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!)

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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

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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.

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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 Odyssey

I considered writing this blog post in the form of an Epic Poem. This story has most of the classic Epic elements: A Hero (in this case Heroines) of Legendary Proportions, Adventures of Super Human Strength and Valor (hours staring at incredibly similar items online, hauling massive tubs up and down stairs), a vast setting (China to Richmond and back!), and multiple sites of action (whats up, Ferguson!).  But, alas, this tale does not involve supernatural forces and I’m not sure this poet can remain objective and omniscient, so this is just going to be a regular blog post.

Have you ever noticed, tooling around online, looking at birth centers, that an awful lot of them have the sort of garden tub your mom might have had in her bathroom in 1994?  

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Often built in to corners, sometimes with outdated tiling, occasionally involving steps, birth center tubs seemed to us to be a design problem in otherwise beautiful birthing spaces.  Every so often you see a freestanding tub, usually appearing, in our browsing, to be way too narrow. These birth center built-ins and narrow tubes are nothing at all like the deep, wide, poofy blow-up birth tubs most homebirth midwives are used to.  

Our favorite birth tub, the LA Basseine, is a dream of cozy, sturdy functionality.

Our favorite birth tub, the LA Basseine, is a dream of cozy, sturdy functionality.

When we set out on this Grand Birth Center Adventure, we naively and offensively assumed these tubs were a failure in taste among our midwife sisters.  Perhaps birth center midwives and designers had just not gotten the memo about Beautiful, Round Freestanding Tubs. Perhaps they had forgotten how nice it is during home water births that to be able to reach a client from all sides of the tub. Maybe they’d never watched HGTV?

The truth is that we had heard whispered tales about birth tub woes before. Through the grapevine we heard about a hospital labor-tub program where all of the expensive tubs were returned not once, but TWICE.  We heard from students who spent hours cleaning jetted tubs after messy water births because, their preceptors told them, they literally had no other tub options. We remembered hearing that tubs were delivered with jets when none were asked for and that plumbing was always, always an issue.  Another midwife had mentioned ominously, in passing, “good luck finding a freestanding tub, we tried”.


So we were smug then, when a quick search in google, lead us to Wayfair. On Wayfair, there seemed to be a plethora of tubs that appeared perfect for water birth. They looked fine, were strangely affordable, and about the right height and size. We wondered, “have midwives never been to Wayfair before?”  We felt worldly and wise, and in the middle of about 49 other renovations, a lake of paint, and the business of starting a new health care business, we didn’t look too carefully at the specs (actually we didn’t know there were specs) and clicked “proceed to checkout”.

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Our new tub began its journey to us from China.  


An Epic Adventure

some of the perils on the journey

some of the perils on the journey

While we waited, we added plumbing to a bedroom where no plumbing was before.  To be clear, the amazing and patient Matt at New Day Mechanical installed the plumbing.  He worked like a surgeon performing reverse laparoscopic surgery. One small incision in the wall here, another two there, and one to let out the gas over there (there was no actual gas involved). Look inside, thread the plumbing in and voila!  

Our ceiling, to this day

Our ceiling, to this day


The Tub arrived. Adrianna and Marinda muscled and rolled it up the stairs, all by themselves!  I was not there, but I imagine they felt very pleased with themselves (and possibly annoyed with me) as they set it in to place.  But…….it was not right. Bafflingly shallow. We texted each other pictures of ourselves in various labor positions and declared that “it had to work”.

The most common labor position in water tubs

The most common labor position in water tubs

At some point, most people do this too

At some point, most people do this too

Then we went back to painting a second or third coat on some trim. We had it plumbed in, and it looked beautiful. I posted a picture of the tub (in black and white because the walls were still the color of baby amoxicillin) on Instagram and it was a VERY popular post (for us, I don’t really understand IG). Okay, we thought, the tub is good.  It has to work.

A moment in the spotlight, Instagram Fame

A moment in the spotlight, Instagram Fame


Paint trim, rip out flooring, imagine that all future clients will be 4’11”.  

That night, I took a bath in it.

You guys. It was AWFUL, and I wasn’t even remotely in labor.  Hard, slippery, so, so shallow. The combination of shallowness and largeness made it feel like I was just sitting naked on the floor in a vast puddle, which, well, I was.  The hard and narrow sides hit a strange part of my back and leaning over the edge in hands and knees - the most common water labor position - was a comedy of errors and bruising.  


Another time, my toddler had a great bath in it.  He declared it a “Great BIG BIG pool-bath!”. So there you have it. Thumbs-up from the under 3 set.

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It was with great sadness that the three of us convened the next morning and admitted to ourselves and each other that it had to go.  We had thirty days to return it.

And thus began The Great Tub Search.  We wanted a tub that was:

  1. Freestanding

  2. Water depth of at least 19 inches

  3. Circular or at least roundish

  4. Interior width of at least 36 inches

  5. Can fit in the building

This seemed like a reasonable list.  We learned more about bathtubs than we ever imagined was possible to know.  We learned that the Standard Depth of a tub in the USA is 14-17 inches. This, of course, is too shallow for anyone who is not a baby.  We learned that a “European depth” is 18 inches and that “Japanese or Greek depth” was 22 or more inches. We studied websites and we learned the listed measurements were often wrong.  So, we downloaded and studied the specs.

