Waterbirth Client Information

Elizabeth Mendoza
elizabeth@wisdomwithinbirth.com
wisdomwithinbirth.com
 Waterbirth at Home FAQs
Why choose a waterbirth? What are the benefits?
Some of the benefits of waterbirth come from just
being in the water during labor (hydrotherapy), and
some of them come from actually delivering your
baby in the water (waterbirth) (Dekker, 2018).  out of the water. This could be during labor, delivery,
Some of the reasons people choose to be in the
water during labor and birth include reducing pain
and creating a more relaxing experience overall.
When you're more relaxed, labor can unfold more
easily (ACNM, 2016). You can also move around and
change positions pretty easily in the water, and we
know that this can help ease pain and shorten your
labor. Research tells us that giving birth in the water
is also associated with fewer episiotomies and severe
tears and less chance of bleeding too heavily after
birth (Nutter, et al., 2014a).
Perhaps most importantly, though, people who have
waterbirths generally report better memories of their
birth experience than those who give birth out of the
water (Cluett & Burns, 2009).
But is it safe? What are the risks of waterbirth?
Even though there are risks to any birth, overall, the
research tells us the waterbirth is as safe as giving
birth on land for both low-risk birthing people and
babies.
There are no increases in poor outcomes for babies
like death, hospital admittance, difficulty breathing,
or infections (Taylor, et al., 2016). Some of the known
drawbacks to giving birth in the water are a higher
chance of having a minor perineal tear in the process
and possibly more chances of the umbilical cord
snapping, although we still need more research to
confirm this (Dekker, 2018).
How does my baby not drown in a waterbirth?
Fetuses and newborns have a dive reflex. This closes
the larynx when a foreign substance (like water in a
waterbirth) is against the throat or on the face. In
addition, the hormones of birth suppress any
practice breathing movements that the fetus might
have made (Nutter, et al. 2014b). These things
combined help keep a low-risk, healthy baby safe
when born in the water. However, this reflex doesn't
work as well if the baby is sick or stressed in labor.
This is one of the reasons why we monitor you and
your baby carefully during a waterbirth and may ask
you to leave the tub if needed.
References
American College of Nurse-Midwives (ACNM). (2016). A model practice template
for hydrotherapy in labor and birth. Journal of Midwifery & Women’s Health, 62(1),
120- Retrieved from http://onlinelibrary.wiley.com/doi/10.1111/jmwh.12587/full
Cluett, E., & Burns, E. (2009). Immersion in water in labour and birth. Cochrane
Database Syst Rev.; 2:CD000111
Dekker, R. (2018, February 7). The evidence on: Waterbirth. Retrieved from
https://evidencebasedbirth.com/waterbirth
Nutter, E., Meyer, S., Shaw-Battista, J., & Marowitz, A. (2014a). Waterbirth: An
integrative analysis of peer-reviewed literature. Journal of Midwifery &Women’s
Health, 59(3): 286-319.
Are there times when I can't be in the water?
We need to help ensure that you and your baby are
as safe as possible. If there is reason to worry about
either of your healths, you will likely be asked to get
or postpartum and may be if your baby needs extra
monitoring, if you have a fever, have had any
abnormal bleeding, or other possible
concerns (ACNM, 2016).
What if I change my mind?
You are free to get in or out of the tub as much as
you feel comfortable. We want you to trust your
body and your instinct about what feels good and
what you need in that moment. One other thing to
note is that sometimes being in the water can slow
your contractions in early labor, so you might be
advised to wait until contractions are more
established to get in. 
Can my partner or children be in the water too?
