Home Birth Reference Site

Heather and Tamsin

Waterbirth At Home

The great advantage of planning a waterbirth at home, as opposed to in a hospital, is that you know the birth pool will be available when you want it, that nobody else will be using it, and that you will not be denied the chance to try it because it 'isn't clean' or 'health and safety don't like us using it', and so on. When the pool is in your home, as long as you have assembled it beforehand and checked that it works, there is nothing to stop you labouring in it. You do not need anyone's permission - while it may sometimes be hard to arrange to have a midwife who is experienced in attending water births, there should never be any problem with you labouring in water. The issue is whether you choose to get out for the birth itself or not. You do not have to get out even if the midwife asks you to because she is not trained in attending waterbirths. Obviously you would need to be confident that you are aware of the issues involved, which are discussed below.

Please note that Having trouble arranging a waterbirth? has moved to its own page.

Waterbirth - Labour and Birth Issues

These are issues that you need to think about before the birth, as there is a lot of variation in midwives' approaches and attitudes. It is a good idea to bring up these points in your birth plan and to discuss them with your midwife team. If you don't discuss it beforehand, you may find yourself having to deal with complex issues in labour.

Water temperature

Discuss this with your birth partner and midwife team beforehand. UK guidelines from the RCOG and Royal College of Midwives are that the pool should be between 34C and 37C. There is a good rationale for avoiding temperatures above 37C - the baby is trapped inside your body and cannot dispel excess heat, and this can lead to distress. However, there is currently no evidence for having any minimum temperature, and waterbirth research in Germany suggests that lower temperatures than 34C may actually be helpful.

Some people automatically assume that the pool should be at blood temperature throughout. While it is one option (not the only one) for the moment the baby emerges, it doesn't apply to the first stage of labour. In fact, for most women, this would be far too hot during the first stage of labour. Because your muscles will be working hard, and generating quite a lot of heat in your body, you may want it cooler. If your birth partner sticks a hand in the water, it may feel quite cold. Make sure that the temperature is adjusted to whatever feels comfortable to the labouring woman, and not to other people's assumptions! It has been known for labouring women to leave their spacious birth pool to use the cramped bathtub, where they can choose the temperature themselves, when well-meaning helpers have made the water too hot!

Safety issues concerning temperature

The main safety concern is that the water should not be too hot, at any point in the labour, as this can send the baby into distress. 37.5 C is the usual maximum recommended. If you stay in the water for the second stage, you may want it warmer than during the first stage - but you may not be able to tell your birth partner this, so it may help to discuss some way of communicating it beforehand. Your midwife may want to ensure that the temperature for the second stage is 36-37C. If you give birth in the water, there are concerns that cool water could trigger the baby's breathing reflex before it comes to the surface. However, this is speculative and there have been no known cases of this happening, despite the fact that in Germany, for instance, waterbirth experts have written that they believe babies born into water at 35C or below are more vigorous and quicker to breathe.

For discussions on water temperature, see the Association of Radical Midwives page on waterbirth (www.radmid.demon.co.uk/waterbirth.htm)

Barbara Harper of Waterbirth International wrote a detailed article challenging ideas about minimum temperatures for birth in water, and discussing birth in seas and rivers. This was published in MIDIRS January 2003, and is reproduced on the Birthing Alternatives site. It's well worth a read, especially for any midwives who've not come across it:
'Taking the Plunge: Reevaluating waterbirth temperature' by Barbara Harper
(http://birthingalternatives.com/Resources/Waterbirth/Water%20Temp.pdf)

Guidelines for midwives

The joint statement on waterbirth from the Royal College of Midwives and Royal College of Obstetricians and Gynaecologists includes this guidance on water temperature:

Practice issues

15 There has been much controversy over the temperature of the water of a birthing pool, with strict criteria recommending differing estimates ranging from 34 to 37 degrees Celsius to a Swedish study which recommended that women be encouraged to regulate the temperature of the water to suit themselves. Given these large discrepancies, it would be difficult to agree strict temperature restrictions. It may be of more benefit to allow women to regulate the pool temperature to their own comfort and encourage them to leave and re-enter the pool in the first stage of labour as and when they wish. Birth attendants should ensure that the ambient room temperature is comfortable for the woman and should encourage her to drink to avoid dehydration.

Immersion in water for labour and birth
Royal College of Midwives/ Royal College of Obstetricians and Gynaecologists
Joint position paper, May 2006

Also found on the RCOG site: Immersion in water for labour and birth
Royal College of Midwives/ Royal College of Obstetricians and Gynaecologists
Joint position paper, May 2006

Giving birth in the water

Is it important to you to give birth in the water, or to have the option of doing so? You may need to negotiate with your midwife about this, although the final decision is yours and if you choose to stay in the water against advice, your midwife should document this in the notes. If there is any sign of fetal distress or complication then you will probably be advised to leave the pool. Reasons for this: if the baby is not in A1 condition at birth then it may be at risk of breathing in water if born under the surface, and if any resuscitation is needed, you might find it difficult to get out of the pool quickly. If you would want the cord to be left intact during resuscitation then you would need to move out very fast - otherwise the midwife would have to clamp and cut the cord, which could deprive the baby of valuable oxygen (for discussions on when to cut the cord, see the Association of Radical Midwives page on the umbilical cord www.radmid.demon.co.uk/cord.htm)

Touching the baby during the birth

Some midwives have advised mothers not to touch the baby during a waterbirth, in case it stimulates the baby to breathe. I have not seen any evidence to support this concern; midwifery guidelines advise midwives to avoid over-handling the baby underwater, but that is a different matter from a mother feeling the baby's head during crowning. See page on touching the baby during a waterbirth for discussion and sample letter.

Third stage in water?

