Q. I am planning a home waterbirth for the birth of my next baby. I know that some midwives and providers want women to wait till they are 5 cm dilated to get into the pool so that labor is well under way and will not be slowed down by the relaxation that takes place in the water. Others feel that women should get in whenever they feel the need for relief and that it will have little or no effect on the length of labor, and that if it does, at least she has been comfortable in the mean time. What is your opinion regarding when a woman should enter the water? In your experience have you seen it slow labor progress for a woman to get into the tub before 5 cm?
A. For a homebirth, I do encourage a woman to use the water whenever she feels the need, especially if she has a bathtub that is big enough. If she is using a portable birthing pool, I generally don't fill it until her labor is well established and she needs to have access to water to help her cope with labor.
In my own first waterbirth, I enjoyed walking and squatting and getting into the shower and by the time my midwife came, I was already past 7 cms. I got into my birthing tub and it was like a lightening bolt hit me. I had several strong contractions back to back and before 10 minutes was up, I was pushing. My body simply took over and I had absolutely no control at that point.
I have witnessed first time moms get into the tub when they were only 1 cm and in an hour an a half they were complete and ready to push. Therefore I don't agree with putting a "blanket" prohibition on getting into the tub only after 5 cm dilation. One of my only parameters is to not keep a mom in the birth pool longer than about two hours without making some sort of environmental change. In other words, get out after and hour and a half to two hours and go to the bathroom, take a short walk, dance, do something to change the environment, then get back in. I don't think that women should stay in for five, six or seven hours without getting out for a change.
Remember, too, that the water temperature should never be higher than 101 degrees. If it is higher than that the mother will get overheated and then so will the baby. The mother can always get cooled down, but the baby has no way of discharging the temperature and little babies don't like to get overheated. They will show evidence of this by having a higher than normal heart rate. So, use your intuition, not a rule book, but don't stay in so long that you get exhausted and dehydrated.