We want you to be comfortable in your labor and
birth. If you would like another person in the water
with you for extra support, that is just fine. The tub
that I loan out is large enough for two adults to sit in.
What if I have a bowel movement in the water?
It would be best if you can get to a bathroom if you
can, but having a bowel movement in birth happens
sometimes. Your birth team will clean it up quickly
out of the water and we'll keep going. If needed, we
might need to put clean water in the tub.
How can we reduce the risk of infection?
Making sure the birth tub is clean is part of what
makes the whole process safe. Not using jetted tubs,
using a new disposable tub liner with each person,
using a brand new hose for filling, and washing and
disinfecting with an appropriate solution before and
after each use help in that effort (AZDHS, 2016).
Is it a lot of work to set up or clean up?
The tub that I loan out to clients is an inflatable one
and does require some setup, but can be done pretty
quickly with an air pump (which is included in the tub
kit). You can even set it up in early labor to have it
ready for when contractions get stronger. After birth,
the tub should be emptied with a pump (also
included) and an old hose, and then disinfected with
a special solution (also included). It often takes
your birth team under a couple of hours to clean and
repack everything.
Nutter, E., Shaw-Battista, J., Marowitz, A. (2014b). Waterbirth fundamentals for
clinicians. Journal of Midwifery & Women's Health, 59(3): 350-354.
Taylor, H., Kleine, I., Bewley, S., Loucaides, E., & Sutcliffe, A. (2016). Neonatal
outcomes of waterbirth: a systematic review and meta-analysis. Arch Dis Child Fetal
Neonatal Ed, 101(4), F357-365.
Elizabeth Mendoza
elizabeth@wisdomwithinbirth.com
wisdomwithinbirth.com
 Waterbirth Supplies
What special supplies will the
midwife bring for a waterbirth?
- the birth pool is supplied, but you'll
need to arrange pick-up (including
spare parts and patches)*
- an electric air pump to
inflate the tub*
- a submersible pump to
drain the tub*
- a bottle of disinfectant; use what you
need and return the remainder*
- a clean, 5-gallon bucket*
- instructions for setup, takedown,
and disinfection of the tub*
- a water thermometer
- personal protective equipment
(regular gloves; shoulder-length
gloves; possibly an apron)
- a baggie or protective gear for a
Doppler with a waterproof probe
- a barrier for the Doppler probe
as needed
- waterproof flashlight
- Howe's mirror
- possible accessories for use in the tub
(a floating pillow, for example)
- waterproof kneepads for comfort or
possibly a stool to sit on next to the pool
- another person to assist
elizabeth@wisdomwithinbirth.com
What will I need to have
especially for a waterbirth?
- you will need to arrange pick-up of a birth
tub from your midwife at about 35-36
weeks of pregnancy
- a waterproof barrier for under the tub
(like a tarp or large plastic sheet)
- a brand new hose for filling (consider
one that is labeled for drinking water
use or is free of PVC and/or lead
- a second hose for draining (this
one can be an old hose)
- an adaptor to connect the hose to the
faucet you will be using for filing
- a brand new tub liner specially designed
for the model of tub used
- a fine sieve or fishnet
- towels (and extras) to wrap the baby
and the birthing person in
- bathmats or rugs for the floors,
especially around the tub
- extra newborn hats
- drinks or powders that replace
electrolytes (similar to Gatorade, other
brands, or make your own) 
*These items are all included as a package
with the tub and should be picked up and
returned together.
Elizabeth Mendoza
wisdomwithinbirth.com
 PROPER CARE SET UP, EMPTYING, AND CLEANING OF TRANSPORTABLE/INFLATABLE
BIRTH TUBS FOR HOMEBIRTH USE
Elizabeth Mendoza
Updated: April 2018