If you do give birth in water, how soon afterwards will you get out of the pool? Some women love to lounge in the pool and get to know their baby, while others can't wait to get on dry land. The water may be mucky after the birth, which could influence your decision! It can be difficult for your midwife to assess your blood loss in the pool, and some people believe that being in warm water may make you feel faint if you lose a lot of blood.

The other issues apply if you are planning a natural (physiological) third stage, but not if you intend to have drugs to speed up the delivery of the placenta. Some sources suggest that staying in the pool for the third stage can delay the delivery of the placenta and hence increase blood loss, particularly if the water is warm - 36-37C. There has been little research on this in the English-language literature on waterbirth, but in Germany apparently the practice is to have the pool at 35C or below for birth, and in 'Holistic Midwifery', Anne Frye states:

"Enning finds that uterus clamps down rapidly after a waterbirth, especially when the water is around 86F (30C), although colder water can lead to premature separation. Conversely, if the water is too warm, the placenta can be retained for hours." (Holistic Midwifery vol. on labour and birth, p479)

There are also concerns about the baby receiving too much blood through the cord after birth, if you remain in the pool and the cord is not cut - the idea is that the warm water keeps blood vessels dilated which would otherwise have closed down in a physiological (natural) third stage. If the baby receives too much blood in this way then it may become very jaundiced (neonatal polycythaemia) . Although there has been one case reported in the medical journals which may have been due to a third stage in water, this cannot be known for certain - after all, many babies have the same problem after land births, and managed third stages. It is certainly true that most babies have had no problems after third stages in water. It is possible that this is a theoretical concern rather than a realistic one.

Personally I am concerned about the issue of third stage in warm water because it simply has not been researched and it *is* an intervention. You would need observations from hundreds of births to see if there was an increase in retained placenta or bleeding, and so far none of the studies available in English seem to have published data on this. I urge you to read up on it carefully and make sure you know what the worries are. Clearly it's not a major problem, or there would not be plenty of experienced waterbirth midwives who are happy to support a third stage in water - but make an informed choice. For discussions, see the Association of Radical Midwives page on waterbirth (www.radmid.demon.co.uk/waterbirth.htm).

You may find that, on the day, you have strong feelings about whether you want to remain in the water or not. Some women love the pool for labour, but are very keen to get out as soon as the baby is born. The water may be clear, but equally there may be blood, bits of membrane, and perhaps faecal matter in the water; birth pools can sometimes look like "a shark attack in a toilet"! However, many other women treasure their moments spent in the pool after the birth as a special bonding time, where they can get to know their baby without having to hurry to climb out.

Be aware that it may be hard to regulate your baby's temperature in the pool after birth, and heat loss can be dangerous in newborns. A baby who cannot maintain her temperature could be suffering from an infection, so if your baby gets cold you may find that concerns are raised about her. Lucy B ended up in hospital with her baby on intravenous antibiotics for a suspected infection, which turned out to be just heat loss.


Jackie and Rose

Practical Issues - Choosing, Installing, Filling and Maintaining the Pool

Is your floor strong enough?

Lots of people worry about this, and to cover their backs, the pool hire companies may advise you to get a report from a structural engineer. In real life, I doubt if anyone ever bothers with this; I have never yet heard of anyone having problems with a collapsing pool! Even the heaviest birth pool, when full of water and labouring woman, weighs only the same as 10-12 adults; would you have a party with that number of people standing in the place you are considering putting the pool?

I am not an engineer or surveyor, but I am a builder's daughter as well as a homebirth supporter, so here is what I have picked up while investigating this!

Some parts of your floors are stronger than others. Floors on ground level are, of course, generally very strong. If you have a solid floor on a concrete base then you have no worries. If you have a suspended timber floor, where there are joists and floorboards, then downstairs floors may still have problems. Note that sometimes a tiled floor is laid over a suspended wooden floor. The strongest areas are in a corner, in a bay window, or above a supporting wall. If you are in a flat, have a look downstairs to see if there are any brick walls which you can site the pool above - eg one dividing the entrance hall.

It is certainly worth investigating all your options for siting a pool, before discounting it on the grounds that you think it might be too heavy for the floor. Discuss it with the pool hire companies which you are considering using. Some pools are considerably smaller and lighter than others.

Some people ask a timber treatment company for a free survey of their joists, for reassurance before installing a pool. However, timber treatment companies only offer these "free" surveys because they hope to pick up business from them, and some independent sources suggest that a "free" survey is likely to result in expensive pesticide treatments being recommended when it is probably unnecessary. For more discussion, see Jeff Howell on timber surveys (if that doesn't work try this archived version). If you want an expert opinion, another alternative might be to ask a local carpenter to have a quick look for you, for a one-off fee.

You can do some investigations yourself, too - for instance, lift a floorboard in the area where you might want to put the pool, and look at the joists. Are they dry? If the wood is hard and dry then it is unlikely to be weak, if it's the correct size for the house, but if the wood appears damp or soft (ie you can poke a fork into areas of it) then this is a huge danger sign and you need to get a builder to inspect ASAP, quite regardless of birth pools! Note that Victorian and Edwardian properties often had much stronger, deeper joists than houses built after 1950 or so, so this over-engineering will compensate for the property being older.

When the birth pool is set up, keep an eye on the join between the floorboards and the skirting boards nearby. It may be necessary to lift carpets up at the edges to do this. Has a gap appeared between the floorboards and skirting boards? Is any gap growing gradually larger, or is it staying the same? If the floor appears to be sagging then you could take measurements and call a builder for help if the measurements confirm the gap is growing.


Do I need a heated pool, or will I have enough time to fill it in labour - eg for an inflatable pool?