Now, we understand that people not concerned about humans emerging from bodies might not have the same sense of urgency over these few inches, but it was frustrating how difficult it was to determine “how deep is the tub”.  


You guys, there are thousands of freestanding tubs on the market. Who knew? They are mostly variations on the theme of “Banana Split Boat”.

Exactly like this

Exactly like this


Or sometimes they are shaped like shoes or horse troughs. We kept searching.  

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Japanese soaking tubs, we learned, were deep and round, but far too narrow for baby having. Like big buckets. We learned that those Friends-era built in garden tubs, usually jetted, offered the best depth, but we couldn’t and didn’t want to tile a tub in to the simple little 1930s bedroom that we loved. And NO JETS EWWW.  So we looked, and looked.

Late at night, loopy, I even tossed hilarious hospital birth tubs like this in to the ring.

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Some of them are actually pretty cool, but mostly not available in the US (of course) or hospital-budget friendly not low-debt birth center budget friendly.

I mean, this could be cool.

I mean, this could be cool.


And, no post about waterbirth tubs would be complete without this:

I’ve always wanted to be a spaceship pilot!

I’ve always wanted to be a spaceship pilot!

or this

Someone actually made this.

Someone actually made this.

At this point, we considered scratching the whole birth center idea and opening a birth tub manufacturing company instead…

At this point, we considered scratching the whole birth center idea and opening a birth tub manufacturing company instead…

We did find one tub that was kind of perfect.  I present to you: The Aquatica Pamela.

Yes,  Aquatica , this tub is perfect for our next birth suite! Construction starts soon!  hint, hint

Yes, Aquatica, this tub is perfect for our next birth suite! Construction starts soon! hint, hint

She wasn’t the prettiest tub at the prom, but she fit every single criteria. Except one. She wouldn’t fit in the birth center, up the stairs or in the room.  We contemplated removing doors, windows, trim, hiring a crane, and/or changing the entire layout of the birth center. She was also way out of budget. So we got special tub financing.

However, before clicking “buy now”, this time, like a pack of geniuses who learn from their mistakes, we made a template from an old sheet and laid it in the room.  No. No way. Way too big. Would be like a cereal bowl in a dollhouse.


We vowed to get Pamela for our next birth suite, because in all other ways, she is kind of perfect. At least we won’t have to go through this again in a few months.  

Finally, in an act of desperation we did what countless people before 2017 have done.  We went to a store.

These still exist!

These still exist!


Now, I had been to another Ferguson the previous week and found a tub that would more or less work, but it wasn’t perfect.  Let’s call this tub “Barnabus”. Here, my husband and child demonstrate “how to make showroom workers uncomfortable”.

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At the time, convinced there was a perfect option, we dismissed Barnabus out of hand.

Back at Ferguson, this time, we scoured not just the internet but the dark web of shopping: industry catalogs.  We learned about the world of Very Expensive Tubs which included copper (the metal) and Solid Surface (the rock) and other rare elements.  We added “must not weigh more than 300 pounds” to our list. Armed with The List and a mountain of catalogs, Marinda and our wonderful sales worker Teresa McClellan, found us a short list of acceptable, or nearly acceptable, candidates.  With names like “Olivia”, “Elise” and “Adriann”, they were fancy versions of the banana split boat. Mostly they were too narrow, too heavy, and had a several week wait time. And were over five thousand dollars.  


Back to the Aquatica Pamela?  We did some more measuring and contemplated our life choices. Maybe we could make it work. MAYBE IF WE GAVE UP AND STARTED FROM SCRATCH.  Did we all cry? I’m not saying.


Enter, stage left. Barnabus. In a sea of almost-right Olivias and Pamelas, we had looked right past the almost-right Barnabus. There he was on my photo roll, comfortably accommodating a giant adult human and a small 10yo. His edges were wide enough to lean over, he was deep enough. He looked alright.

See, looks almost right!

See, looks almost right!


We ordered him.


When he arrived from across town, we visited him at the Fergeson showroom.  He was good. A little underwhelming among all the shiny copper pennies and cold, hard rocks, but we took him home. (I mean, some strong workers brought him to the birth center).  

And here he is!  

He fits in very nicely, we think, even without IG filters

He fits in very nicely, we think, even without IG filters




I have to say, he looks great!  So deep and cozy, lovely, freestanding.  We can get to all sides, he fit in the door.  

Toddler contemplates life as a tub model

Toddler contemplates life as a tub model

Now, we just have to get Matt here to move the drain over three inches….

Stay tuned for reports on Barnabas in action!

(but seriously, we think this will be a wonderful place to labor and have a baby. It is deep and wider than it seems. One end is sloped for comfortable learning back or side-lying, and the other is straight, making hands and knees easier. The bottom is textured and not slippery and the sides are wide and easy to drape over without armpit bruises. We especially love how deep it is, so everyone, even tall people, can give birth in any position that makes sense for them.)