1. Before you begin – When choosing a location for the tub, make sure it has ample access around
it on at least two sides, that the water source can reach it, and that the floor is swept under
where it will be set up (Waterbirth Solutions, 2015b). Also ensure that the floor is stable enough
to hold the weight of about 10-12 people at once and consider proper placement for the season
(Pregnancy, Birth and Beyond, n.d.(b)).

2. Setting up the birth tub – Using the electric pump, inflate the floor of the tub first, one
chamber at a time, then inflate the walls and lastly the top chambers. Leave the top chambers
slightly under-inflated to be able to more easily put a liner on (Waterbirth Solutions, 2015). Wipe
the pool out with a tuberculocidal disinfectant solution approved by the Environmental
Protection Agency before putting on the liner (Arizona Department of Health Services (AZDHS),
2016). Line up the handles on the liner with the handles on the tub as needed. Finish filling the
air chambers on the top of the tub to get a tight fit of the liner. If possible, let the inflated tub sit
overnight and re-inflate as needed and check for any air leaks (Pregnancy, Birth and Beyond,
n.d.). If leaving the pool inflated for any amount of time before birth, ensure that children or
pets do not play in it and that it is covered with a lid or fitted (bottom) sheet to reduce debris or
damage. Try and attach the hose to the faucet ahead of time to ensure a good, leak-proof fit.

3. Filling the birth tub – Use a new hose to fill the pool and consider using one free from of PVC
and/or lead. Run hot tap water through the hose but not into the pool for three minutes to clear
sediment and possible pathogens (AZDHS, 2016). Then start filling the tub with cooler water. The
water should eventually be about 98-100.4°F and about 21-24 inches deep, which cover the
birthing person’s abdomen but not their shoulders when sitting, or to the birthing person’s
preference (Waterbirth Solutions, 2015b). Cover the tub with a fitted sheet, lid, or cover when
not in use. Add warm or cool water as needed to maintain a suitable temperature (Pregnancy,
Birth and Beyond, n.d.(b)). Do not let the water sit in the pool for more than six hours and do not
use additives in the water (AZDHS, 2016).

4. Emptying the birth tub - Scoop out any debris from the water. Use a submersible pump. Attach
the non-filling hose to the appropriate place on the pump. The other end of the hose should be
put outside, in a shower, in a toilet, or other appropriate place. Put the pump at the bottom of
the tub and start it. As the water gets lower, tilt one side of the liner so water is directed toward
the pump. Unplug the pump as soon as water stops flowing (Pregnancy, Birth and Beyond,
n.d.(a)). Remove the liner from the tub and dispose of it and all other disposable supplies
appropriately.

5a. Cleaning the submersible pump only – Keeping the drain hose connected to the pump, put the
pump into a nearly-full five-gallon bucket of clean water. Plug the pump in to remove all the
water from the bucket. Once that is gone, refill the bucket with a solution of water and
tuberculocidal disinfectant (same type used for the tub). Once this solution is gone from the
bucket, then unplug the pump. Let the pump and bucket airdry fully to properly disinfect.
5b. Cleaning the submersible pump and drain hose – It is only necessary to disinfect the drain
hose if it will be used for birth purposes or other situations where sanitary conditions are
important. If the hose will simply be used for standard outdoor uses, disinfection may not be
necessary.
Keeping the drain hose connected to the pump, put the pump into a nearly-full five-gallon
bucket of clean water. Plug the pump in to remove all the water from the bucket. Once that is
gone, refill the bucket with a solution of water and tuberculocidal disinfectant (same type used
for the tub). Coil the hose into the bucket so that it is submerged, especially the drainage end.
This allows the water to fully circulate in and on the hose and pump (Waterbirth Solutions,
2015a). Let it run for five minutes, then unplug the pump and let it sit for an additional ten
minutes, or as recommended per the manufacturer. Drain this bucket and hose completely and
allow to air dry fully,

6. Cleaning the birth tub – After the tub has been completely emptied and the liner removed, it
will need to be washed first with a detergent, rinsed, and then disinfected. Use of a
tuberculocidal disinfectant is recommended (AZDHS, 2016). Follow the disinfectant
manufacturer’s recommendation for wet and drying time before packing up the tub. Also
disinfect any accessories that came in contact with the water and cannot be disposed of (AZDHS,
2016). Use personal protective equipment during this process and keep children and pets away.

