Water birth @ home!

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!

Tub Selection

Although people do give birth in these Fishy Pools (I did with baby 1 and 2!)

aquarium pool.jpg

and, especially with Nancy Giglio, these horse troughs

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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

gardentub.jpeg

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.

one-sided access is not ideal

one-sided access is not ideal

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.

Narrow lips on tubs will NOT be comfortable to hang over the edge. You can put pool noodles aroudn the edge if you want to get fancy!

Narrow lips on tubs will NOT be comfortable to hang over the edge. You can put pool noodles aroudn the edge if you want to get fancy!

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.

la bassine.jpg

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)

BPIAB.jpg

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.

Location Considerations

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.

bloody footprints.jpg

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 ;)

somewhat like this

somewhat like this

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.

This baby was born over 7 years ago! I remember this year we also had a sunroom and back-yard birth <3

This baby was born over 7 years ago! I remember this year we also had a sunroom and back-yard birth <3

Wherever you put the tub, make sure it is close enough to an indoor faucet that you can attach a hose to.

Supplies

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.

A table cloth like this!

A table cloth like this!

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.

not for fish tho

not for fish tho

Set-Up

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.

Fishy pool, just FYI

Fishy pool, just FYI

La Bassine

La Bassine

Birth Tub Bloopers

A few months ago I brought you a story of the trials and tribulations of finding a birthtub for the birth center.  If you haven’t checked it out, you can read it here. I am happy to say that we have an Aquatica pre-ordered for the new birth suite. But what about home births?

labassine.png

What could go wrong?

not much but…..



In Richmond, many folks have had babies at home with Adrianna or Nancy using the horse trough birth tub.

horse trough.jpeg

One option

Horse Trough

The vast majority of folks planning home births in the US, however, use an inflatable tub.  At River City Midwifery we have one of these (big) and two of these (smaller) for our clients to use at home. Sometimes people will plan to use a garden tub they have at home or skip the water birth plan completely. But most of the time, one of these is part of the equation. Inflatable tubs have some advantages over other birthing tub options - they are super comfy, somewhat translucent (better pictures) and, because they deflate, they are portable.  Unlike built-in tubs they are harder to keep warm, sortof a pain to drain, but for the most part they work fine. We’ve been doing this a long time and have a system practically guaranteed for success.

But, over several hundred births there have been a few….. shall we say…. Bloopers.  And I am here today to share them with you.


Birth tub problems

A question on a lot of people’s minds, definitely a question on more Dad Minds than Mom Minds, is the safety and reliability of the old inflatable birth tub. I would call some people (men) Tub Skeptics.  And although Inflatable birth tubs are usually filled, used, drained and deflated with no issues whatsoever, there’s always a little element of truth feeding any skeptic mind.


Filling with Air

If something is inflatable, it will eventually leak.  Balloons, rafts, camping pads and birth tubs. We try to find and fix leaks before labor  - we are there to hold space, not whip out patch kits and kick you out of the tub so we can take over your birthing space with solvents and sandpaper. So, if you ever see a midwife clinging to the side of an inflated tub with a bucket of soapy water (leaks make bubbles) or a stethoscope, try not to laugh. She is just trying to locate a tiny leak.

If you didn’t know, soap is a great way to find a leak in something right before you decide to just throw it away.

If you didn’t know, soap is a great way to find a leak in something right before you decide to just throw it away.


Several years ago I had a run of birth tub problems. It seemed like they leaked air at Every. Single. Birth. I checked them in between births, patched what I could, suffered through slowly leaking tubs during labors and replaced tubs just to have the new ones leak. One tub failed spectacularly. This was baby number two for a lovely family in my neighborhood. Her first labor and birth had been pretty quick and straightforward, so we were surprised that her 2nd labor was harder, longer and more intense. After several hours she decided to get in to the tub. As she stepped in, I heard the familiar hiss of a patch not holding. I found the patch and attempted to re glue it, but the tub was losing air FAST. My client was only getting relief from the tub. So, I did what any reasonable person would do. I called a doula in the neighborhood and paid her to hold the patch on the pool for the duration of her labor. This meant snaking her arm in between the tub and the liner and leaning over the side, practically in the pool herself and applying not-insignificant amounts of pressure on the plastic patch. For 4 hours. Thanks doula!  (have I mentioned how much we love doulas?)

At other births we have had to refill tubs between every contraction.  The mom has her contraction, doing what all laboring people do (moaning, breathing, coping) and also what most don’t (sinking toward the floor).  Then, we turn on the air pump and up she goes, the sidewalls filling and raising her back to position, water sloshing out all the while. So yes, it is not unheard of for birth tubs to lose enough air so that some water sloshes over the side. You will be heartened to know, however, that never, not once, over hundreds of births, has a tub popped completely or lost air quickly enough for the water to flood out.  Has this ever happened to you? Let us know if it has!



Filling with water

When I was a student, 13 years ago, I arrived with my preceptor at a labor on a hot, swampy, July day.  The dad had already helpfully inflated the fishy pool (we used to use these fishy pools almost exclusively back in the old days) with air and as we arrived, he was starting to the run the water.  We busied ourselves with the usual tasks of setting up for a birth - unfolding chux (why? I don’t know), assembling birth supplies, listening to the baby’s heart rate. Eventually I went in to the bedroom to check on the birth tub. Y’all, I have a strong stomach.  Nothing makes me nauseous on sight except maggots and…. this tub. The tub appeared to be full of egg drop soup, which is not something you want or expect, birth tub wise.

egg-drop-soup-8.jpg

Actual picture of the birth tub

plus onions



The water was yellow and cloudy with long, thin, gelatinous strands of egg-white looking goop throughout. If you’ve ever wondered why I am so adamant about using a NEW hose for filling the birth tub, this is why. In this instance, they had used a very, very long hose that had been sitting in the heat, full of water.  What grew in it was like the SCOBYs (symbiotic culture of yeast and bacteria) you find in your kombucha bottle. Interesting, but not something you want to have a baby in. We sent the dad to the hardware store for a new hose, drained the tub, sanitized it and filled it again.