This is discussed in more detail in the page on 'Choosing a Birth Pool' , but briefly:-

There is currently a choice of excellent inflatable, low-cost birthpools which have made waterbirth more accessible to many women. You can get set up with an inflatable for under 100, whereas hiring a rigid, heated pool is likely to cost you over 200. Inflatable pools have been wonderful for many women - not only are they excellent value, but the soft, inflated floor is very easy on the knees. However, there are certainly times when a heated pool makes more sense. It depends on individual preference, how fast you think your labour might be, and whether you are likely to have someone with you in labour to sort the pool out. I know of quite a few women who have been clinging to the edge of a birth pool, looking at it longingly but unable to get in as there was only a few inches of water in there. With a first baby, most people will have time to fill a pool in labour (although Sam didn't). It's much harder to predict with subsequent babies.

Other advantages to having a rigid pool are that it is generally more stable for the mother, or the midwife, to sit on the side, and that they are less at risk of punctures. There have been cases of inflatable pools being punctured by scissors from the midwife's kit and, recently on the HomebirthUK list, by a sharp piece of dry lasagne! Punctures can be mended, and the liners of rigid pools can also leak, but it is one more reason why rigid pools are certainly not redundant.

Will I have enough hot water?

This can be a real concern... it was only when I was in labour with my fourth baby, in the middle of the night, that I realised our boiler was not working, and our immersion heater was struggling to keep up! Kelly faced a similar situation, and was unable to use the pool for her baby's birth. The information below comes courtesy of my plumber, in case the same problem happens to you.

First, some basic plumbing terms. The 'traditional' arrangement in the UK is that you have a separate boiler and hot water storage tank. The boiler heats water and it's then stored in the tank until needed. Your boiler can heat water as you need it, but having a tankful of water ready to go will make the process much quicker. The hot water storage tank normally will also have an immersion heater in it (like the heating element in a kettle), so that if your boiler fails, you can still get hot water. However, this is usually much slower than getting water heated by the boiler, and it's also expensive.

Before labour - check that your boiler is working, and that it is set to provide hot water on demand throughout the day (ie water switched to 'always on' rather than on a timer). Check that the pilot light is lit, and that your birth partner knows how to relight it if it goes out. Yes, maybe it's never failed before, but you don't want the first time to be when you're in labour!

A hot water storage tank with an immersion heater should have a temperature setting on it - often this is either on the front of the cylinder about halfway up, or occasionally near the top where the copper pipes come out. Set it to the highest temperature but beware when you put your taps on. If you have any kids in the house be very careful. Most immersion heaters take 30 - 60 mins to fill up a tankful. You can fill the pool with the heater, then leave the hot taps all turned off to allow the immersion to recharge. If you want to use the pool in this time, add cold water to suit.

Combi Boilers

A combi boiler provides hot water on demand, but it generally provides it more slowly than a traditional arrangement. This is because the combi boiler has to heat the water as it's needed. Some homes have both a combi boiler and an immersion heater/water storage tank, but this is unusual as one of the main pluses of a combi is that you don't need the space for a separate hot water storage tank.

A combi boiler should have a temperature control on it, and this may have been set to a low temperature as a safety precaution. A lower temperature means that the boiler can provide warm water faster. However, for the purpose of filling a birth pool, it will be faster to turn the combi boiler to its maximum temperature, and add cold water separately - either by separate hose or bucket.

If the pool still isn't hot enough....

Ask your birth partner or other helpers to keep boiling kettles and pans of water. If you're boiling pans on the hob, put the lid on to make them boil faster. A few can make a big difference. Maybe ask your friends/neighbours if they have any old kettles you can borrow, so you can have several on the go at once.

Do you have an insulated cover for your pool?

These not only keep your water warm, but also help to stop the room from dripping with condensation. Many birth pool suppliers sell them very cheaply, but if you don't have time to order one, you can improvise. I made one from giant bubble wrap (get from most garden centres, which sell it for insulating greenhouses - I paid about #2 per linear metre for pieces 1.75m wide ) or, even better, silver-backed insulating bubble wrap or silver-backed insulation material to go behind radiators - from B&Q etc.. I cut it to shape and used silver gaffer tape to stick strips together to make a lovely floating cover for my friend's pool. I was rather proud of it ;-) Then you can start filling pool at the first twinge, put in hot water as and when available, and keep covered when not needed to keep the temperature up.


Types of Birth Pool

'Choosing a Birth Pool' is a separate article with some things to think about before you decide which pool is right for you.

I would like to include reviews of different birth pools from people who have used them - if you would like to send in your own comments, anonymously or otherwise, please contact me on angela@homebirth.org.uk. Contact details for birth pool suppliers are below.

Angela and Athena, moments after the birth

GentleWater pool

For my third labour, I was given free use of a Gentlewater pool in order to review it. We set the pool up a week or so before the birth - my two older boys and I enjoyed relaxing in it.

The Gentlewater pool is made of reinforced polystyrene panels which clip together, with a strong inner liner, and padded top rails. It is adapted from a portable hot tub/spa from the USA. It has a heat retention cover which clips securely all around the edges of the pool, and which can be locked in place to stop older children or pets from falling in. The pool is supplied as two large boxes containing most of the equipment, and one smaller one with a pump - all fits into a hatchback car. The boxes were surprisingly light and I had no trouble in moving them around myself at 37 weeks of pregnancy. Assembly was very easy - my oldest child (nearly 5) did most of it! One person would have no problem in doing this alone. It took about half an hour.

This pool is supplied with a heater/filtration unit, which was also pretty easy to set up. You can set it to maintain the water at a particular temperature, and it also seems to heat the water efficiently.