7. Packing the birth tub away – Use the air pump on the deflation setting to remove the air from
the air chambers, starting with the floor, then the walls, and the top chambers. Folding the tub
appropriately per the instructions will help to remove any remaining air (Pregnancy, Birth and
Beyond, n.d.(a)). Place all the included equipment in the bag.

8. Contents checklist – All items should be fully cleaned and disinfected as appropriate
i. The tub (and any spares or patches)
ii. Electric air pump
iii. Submersible pump
iv. Bucket
v. Bottle of remaining disinfectant
vi. Instructions
vii. Included bag for supplies
 References

Arizona Department of Health Services. (2016). Guidelines for water immersion and water birth.
Retrieved from
http://www.azdhs.gov/documents/licensing/special/midwives/training/guidelines-for-water-
immersion-water-birth.pdf

Pregnancy, Birth and Beyond. (n.d.(a)). How to pack up a birth pool. Retrieved from
http://www.pregnancy.com.au/birth-choices/waterbirth/waterbirth-articles/how-to-pack-up-
a-birth-pool.shtml

Pregnancy, Birth and Beyond. (n.d.(b)). How to set up a birth pool. Retrieved from
http://www.pregnancy.com.au/birth-choices/waterbirth/waterbirth-articles/how-to-set-up-a-
birth-pool.shtml

[Waterbirth Solutions]. (2015a, April 10). Care of the drain pump [Video file]. Retrieved from
https://www.youtube.com/watch?v=7B0BSFRLhK8

[Waterbirth Solutions]. (2015b, April 10). Birthing pool inflation (part one) [Video File]. Retrieved from
https://www.youtube.com/watch?v=NPNIjOKFDXk

[Waterbirth Solutions]. (2015c, April 10). Filling the birth pool [Video File]. Retrieved from
https://www.youtube.com/watch?v=9e-Gsv7rovE
 INFORMED CONSENT DOCUMENT: WATERBIRTH AT HOME
Elizabeth Mendoza
Updated: April 2018

Definition: Waterbirth is defined as the act of giving birth while completely submerged in a tub of water.
Waterbirth is contrasted with hydrotherapy, which is immersion in a tub of water during labor, but not giving
birth there.

Is it safe? Due to its increasing popularity among birthing people, there have been several large-scale research
studies and research reviews on waterbirths in recent years. It has been well-established and relatively
undisputed among experts that hydrotherapy can be a highly effective form of pain relief and relaxation with
little to no adverse effects (Dekker, 2018). Just like with any birth, though, there are both risks and benefits in
waterbirth as well. However, waterbirth does not seem to be any more dangerous than births out of water
(Dekker, 2018).

Potential risks
- You could decide that being in the water is not comfortable or you do not enjoy it.
- Overall, waterbirth is not known to be harmful to newborns (Bovbjerg, Cheyney, & Everson, 2016).
There is no known increase in the risk of infections, difficulty transitioning to life outside of the womb,
hospital admissions, injury, or death in babies born underwater versus not (Taylor, et al. 2016).
- People who give birth in water have an 11% higher chance of having some sort of tearing or trauma to
the perineum, vulvar, or genital tract than those who birth out of water (Bovbjerg, et al., 2016).
- The risk of the umbilical cord breaking or snapping during a waterbirth is about 3 per 1,000 births
(Schafer, 2014). Some experts suggest that this rate is higher due to the water, but there is no current
evidence on cord snapping out of the water with which to compare these numbers.

Potential benefits
- When taking into account which number baby this is for you, newborn babies born underwater have
better outcomes on all measures (Bovbjerg, et al., 2016).
- When people in research studies labor underwater in a hospital or birth center, they request less pain
medications (Dekker, 2018). We can conclude that this is because water helps to relive the pain of labor
and birth.
- Underwater, you have more ability to change positions to get comfortable, relieve pain, and help
facilitate a normal labor and its progress (Garland, 2017).
- Birthing people have an average lower transfer rate to another provider or facility during labor,
postpartum, or in the first six weeks after birth if they give birth in water (Bovbjerg, et al, 2016).
- Waterbirths are associated with fewer episiotomies and fewer severe perineal tears (Nutter, et al.,
2014a).
- After waterbirths, there are less cases of bleeding too much postpartum (Nutter, et al., 2014a).
- People who are in the water during labor or birth tend to be more satisfied with the experience overall
(Nutter, et al., 2014a).