Sometimes there is not enough hot water to get an entire birth tub full of water warm enough for a birth.  This was always true in apartments in the city, so we started pots and tea kettles boiling when we began filling the tub. A little known fact about me is that while I am patient when it comes to big things - labor, long drives, listening to my kids talk about space, I am REALLY impatient with little things.  Like, it’s extremely annoying how long it takes to pour all the water out of a tea kettle! It takes forever! It is so boring! So, at a birth one chilly April morning, I decided to pour the water out the top of the tea kettle instead of the spout. And this happened.

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I know

It was gross


The birth was imminent, so I gloved up and finished my work, swallowing a handful of ibuprofen when I had the chance. All I remember about the rest of that day is red hot searing pain and an internal dialogue that went something like “you IDIOT!”



Draining the Water

Cats and kittens, this is where we have the real fun. A hundred gallons of bloody, sometimes poopy water. What could go wrong?


Back in the old days - the aughts -  we used to drain birth tubs via gravity siphon. I actually have no idea why we did this because sump pumps are not a new invention.

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not like this!


Nevertheless, this was the apprentice’s task and it went like this:  hook the hose up to an outdoor spigot and run water until it reaches the pool which, ideally, is quite a distance above the spigot. One you hear your helper shout “OKAY, ITS RUNNING” (very relaxing for the new parents, obviously) you rapidly turn off the water, unscrew the hose, and if all goes well, and gravity being a pretty solid theory, it usually did, the water will start to flow out in to the yard. The water runs slowly and it takes a very long time to drain a tub. But it will drain.  Even on a good day this was a ridiculous procedure, often cold, always wet, involving tromping through bushes and mud. A bad day involved poison ivy, rain or snow.

After one cozy winter birth, the kind where you arrive to christmas lights twinkling in the snow and leave as the sun peeks over the horizon, the neighbors got a siphon-related surprise. After tucking in mom and baby, after packing everything up, after pulling the hose back in through the window and winding it up in the bathroom, I got in my car and pulled down the long driveway. Only then did I notice the snow. I had drained the bloody tub on to a hill of snow.  A hill that now appeared to be the site of a massacre or mauling. Sorry neighbors!

 

There are a lot of bloody snow pictures out there….. here is one

There are a lot of bloody snow pictures out there….. here is one

Now, of course, we use sump pumps and with the aid of electricity we pump the dirty water straight in the bottom of the toilet. The sump pumps are powerful and drain the water fast. This is very effective, and also very fun for small people who enjoy hoses and water and don’t know about germs.  As a bloody pool was draining in to the toilet one morning, a wee toddler friend pulled it out and sprayed bloody water all over the bathroom. She did this for several minutes before anyone noticed. Another horror movie scene. We lock doors and supervise now, when there are curious toddlers around.

And here we are at, hopefully, the biggest birth tub bungle of my career (shared with permission). This was another birth in my neighborhood, a lovely first time mom on the second floor of a two family city building.

2family.jpg

Classic STL 2 family

Picture the birth on the 2nd floor there




She labored beautifully, and had her baby in the tub quickly and easily. In fact we had not finished filling it when she had the baby so the end of the hose was still in the tub, and we left it there, busy with other tasks, and maybe a little tired. Since the mom was small, we hadn’t used as much water as usual - it was a pretty concentrated mess as far as birth tub water goes. Baby poop, lots of blood. But normal stuff.

We got her and her sweet baby girl to bed and did the tasks of immediate postpartum: watching, waiting, cleaning. The hose had been screwed in to the kitchen sink faucet and I unscrewed it in order to wash my hands. You probably know where this is going and I am sorry to say you are right. Remember the siphon and the laws of physics?

At some point, the end of the hose was knocked out of the sink and on to the kitchen floor where it proceeded to drain the tub. By the time I made it back in to the kitchen there was two inches of bloody, poopy water on the floor.

This seemed bad. My apprentice and I frantically sopped and mopped, pushing water in to buckets with a broom and dumping it in the bath tub. The water has seeped in to the floor boards and under appliances. It was an endless, multiplying mess the way blood can be. Everywhere. We somehow got it cleaned up, disinfected the floor, and finished our midwifery work and went home. I went home thinking, well, that was bad but, LESSON LEARNED, to always take the hose out of the tub. That night I packed a roll of duct tape in the birth bag, vowing to also always tape the hose to the sink.

Several days later the landlord of the building called me. In the only stroke of luck in this story, he was the client’s father in law.  So it was with sadness and not anger that he told me what had happened.

I googled “bloodbath” so you don’t have to.

I googled “bloodbath” so you don’t have to.


The people who lived downstairs had been on vacation during the birth.

When they came home, they were surprised to find their kitchen ceiling red, brown and crumbling wetly. They were also surprised to find all of their many things in the kitchen, soaked in, and in the cases of dishes and pans, containing, old bloody birth water.  The landlord told me that, not only was the ceiling ruined, but that the people were “sort of hoarders”. They had dozens and dozens of kitchen items that were now, according to any reasonable person, ruined. Also, they were so traumatized, they decided to move.  

Were-moving-van.jpg



No, it really does not get much worse than this.

I did pay for their items. But, after a small investment in bleach, I also kept some of those items.

So, if you ever come to my house for cookies, know that they were made with love…. and a kitchenaid mixer that was once covered in bloody birth water.

kitchenairmixer.jpg



The end.