Preliminary findings from my family's test run of the pool before the birth were very favourable - the padded rails around the side are comfortable to lean against, and it seems to be strong. The heater/filtration unit is unobtrusive and does its job well. Although the pool is supplied with a thin layer of padding to go under the liner, this didn't look sufficient to me for our hard floors, so I chopped up some carpet underlay and simply lay this in the base, before I put the liner in. There was plenty of room to move and the pool seems to be strong. It did creak a bit when I tried bracing my feet against the sides, but the pool's supplier assures me that this is normal and is not a sign of weakness. Apparently it is designed to be strong enough to withstand having a ride-on mower crashing into it.

Update:

My third baby, Teàrlach Andrew McKenzie Horn, was born at home on 29 December 2002, in the Gentlewater pool reviewed above. He is gorgeous, and the pool was wonderful!

The heater unit performed well - I wanted the water hotter than I had expected, and the heater unit seemed to take only around 15 minutes to heat the whole pool up by one degree C. The padded top rails were a real bonus - no need for inflatable pillows or rolled-up towels to make it comfortable to lean your head or neck on the sides. This made a real difference to me - one less thing to have to fuss about while in labour. It also made it easier to climb in and out of the pool - the soft rails are less slippery than hard edges. The submersible pump provided to empty the pool performed well, and made cleaning up easy.

The midwives were impressed with the pool, and particularly liked the fact that the sides were not too high, so it was easy for me to climb in and out unaided. They also liked the digital temperature control and display.

Overall I was very pleased with this pool and would certainly recommend it. I loved the combination of a rigid, stable pool, and soft, padded sides. I hope to use this one again.

Gentle Water Birthing Pools

Birth Works Hexagonal Pool

I used this pool for my first two labours, and for my fourth one. I would have preferred the Gentlewater pool for my fourth labour, but couldn't justify the expense as I was given a free loan of a Birthworks pool.

The pool is made from solid panels of wood which fix together, with a strong liner inside. It is supplied in the form of several large flatpack boxes which will fit into a hatchback car. They are quite heavy to move, so a pregnant woman would almost certainly need help to load and unload them. Most of the assembly can be done by just one person, although we have found it necessary to have two people to do the final stages, which meant that I had to break off labouring to help with pool assembly.

The pool is normally supplied with a heating and filtration unit, which means that you can set it up beforehand and use it for relaxation before the birth, so that it is ready to use when you go into labour. I found the heater unit was OK for maintenance, but it took ages to actually raise the temperature - it was much quicker to do this by adding some more hot water. The pump/heater unit was quite fiddly to set up and there was quite a lot to remember about priming it etc, but I am told that the pump/heater units have since been updated and improved. There is a floating heat-retention cover. I did not want to have the pool set up for use before my second labour as I was worried about my toddler getting into it.

For labour itself, the pool was very good, and the midwives wanted to know where I got it from! Bonuses are that it is spacious, and very solid - a large pregnant woman can clamber over the sides, or brace her feet against them to push, without any worries about the pool collapsing! This also makes it relatively easy to get in and out - you can sit on the side if you need to, and it will not wobble. I found the hard rim was good for holding on to, but uncomfortable to lean against, so used folded towels and inflatable neck pillows for comfort. During my first labour I spent a lot of time kneeling, and felt that the base of the pool would benefit from having some padding - second time the agent supplied some padding in the base, under the liner. If your agent does not provide this, you could improvise by cutting some carpet underlay, foam rubber, or a camping mat to fit.

Birthworks

Birth Pool In a Box / inflatable paddling pools

Comments from Sarah-Jane:

I used the deluxe birthpoolinabox, though I bought it from Toymaster in Derby for £30.00. It was identical to the one sold by birthpoolinabox.

I bought a hose and devided it in two to provide water from both the hot and cold taps. The pool takes quite alot of water to fill it. We only have a small hot water tank and it took about an hour to 1/2 fill the pool. This is about as deep and a full bath tub.

We never did fill it to the top because my baby arrived before we finished. However, it was still lovely to soak in the warm water and there was a lot more room than a bath tub to move around in. I gave birth to my baby in the pool. It was fine at half full, but would have been better full as the back of my babies head sometimes touched the surface.

I would advise anyone using an inflatable pool to ensure the sides are blown up fully. Mine were left slightly soft and tended to give too much when I lent on them with all my weight.

The midwives loved the pool for ease of monitoring the baby's heartbeat. They found low soft sides more comfortable to lean over than a rigid pool and they could easily reach my tummy.

The pool has now become the kids paddling pool!

Sarah

Comments from Sallyann Beresford, a doula:

I was at a birth as a doula, and my client was in a birth pool in a box (an old 'paddling pool' model which they no longer supply). She used the larger pool and was quite tall. She found it hard to grip the pool, and was splashing water when she rocked from front to back whilst on her knees as she wanted to do instinctively. She was also unable to give birth on her knees as her bum was too high and the baby would have been born half in and half out of the water, so just before the 2nd stage we had to get her to flip round.

It was her only experience of water birth, and I would say she thought it was fine, but I could really see the difference between this and the traditional, rigid oval pool, which is the only other one I've seen in use.

Review from Kim Cotton:

I used the smaller of the pools for the birth of my son Thomas in July this year. I don't have a lot of room and wanted one I could use for more children (or as a paddling pool), so it was ideal. It doesn't take long to inflate at all and has an inflated floor too. The sides are nice and thick, so if inflated well they could even be sat on. I spent all my time in there leaning on the edge, which hardly dented, even though I'm on the rather heavy side. I found it so much more comfortable on arms as well as knees that the rigid pool I used in hospital with my daughter.

The pool was lovely and deep and deceptively big once inflated. My 3 year old daughter keeps calling it mummy's swimming pool after she went in it with her armbands on! I don't know how good it is at keeping the heat as it was right under our ceiling fan and my husband was too eager to get it filled. I have heard it's pretty good. It takes a while for the amount of water it holds to lose enough heat to make a difference.

