring you this tub. Both tubs accommodate two average sized people, but if you want your partner in the tub with you and one or both of you is bigger, the BPIAB is perhaps the better choice.
For the remainder of the article, we are going to assume you are using an inflatable tub.
Where should you put your tub? We recommend putting the tub somewhere sturdy and somewhere private. Any building built to code is likely sturdy enough for even the biggest birth tub. If in doubt, put it near the side of the room, not the center. Consider also the carpet – we can get blood out of carpet like pros, but if you have the choice, white carpet is not the best spot for a birth tub.
People often want to put it in the living room, or in a large kitchen. But these are not the ideal locations, especially for people who are having a first baby, who have long labors or who are really sensitive to their surroundings. The, for lack of a better word, energy in living rooms and especially kitchens can be very busy. During a long labor a kitchen can literally be really busy - we will be cooking, charting and eating. You want to be able to labor somewhere where you can close the door and be alone or at least shut out the concerns of the world beyond the important work at hand. Our favorite spots are:
1) your bedroom. If you have the space, your own bedroom is ideal. It is usually your private sanctuary and the room where you feel most at rest, at peace and uninhibited. It is usually close to your bathroom. Importantly, it is close to your bed. You might not touch your bed in labor, but pretty soon after birth you will want to go there. (a sub category here is YOUR BATHROOM - every once in awhile someone has a bathroom big enough for a birth tub, and this is hands down the best spot). A downside of bedroom placement is the noise/fuss when we drain it.
2) A guest room or the baby's room. The baby's room can be a great place for the pool! Private, usually close to your bedroom, and usually unused for the first couple months ;)
3)Wherever you want. Is there a special place in your house that calls to you? We have had birth tubs on screen porches, back decks, sun rooms and any/all other rooms. Sometimes houses are small and the best place is the living room or kitchen, and that is fine too.
Wherever you put the tub, make sure it is close enough to an indoor faucet that you can attach a hose to.
Your midwife will provide you with a list of supplies to have on hand, but here are our recommendations with explanation, in no particular order
1) something for under the tub that is at least 2 feel wider than the tub all around. This can be a tarp or one of those flannel backed waterproof tablecloths from the dollar store. You can use a drop cloth as well, but keep in mind it can be slippery.
2) A NEW hose. A drinking water safe hose is great, but any new hose will do. The most important thing is that it has never been used before. Great colonies of bacteria can grow in any standing water over time.
3) Faucet adapter. We have a variety of adapters we can lend to you, but you can purchase an adapter at a hardware store as well. A fairly traditional sink usually has an aerator that you can unscrew and use this common adaptor. Fancy new faucets are trickier. If you have an old fashioned hardware or plumbing supply store nearby, a picture and a chat with an expert should lead you in the right direction. You can always get this which works decently.
4) Tub Liner. These can be purchased when you order your birth kit.
5 )Fish net – also can be purchased when you order your kit.
In late pregnancy
1) get your tub and make sure you have all the supplies you need
2) Turn up your hot water heater as high as it will go. Take care that little ones do not burn themselves washing hands or during baths. Ideally the water will be quite hot!
3)Make sure your adapter and hose set up works relatively leak free
In early labor
1) inflate your pool and check for air leaks
2) put the liner on and put the tub on top of your tarp/drop-cloth.
3) Attach the faucet adapter and hose
4) If you have a history of fast labors you could put a few inches of cold water in the the bottom of the tub.
5) Once the tub is set up, and especially once it has water in it, keep small kiddos and pets away from it.
When Midwife arrives/active labor
It is best to wait to fill and get in the tub, if possible, until your birth team arrives. The water can speed a labor, and unassisted births in the water are not ideal for most folks. Once your team is there, they will fill the pool the rest of the way with hot water, aiming for a temperature around 99 degrees. Your midwife will usually supply an inflater, a hose to drain the pool and a sump pump.
Break down and Clean up
Most birth teams take care of breaking down the tub and any cleaning. This involves draining the tub with a sump pump, throwing away the liner, cleaning the tub, deflating it and taking it away. Sometimes we will leave the pool to thoroughly dry after cleaning until the first postpartum visit, bit ask your midwife what her protocol is.