Eligibility criteria for waterbirth It is generally considered safe for birthing people to be immersed in water
throughout labor. However, waterbirth at home should be reserved for low-risk situations. This means that the
pregnancy should be at term (at least 37 weeks of gestation), you should only be pregnant with one fetus, and it
should be in a head-down position.

If you are affected by current or past health issues such as infections, history of shoulder dystocia, history of
severe postpartum hemorrhage, or growth problems with the fetus, it may not be the safest situation for a
waterbirth. Some differently-abled persons (whether temporary or long-term) who are not able to be fully
mobile and get out of the water quickly may not be a good candidate for waterbirth. Each situation will be
evaluated individually.
Indications for leaving the water
- If contractions or labor progress slow too much
- fetal heart tones that are abnormal
- thick meconium-stained amniotic fluid (release of the bowels while still in utero)
- a fever
- suspected shoulder dystocia (fetal shoulder stuck on your pubic bone)
- bleeding too much in labor
- water cloudy from fecal matter
- for neonatal resuscitation
- for suturing
- any other concerns you or the midwife may have

Reasonable alternatives to waterbirth Many of the benefits of waterbirth seem to come from being in the
water during labor. If you are not a good candidate for waterbirth or if you change your mind, it may still be an
option to use hydrotherapy during your labor and then exit the birth tub when it is time to start pushing. There
are many other comfort measures that may help to offer pain relief in labor and birth such as a shower,
positions changes, touch, massage, counterpressure, warm or cold packs, aromatherapy, relaxation techniques,
and others can all help in lieu of the water.

Statement of understanding
If you understand the information presented here and above and would like to pursue a waterbirth during your
birth experience, please read the following and sign below if you agree. This document must be signed in order
to attempt a waterbirth with this midwifery practice.

1. I have had the opportunity to fully discuss waterbirth with my midwife.

2. All my questions about waterbirth have been fully answered to my satisfaction.
3. I fully understand the risks and benefits of waterbirth compared to not giving birth in the water.
4. I understand that if I am being asked to leave the tub at any point in my labor or birth, this is due to the
discretion and/or experienced judgement of my midwife (whether for routine examination or checks or
in case of a concern or emergency) and it is my responsibility to do so to help ensure safety.
5. I understand that my plan and approval for a waterbirth may change at any time due to changes in
plans or preferences, updates in the state of the evidence, changes in my health status, or other
various reasons.

_________________________________ ____________ _________________________________ ____________

Client Signature Date Midwife Signature Date

References
Dekker, R. (2018). Evidence on: Waterbirth. Retrieved from ebbirth.com/waterbirth
Garland, D. (2017). Revisiting waterbirth: An attitude to care. London: Palgrave.
Nutter, E., Meyer, S., Shaw-Battista, J., & Marowitz, A. (2014a). Waterbirth: An integrative analysis of peer-
reviewed literature. Journal of Midwifery &Women’s Health, 59(3): 286-319.
Nutter, E., Shaw-Battista, J., & Marowitz, A. (2014b). Waterbirth fundamentals for clinicians. Journal of Midwifery
& Women’s Health, 59(3), 350-354.
Schafer, R. (2014). Umbilical cord avulsion in waterbirth. Journal of Midwifery & Women’s Health, 59(1), 91-94.
Taylor, H., Kleine, I., Bewley, S., Loucaides, E., & Sutcliffe, A. (2016). Neonatal outcomes of waterbirth: a
systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed, 101(4), F357-365.