The midwives thought it was fantastic. Neither of them had seen one before and thought the fish round the edge were great fun. Maybe would give you something to count during a contraction? They weren't worried about the depth, which was fine for me, and from what I remember, they didn't have any trouble doing what they had to, and getting in and out was pretty easy. I'm 5'2 so pretty short, but had no trouble. Can't wait to be able to use it again.

Kim

Lay-Z-Spa

i had a home water birth with an independent midwife in july. I spent the early part of my labour in bed alternating from lying on my left side to rolling onto my knees.. i ended up being in the pool for about 5 hours and found this much better than dry land as i could move into any position quickly with almost no effort compared to the heaving you get when dealing with full strength gravity!

It also eased the pain very effectively for me (no drugs at all used!) and i was able to really relax and flop being supported by the water in between contractions. I also had no damage following the birth which I believe is helped by the water - i'm not sure of the exact figures but i think it reduces the risk of tearing by 30% ish?? It also meant that when DD was born I was the first person to touch her and bring her up out of the water onto my chest... just magical!

The pool i used was called a 'Lazyee-Spa' and was actually an American camping jacuzzi! It was massive about 1.9m wide but we cleared out our dinning room (Although it would have fit anyway but we had just had a new floor fitted the day my waters broke!) It was very sturdy with thick walls. It came with a little control pod which firstly inflated it for you in about 5mins, then filtered and heated the water for you. It also had a bubble setting which was fun before the baby arrived! It was great because once it was filled it took about 12-14hours to heat up to 35degrees and had a thick lid to keep the heat in. Our cats enjoyed snoozing on it overnight! It was great because at the touch of a button i could alter the temperature and i knew that the water was being filtered the whole time. The sterilising tablets that came with it had no smell (i'm really sensitive to chemically smells) which was a bonus.. the cats also enjoyed drinking from it so it must have been ok! It had a pump to empty it out after wards too which i'm told worked a treat (I was resting in my boudoir with DD while my parents were put to work!)

I would definitely use this one again as:

1. it required no brains to control the temp etc and it kept pretty warm overnight so didn't take too long to heat back up the next day.
2. it had an inflated bottom which was very comfortable and meant i could sit up in between contractions and didn't get sore knees/wrists being on all fours
Only down sides for some may be that it is big ( I could float like a starfish and barely touch the sides) and i could just climb over the side without a step and i have very long legs... it may be less convenient for shorter people.

I found it on www.gentle-birth.net

Hope this is useful information!

Genevieve



Water Labour and Birth Stories

My own five children were all born in water - in Lee's birth story I discuss how it helped me in some detail, and for Robert and Teàrlach the pool was invaluable again. When I had Lachlan it was lukewarm and half-full for most of the labour, but I still found it helpful. For Athena I had a deluxe heated pool and it had been up and ready for three weeks! I only got in there for the last 30 minutes or so (fast labour) but when I did, it was an "aaaah - that's more like it" moment. Personally I've felt truly ready for the birth only when the pool was up; I love the privacy that a birth pool gives, the fact that nobody can see my rear end (I've never had anyone shining torches in there), the fact that it's easy to change positions. I've always been open to the idea that it might well be best to get out for the birth, but the water was so supportive and felt so right that I never did. All of my babies were born with me kneeling upright in the water. This position just seemed instinctive, and meant it was easy to guard my perineum and to help ease their heads out, and to bring them to the surface myself.

Sam RK's first labour progressed much faster than she expected: "The pool had three inches of water in it, the 2nd midwife was still on her way with the entonox and I had a baby!"

Charlotte H : "I had to hop out the pool to go to the loo at some stage and as I was on the loo I really noticed the difference out of the water. I had to stop at the stairs for 3 contractions before I could manage the walk to the pool again!"

Charlotte had her second baby at home, in water, using an inflatable pool. It may have been bliss for her to sink into the pool, but her immersion heater was not up to the job, so her husband was kept busy boiling kettles to top it up!

Claire S gave birth to her first baby at home, in water. She used a Hello Baby rigid pool.

Rosie Evans found the birth pool invaluable:
"The pool made me feel I had more privacy to birth. I imagined that you could not see through the water, and felt that I could let go once my bottom half was submerged. I felt lighter and more flexible than I had been on dry land....Sometimes I crouched, and other times it felt good to spread my legs back straight behind me floating in the water."

Rebecca used a hot bath in her first baby's labour, and it helped her to manage an early urge to push.

Amanda Saini's third baby's birth was a remarkable, and triumphant, arrival. Her first was a hospital birth, with a difficult recovery from an episiotomy. Her second baby was breech and Amanda opted for a caesarean in preference to the vaginal breech delivery on offer in her local hospital. When expecting her third, she researched her options, and planned a homebirth. In the event, baby Connor did indeed have his gentle home waterbirth - and was caught by his dad, before the midwife arrived.

Emma had an inflatable birthpool for her first baby's birth. When she got in the water, "Gordon describes the change in me to being from Mrs Angry on steroids to being me again. The water definitely worked for me, not only to help with the surges but to relax me and help me feel more in control."

Angela Hennessy had to wait while her husband boiled kettles to bring her birth pool temperature up, but it was worth waiting for: "I've never felt such relief in my whole life, it was magic, as if the contractions had decreased in pain by about 50%. ".

Rachel White had a homebirth after two caesareans. She found the pool helped her to relax and deal with severe pain from an OP labour, but got out because it was slowing her labour down.

Victoria Whitworth used a La Bassine inflatable pool. She found the combination of hypnotherapy and birth pool very effective. She got out of the pool as labour progressed because she was turning into a prune and the water was too cold for birth.

