Water, Pregnancy, and Birth

By Heidi Dahlborg
Web Exclusive - July 6, 2008

Water covers 70 percent of the earth, and makes up 60 percent of our bodies as adults and 85 percent of a baby's body. The salty primordial sea gave rise to much of life on earth, just as each of us gestated in the watery amniotic fluid of our mother's womb before birth. Humans have a special affinity for water. It is a medium that is naturally comfortable for pregnant women, and provides endless fun opportunities for babies and toddlers. There are many ways you and your baby can explore the joys of water before they are old enough for classes.

Pregnant women and their growing babies can benefit from being in the water long before the baby arrives. I have taught American AquaNatal classes for six years. American AquaNatal is a method of water exercise developed to prepare the mother-to-be for birth on many levels. It prepares the physical body for birth by opening the pelvis, is an experiential lesson in breathing and relaxation for labor, and helps the mother connect to the baby growing in her watery womb. Water conducts sound well, and sounding to a growing baby while underwater is a particularly effective form of intrauterine communication. Many women over the years have reported feeling their baby for the first time when we were humming or talking to the babies during the class. Additionally, water offers pregnant women the comfort of reduced gravity, relieves back strain, lowers blood pressure, balances the amount of amniotic fluid in the womb, increasing the joint lubrication on stressed joints, and reduces ankle edema. The uniform hydrostatic pressure on your body when you are submersed from the neck down forces pooled fluids back into circulation and helps relieve many pregnancy-related discomforts, and makes for one big pee when you finally get out!

Many women who participate in AquaNatal also choose to use water for labor and birth. Water submersion has been rated to be as effective as narcotics for pain relief in labor without any of the harmful drug-related side effects for the baby. In many parts of the country, water tubs are available in hospital settings. In our local hospitals, you can use the shower for labor and ask to have your baby monitored intermittently. Birthing centers and homebirth midwives offer water tubs for labor. The doppler the midwife uses to monitor the baby is submersible, so the baby can safely be monitored while mom is in the water. Personally, in my labor, I found the difference between a contraction in the water tub and out of the water to be the difference between a three and an eight on a pain scale of one to ten. A contraction in the water was a whole other, very manageable world! I floated, and sometimes submerged myself with each contraction, and exhaled slowly into the water, to resurface after the contraction was over; it became a slow dance. I also spent long periods of time in the shower letting the water run over my back during painful back labor. The water gives the mother a sense of privacy and emotional safety, as she is not exposed. This sense of privacy, and the fluid environment of the water, supports the mindset of release and flow needed to birth instinctually.

Babies born in water experience an especially gentle transition, from the watery womb, into warm water, and are brought immediately out of the water into the mother's arms, where they remain. And the connection of staying with your baby from the moment she emerges is priceless.

Large studies have shown waterbirth is completely safe. But water birth seems counterintuitive for many people, and brings up the fear that the baby could drown. At birth we are waiting so anxiously for a baby's first cry, the signal that he is present and strong in his body. Babies develop in amniotic fluid. They do not gasp in amniotic fluid unless they are in crisis, and that is detectable in labor. That is why water birth is used only in normal healthy births. When babies are born, it is not the fact of emerging, but the contact with the air and the cooling evaporation off their wet, new bodies that stimulates the chemo receptors on their skin to send a signal to take the first breath. Water born babies do not breathe until they are out of the water.

Babies have a reflex called the mammalian dive reflex that keeps them from taking a breath under water. When submerged, their glottis, the valve at back of their throat, closes and their heart rates slows. The mammalian dive reflex is not only what keeps babies from inhaling water in water births, but also makes infant submersion possible. Remember the cover to Nirvana's album Nevermind with the baby swimming underwater? That was not trick photography. Babies can go under water. The mammalian dive reflex is present in all babies at birth, and if not trained into a learned behavior, disappears at six months.

It is possible to train your infant to retain the mammalian dive reflex with simple playful exercises in the bathtub, and then you move on to a warm pool. You do not begin by submerging your infant, and parents should never submerge babies without guidance from a trained person. Swim instructor Rob McKay, founder of the Lifestyle Swim School in Boca Raton, Fla. says, "Children need to be comfortable and confident above water before they can ever begin to swim with their face in."

Initial exercises parents can do at home include nursing in the tub or cuddling skin-to-skin, floating, and using verbal cues while gently running water on your baby's face stimulate the dive reflex. The first way to orient a new baby to water is to simply bathe with them. Water is a great medium for bonding and for new babies to explore the use of their bodies. They unfold into the warm water. When babies float in the water with their mothers a few days after birth, they will resume positions and actions they are familiar with from being in the womb.

Just cuddling and floating in your tub will get your baby comfortable in the water. An old client said she was never as wet as the time she tried to forgo cobathing with her baby and use the infant bath. An infant bath topped the list of utterly useless baby gear for me. I spent long hours in the bath when pregnant, and spent long hours nursing my baby in my standard shallow, little tub. It was great to have the tub as a destination within my home in the first long weeks of parenting. My daughter got a lot of exercise standing in the water while at the breast, and kicking her little feet against the boundaries the tub provided. I would sit up and hold her little head out near my knees, and let her body float between my legs, suspended and supported by the water. When she was cranky or overwhelmed, the water was like a reset button. It restored calm, like she was being comforted by the familiar feeling of the amniotic waters she had recently come from.

If water runs over your baby's face, that is enough to stimulate the dive reflex. To try it out, just take a washcloth, and warn your baby that you are going to put water on her face by telling her, and ask her permission. Say "1, 2, 3... go!" And squeeze water from a washcloth over her forehead so it runs down her face. You can do this in the shower. Just say, "1, 2, 3 go!" And then let the water run over her face. There is a particular congested look babies get when they are doing involuntary breath-holding from the closed glottis. If she does not seem to like it, stop. The reason you count is to give her a verbal cue that water is coming so she learns to anticipate it and hold her breath. This is how the dive reflex goes from an involuntary response to a learned behavior.

When introducing babies to water outside the tub, be sure it is warm. Begin acclimating the baby to cooler water temperatures by lowering the bathwater a degree or two until it's around 90-92°F..If you find a nice, warm outdoor pool, be sure there is shade. A water play session with an infant should last about 20 minutes. If the baby becomes upset while in the water, nurse her or soothe her in the water. Try not to leave the water when the baby is agitated; wait until the baby is calm and then leave the water.

When my daughter was three-months-old, we were ready to move from the bathtub to a pool. We borrowed a relative's hot tub, and set it at 90°F. She enjoyed just splashing around in the water with us. We kept the mood light and fun. Even with extensive knowledge of baby swimming techniques, my husband and I were both nervous when we tried the submerge techniques we had learned. We tried a simple "1, 2, 3 go!" as if we had been doing with washcloths and in the shower, and dunked her under and brought her right up. We just made it part of the continuum of water play to go under. When she was very young, she did not want to go under more than three or so times in a swim. We swam frequently, and when she was four-months-old, she was able to hold on to my shoulders and take a short dive underwater across the pool, or in the ocean. She progressed to being able to swim a short distance between us underwater. After each winter, she takes a few days to regain her old skills, and then quickly adds new ones to her repertoire.

The purpose of being in the water with your infant is to have fun and bond. Always respond to your baby's receptivity to the water. If it's not fun for both of you, don't do it. "There are a number of excellent reasons for teaching toddlers to swim," says McKay. "The best reason is probably just the sheer joy of it."