Kirsty Crowther makes a great case for water: "I was struggling to get control of myself. I just kept repeating 'panic'...In the next gap, I tentatively lowered myself into the water, and the effect was instantaneous. The ache between the contractions disappeared, and the pain in my stomach was less during the contractions, allowing me to concentrate on what the baby was doing. Also, I lost the urge to tense all the muscles in my arms and legs, so became much more relaxed and the panic subsided.

Sarah Harradence was messed around somewhat by her local hospital because of staffing issues and lack of midwifery confidence with waterbirth. Despite this, Ethan arrived at home, in an inflatable birth pool.

Heather had a false start before finding a birth pool that she really got on with, but her Made in Water pool served her well on the day - although her husband was kept busy with pool maintenance!

Fiona's second baby, Gabriel, was born in her bathtub, assisted by a supportive midwife who took care to keep his head underwater until his body was born.

Donna Freeman beautifully describes seeing her son as he came to the surface after a calm home waterbirth.

Caroline Brown gave birth to her first baby at home in Edinburgh, using just TENS and a Birth Pool In a Box for pain relief.

Miriam went into labour with her first baby at 36 weeks and 3 days, continued with her plans for a home waterbirth despite local guidelines that babies under 37 weeks should be born in hospital and not in water. She had some hiccups with her birthpool along the way, and when the water was too cold, a friend bought four kettles from the local supermarket and dad-to-be was kept busy in the traditional male role of boiling water at a birth!

Jessica B used the Birth Pool In a Box mini and found it suited her perfectly. She caught her baby in a lovely gentle waterbirth.

Sarah planned a home waterbirth for her first baby: "I sat in the pool for a while, which was quite relaxing but it felt a bit strange. After a while I needed to go to the loo so left the pool. From that point the contractions were really painful and I started trying the gas and air. .. I didn't feel that I wanted to get back into the pool so used my birthing ball instead, which I found really helpful."

Alicia planned a waterbirth for her first baby. She found the pool very useful in labour, and stood up at the end so that gravity could help to move her baby down.

Helen O'Donnell didn't book a birth pool because she'd left it too late, among other reasons. She used her bathutub to great effect instead.

Rachel Hale gave birth to her first baby, Jude, at home in water (she used the Birth Pool In a Box).

Justine Caines gave birth to twins Rosie and Majella at home in Australia, in water, in December 2005. The second twin was a footling breech. A very well-informed mother and a wonderfully straightforward birth.

Jane had two caesareans, five hospital VBACs, and two ectopic pregnancies before she gave birth to her seventh and eighth babies at home, in water.

Carrie planned a home VBAC and was labouring in water when baby Imogen's heartbeat dipped alarmingly, so her midwife asked her to get out of the pool, but the heart rate quickly recovered and Imogen was born safe and well at home.

Tric gave birth to her daughter in water, at home in Ireland. There was meconium in the waters but baby Caoimhe was fine.

Jo gave birth to her first baby, Cora, in water. She writes: "I was apprehensive about getting into the pool as I had such high expectations of how it would make me feel and was worried that it wouldn't be that great. Matthew had hung sheets up at the kitchen windows and lit candles around the room so when I crawled into the kitchen it looked magical. I can still vividly remember the moment I stepped into the pool, it was the most soothing, gorgeous moment, I almost cried with relief. I kept crawling around the pool saying 'oh this is amazing'. The contrast between the pain I'd been experiencing and the feeling in the pool was immense, so much of the pain was taken away and it symbolised moving into the next stage of labour for me."

Julia used a pool for about an hour in her first labour but got out at the midwife's suggestion because she was feeling 'hot and bothered' - the temperature may have been too high.

Rafeeqah did not think that a bath would help her labour pains, but on her midwife's suggestion she tried one and found it made a huge difference.

Karen Tye-Walker gave birth to her first baby, Oliver, in a birth pool and Karen caught him herself: "I lifted him out of the water and placed him against my chest. He opened his eyes wide and looked up at me and Jon. He didn't cry - he just looked at us and I thought he was absolutely gorgeous"

Amélie had an unintentional, unattended waterbirth - it all went very well, and she was fortunate to have a husband who made a great birth partner.

Rebecca writes: "I got into the pool. The relief was amazing but all of a sudden it felt like I'd gone up several gears in intensity".

Katherine writes of water in labour: "It was relaxing. Beautiful. Bliss.

Jamie spent much of her first labour in water, but got out for the second stage because she wanted a change of scenery.

Michelle had her first baby at home in water, and writes that "I think the water - whilst it was a great relief to get in a bob around in there - brought the contractions on - a very good thing if you don't want a long labour. They seemed to be much stronger and closer together when I was in the pool." Unfortunately her midwives made it difficult for her to use the pool when she wanted to - a good story to read for examples of conflicts which might arise.

Claire found her birth pool to be a great investment for labour, but "After a couple of hours in the pool I'd had enough and went into the kitchen to lean on the sideboard".

Sarah H had to be assertive with a midwife who tried to persuade her to leave the pool to give birth, and who misunderstood temperature guidelines for waterbirth.

Dawn gave birth to her second baby, Matthew, in water.

Oddny planned a waterbirth for her second baby, Anton, but when she realised he was a surprise breech presentation, her midwife and partner got her out of the pool for the birth.

Keri had her second and third babies at home, in water - her third weighed 10lb 6oz!

Lucy gave birth to her first baby underwater, after a three hour second stage.

Helen only just managed to get into the pool for a couple of pushes, before her second baby arrived!

Dawn's first baby, Maya, was born at home, in water, after a long, hard labour.

Caroline arrived in the UK from Australia at 34 weeks pregnant, expecting a fight to book a homebirth. Instead, she found that her midwives were wonderfully supportive, and her first baby, Xander, arrived calmly in a birth pool, at home.

Joanne's first baby was born at home in water. A thoughtful and inspiring story.

Elizabeth's first baby was born at home, in water.

Christine's twin daughters were born in water, at home, in August 2003.

Sarah's third baby, Rafferty, was born in water, weighing 11lb 3oz!

Antonia's first baby, Hugo, was born at home in water.

Becky's first baby, Sam, arrived by home waterbirth. He weighed 9lb 1 oz, but Becky managed to deliver him without intervention, and with only a minor tear.

Cerys Byrne's third baby, Alexander, was born at home, in water, on 3rd August 2003. He weighed 9lb 5oz.

Clare Kirkpatrick - Rosie's home waterbirth

Lonnie Fletcher used a pool in labour with her fourth baby, Aoife, and gave birth shortly after getting out.

Zoe used water for labour, but gave birth on land.

Elaine Lyden had a gentle home waterbirth for her second baby, after a traumatic ventouse delivery in hospital for her first.

H used a pool for the labour and birth of her fourth baby, and her first home birth.

Sarah Mitchell used the bath a lot during labour with her first baby, Amber.

Ruth made good use of a birth pool during a long labour with her first baby, Ella, which eventually ended in a transfer to hospital.

Rachael Moore's second baby, Archie, was born in water, weighing 9lb 4 oz.

Lucy Banwell used a pool while labouring with her first baby, Adan, but it seemed to contribute to a rise in her temperature, and a rise in her baby's heart rate.

Caroline Creasey's fourth baby, Mia, was born at home in water. Mia was in the posterior position and stayed that way throughout labour - she was born face-up. Caroline found the water "amazing..warm and welcoming and so supportive"

Rachelle and Richard Strauss write about the home waterbirth of their first baby, Verona.

Kirsten Millinson writes about her home waterbirths in a wonderful article about informed choice in childbirth.

Julia De Lucchi's third baby, Hudson, arrived weighing 10lbs in a home waterbirth which his mother describes as 'one of the most amazing experiences I have ever had'.

Tikki Potter used a birth pool for her home birth after a prior caesarean.

Haydon Bambury writes about the home waterbirth of his first child, Monica. Wendy, Monica's mother, did not find the pool helpful in the first stage of labour, but used it for the second stage.

Jo Bottomley did not use a birth pool, but she only got out of the bath shortly before her baby's birth!

Julii Brainard used a pool for her labour, but found that she needed to get out to find a good position to give birth to her baby.

Louisa Todd's large second baby, Joe, was born at home in water. Louisa describes the birth as a "wonderful, beautiful experience".

Sian Lupton had her second baby at home, in water, shortly before her 37th birthday. Her first baby was a forceps delivery in hospital.

Juliet had a gentle waterbirth for her first baby, Florence.

Ziva's birth story is a lovely example of how a petite mother (4'11" tall) can give birth to a large baby (8lb 9oz) perfectly naturally, in water. There was some shoulder dystocia, but it resolved as Ziva's mother climbed out of the birth pool.

Lucy Burns had her first baby, Morgan, at home, in water, in September 2001. Here's a taster:
"I reach down and put my hands underneath the baby's shoulders and lift it to the surface. This has to be the most amazing moment of my life - to see my baby floating up through the water, so alert and amazed by what is going on.".
There are some wonderful photos of the new family on their website. (www.easyweb.co.uk/morgan/lucy_story.html)

Books and Videos on Waterbirth

Water Birth Unplugged

Edited by Beverly Beech
This book contains the proceedings of the First International Water Birth Conference held in London in 1995. It provides an invaluable resource of information on research, studies and experience of the world's leading experts on Water Birth.
Available from NCT Maternity Sales, or from AIMS for £14.50 including P&P

Choosing a Waterbirth

By Pat Thomas
How to arrange a waterbirth and overcome obstacles. Lists pool rental companies.
Published by AIMS - £4.00 + 50p P&P from AIMS - extracts on the AIMS website at www.aims.org.uk

The Water Birth Handbook

By Dr. Roger Lichy and Eileen Herzberg
A comprehensive guide which offers useful advice on how to make the most of water throughout labour and delivery. A practical and readable book with lots of vivid personal stories and answers to the often-asked questions about this innovative birthing option.
£8.95 from the Active Birth Centre

Water Birth

By Janet Balaskas and Yehudi Gordon
Thorsons, 1992, ISBN 0 7225 2788 8
Guide to using water in pregnancy and birth, at home or in hospital.

Water & Birth -The Video

By Janet Balaskas and Amy Hardie
The birth experiences of three women at home and in hospital. The mothers and midwives involved are interviewed and the film is introduced by Janet Balaskas.
Running time 45 minutes. £12.95 , from Active Birth Centre

How to prepare for a safe and easy water birth

Obstetrician Dr. Gowri Motha follows several first-time mothers though their pregnancies and births in water, including home birth. (58 min.)
£20 to buy, £10 to hire, from Splashdown

Gentle Birth Choices

Six births, including home and water birth, and interviews with Michel Odent, Marsden Wagner and others (46 minutes, USA 1995)
£27.50 to buy or £12.50 to hire, from Splashdown, £40 from ACE Graphics.

Suppliers of books and videos

(These suppliers are all in the UK; to use the phone numbers from outside the UK, remove the first zero and add +44)

NCT Maternity Sales (www.nctms.co.uk), Tel. 0141 6360600

AIMS Publications (www.aims.org.uk), Mandy Hawke, 2 Bacon Lane, Hayling Island, Hants POll ODN

Splashdown Waterbirth Services Bookshop - (www.splashdown.org.uk/book_list.htm) Tel. 020 8422 9308

Suppliers of Birth Pools and Equipment in the UK

Samantha Jayne Birthing Pool hire - also hire out birth stools and valley cushions (to help recovery after bad tears) and offer advice and support. Based in West Sussex but deliver throughout the UK. Tel (01243) 265231
www.samanthajaynebirthingpools.co.uk

Gentle Water Birthing Pools - rigid pools with padded top rails and integral heating/filtration unit. Based in Brighton, but can deliver nationwide. I used one of these pools for my third baby and absolutely loved it - see review above.
(www.gentlewater.co.uk)

The Good Birth Company - owners of Birth-Pool-in-a-Box .
Range of purpose-designed inflatable birth pools for sale, and rigid pools for hire. Range regularly updated. Lots of articles on the website, and plenty of guidance on choosing a pool.
www.thegoodbirth.co.uk

WaterBaby Birthing Pool Hire - hires out the inflatable Birth Pool In A Box, with equipment. Very low prices.
www.waterbabybirthingpoolhire.co.uk

The Howes Birth Mirror has been specifically designed for waterbirth by UK homebirth midwife Virginia Howes. It is a sterilizable, stainless-steel mirror, angled to make it easier for mother or midwife to watch the baby. (www.kentmidwiferypractice.co.uk)

Aquabirths - based in Bradford, but agents elsewhere.
www.aquabirthsathome.co.uk

Hello Baby Birth Pool Hire
6-foot diameter octagonal pool with heater and filter. I used this pool for my fifth baby, Athena, and highly recommend it - review above.
www.birthpoolhire.co.uk

Born In Water - Based in Wiltshire but supplies nationwide. Rachel runs a homebirth support group and also hires out luxury heated pools with a heater and water filter maintenance system, as well as wooden unheated pools.
www.borninwater.co.uk

Mum's Birth Pools
Based in Newbury, offer a collection service in Reading, Oxford, Swindon, Basingstoke and surrounding areas. Oval and hexagonal fibreglass pools with padding and liners.
(www.mumsbirthpools.co.uk)

Aquabubs is based in the New Forest and rents out robust inflatable pools with built-in filter and thermostat. Offers cheap local delivery and setup service, or nationwide delivery via courier.
www.aquabubs.co.uk

Babymoon
We have both oval and hexagonal pools, and our website has lots of info about water birth. I''m also getting together a page of 'local' (to me, which means parts of Hampshire, Dorset & Wiltshire) resources for pregnancy and after.
www.babymoon.co.uk

Baby Basics Birthpools
Kim Cotton's new company, hiring out oval and hexagonal pools, as well as birth stools, birthing balls, and other items to hire or buy.
www.babybasicsbirthpools.co.uk

Made In Water

Custom-made inflatable birth pool costing £50 to buy, and an interesting website to browse, too. (www.madeinwater.co.uk)

Eau Baby!

Birth pool hire in Birmingham. The website includes lots of information about water births, and Active Birth. Owner Paula says "I am always available to offer advice on home or water births, and would be interested in helping any of your readers fulfil their birth wishes." (www.eaubaby.net)

Active Birth Centre - (www.activebirthcentre.com)

Splashdown - hires out pools for an all-inclusive fee covering 4 weeks - 2 weeks before and after your due date. You may be able to keep the pool for longer afterwards if you wish, at no extra charge. Inflatable pools and rigid oval or round pools
( www.waterbirth.co.uk)

Splashdown
Splashdown has an inflatable water birth pool (made of reinforced liferaft material) and a fully padded oval and round fibreglass pool. www.splashdown.org.uk/)

Birthworks - rigid hexagonal pools constructed from wooden panels with a strong liner, with heater/filtration unit. I've used these for three of my babies and found them very strong and nice to look at. Also supply a smaller rectangular pool for those worried about weight or floorspace. Quite a few local agents, but can also arrange nationwide delivery.
(www.birthworks.co.uk)

Bubbatubs - rigid, hexagonal pools with a wooden cladding. Hired on a weekly basis with a variety of optional extras such as birth balls and videos. Claims to be the cheapest pool hire in the UK - presumably if you only want to hire for a week or two, rather than committing for a four-week period. Based in Hertfordshire, but can deliver nationwide.
(www.bubbatubs.com).

Mamma Works - (www.calltech.demon.co.uk/mamma.works/POOLS.HTML)

Blue Lagoon Birth Pools - based in the northwest in Skelmersdale Lancashire, and also have a collection base in Rendlesham in Suffolk near Woodbridge and Ipswich. Hire out portable pools nationwide.
(www.bluelagoonbirthpools.co.uk)

Tranquil Waters - (www.tranquil-waters.com) - not hiring out pools at the moment, but interesting site.

Waterbirth Resources on the Web

Having trouble arranging a waterbirth? - on this site. Sample letter to use if you are told that there may not be any midwives trained in waterbirth on your team.

Discussions on waterbirth from the UK Midwifery email group

THE USE OF WATER IN LABOUR AND BIRTH
Royal College of Midwives
Position Paper No 1a, October 2000
http://www.rcm.org.uk/info/pages/introduction.php?id=4

Immersion in water for labour and birth
Royal College of Midwives/ Royal College of Obstetricians and Gynaecologists
Joint position paper, May 2006
www.rcm.org.uk/professional/docs/RCOG_RCM_Birth_in_Water_FINAL_COPY.pdf

"What type of birth pool should I choose?", by The Good Birth Company.

The Waterbirth Webring includes many sites worth a look.

Choosing a Water Birth - extracts from the AIMS booklet by Beverley Beech, with guidance on obtaining a water birth either at home or in hospital, for women in the UK.

Karil Daniels' Waterbirth Website - the benefits of waterbirth, including at home
(www.waterbirthinfo.com)

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Home Birth Reference Page
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