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I'm the envy of all my friends at the moment! It's the only place I can completely relax, and I'd recommend anyone to have one in the last weeks of pregnancy

Why Choose Water

"Water immersion during labour/birth may be beneficial for women with certain risk factors, e.g. uterine scar and those with pregnancy induced hypertension (PIH). (Cefalo et al 1978, Weston et al, 1987, Brown 1998)"

"A water pool offers a mother an environment where she can behave instinctively and feel in control. When a woman feels in control during childbirth, she experiences a higher degree of emotional well-being post natally. (Green et al, 1990)

Ethel Burns and Sheila Kitzinger state in Midwifery Guidelines for Use of Water in Labour, 2000;

What are the benefits of using water before labour?

• Relaxation in the days leading to the birth (Particularly those moments when you wake up in the middle of the night and can't get back to sleep)
• Special family time together before the new arrival (Children sleep very well after an hour in the pool)
• Evidence that immersion in warm water can lower blood pressure during labour.
• It is very much easier to maintain active birthing positions in the gravity-reduced environment of the pool.

How does it give pain relief?

Pain is a subjective sensation, that is to say it only exists for the individual who
feels it. Factors such as personality, cultural and social expectation will account for differences in pain perception. Something as simple as fatigue can make a difference to the perception of pain. Feelings of anxiety, fear and loss of personal control make a big difference.

Combination of many factors; feeling safe, supported and in control, lowers anxiety and fear. this reduces psychological impact of pain. In addition, the Gate Control Theory of Pain (Melzak and Wall 1988) suggests that stimulus on the superficial nerve endings in the skin can override the sensation of pain being transmitted by deeper nerves. Therefore warm water on the lower back (which is the area of the spinal chord that receives the nerves from the lower abdominal region) can reduce labour pain.

Hormonal activity is very relevant. The process of labour and childbirth is controlled by different hormones, and endorphin production is possibly the key to both pain relief and good progress in labour. Endorphins are the body's natural analgesics; they produce an opiate-like sensation and regulate the production of other hormones including oxytocin. (Jowitt, M; "Beta-endorphin and Stress in Pregnancy and Labour." Midwifery Matters 1993) Any person who enjoys the sensation of immersion in warm water will find that their endorphin levels rise automatically, whether or not they are a woman in labour.

Can I use other forms of pain relief while in the pool?

Yes, you can use massage, acupressure, music, aromatherapy, loving and encouraging words from midwife and partner, breathing, visualisation, and gas and air. The point here is that using water for pain relief is just part of your "tool kit of pain relief options". Which will include many of the above and others unique to you.

Because there are no side effects connected to the use of water as pain relief, it does not preclude any other form of analgesia that may be appropriate at a later time. For instance, you could decide later to have an epidural (in hospital, of course), although you could not reverse the order and use water after an epidural!

Using water as pain relief can help you get further down the road of labour without closing doors on other options.

How long can I be in the water?

As long as you need/want to be. It sometimes happens that water slows things down to a point where the midwife suggests that you get out and walk about for a bit. There are opinions that suggest there is nothing wrong with a long labour, if you feel comfortable enough with it. However, midwives are taught that there is a recommended time frame. How long you stay in the pool if things have slowed down will depend on 1) the experience and open-mindedness of your midwife and 2) how able you are to challenge her request to leave the pool if you don't want to.

Why might my midwife ask me to leave the pool?

There are occasions when the midwife might require you to leave the pool for good reasons.

• An abnormal foetal heart beat
• Meconium
• Abnormal maternal observation such as high temp, pulse or BP
• Agreement on the need for an internal examination
• Midwife's intuition

The role of the midwife is to assess that labour is progressing normally, and if deviating from normal to take appropriate steps. How she assesses, and what the appropriate steps are will to a degree depend on her knowledge, experience and intuition. Therefore it is fine for you to ask for her rationale in asking you to do something you might not want to do, and to expect a reasonably detailed explanation. However, you may not be able to take in all the information, and your partner (and/or doula) can help here.

When all is said and done, the midwife is legally responsible for the safe delivery of baby and mother, and if she has real concerns for you then it is advisable to accept her recommendation.

When can I get in?

When labour is "established". This is about 4-5cms dilated, or when contractions are about 2 minutes long, regular, and about 5 mins apart.

Use this "tool" when you find that other techniques like massage, TENS, dancing, no longer help, when you begin to think; "now I really need something".
Often, getting into the pool at this point gives a wonderful whooshing release of tension. This relaxes the muscles, eases fear and anxiety, floods the body with endorphins and quite often moves you along the road of labour quite a way.

Once in, will I be able to get out again?

A plastic stool is provided to help you get in and out. Remember that water is a tool, or a technique for you to use as you require.

How does the baby not drown?

A baby born without distress into water will not receive the stimulus to breathe.
Breathing may be stimulated by;

• Excessive handling while still underwater
• A drop in temperature lower than 37.degrees
• Having received some distress during delivery

Baby is still connected to the umbilical cord and receiving an oxygenated blood supply via the placenta. In water, the cord remains soft and continues to pulse after the baby is delivered, so s/he does not need to breathe until after the cord is cut.

Also, there is suggestion that a "dive reflex" may be present. It has been demonstrated that newborn lambs automatically inhibit their breathing underwater.

Can I deliver the placenta in the pool?

Ethel Burns and Sheila Kitzinger state in Midwifery Guidelines for Use of Water in Labour, 2000;

Rationale; whilst there is evidence to suggest that women bleed more when the third stage is conducted physiologically (Elbourne et al 1988, Rogers et al1998), other evidence suggests that when midwives know how to appropriately select and care for mothers opting for expectant management of the third stage, there is no increase in the incidence of post partum haemorrhage (Levy 1990, Thilanathan 1993) Clamping of the cord disturbs the physiology and can predispose to PPH/retained placenta (Levy and Moore 1985, Inch 1989/90)

However, some midwives may prefer you to leave the pool for the third stage (which may still be conducted physiologically on "land") because it is very hard to assess blood loss in the water. The advantage of leaving the pool to deliver the placenta outside it is that the water may still be reasonably clean, and you may be able to hop back in it for a quick wash while everything is being tidied up.

Why are some midwives more at ease with the idea than others?

The Midwife's Code of Practice states that midwives should operate within the sphere of their expertise. Some might interpret this to use as a get -out clause if they have not been trained in the use of water. However, the Royal College of Midwives clearly says that it is also the duty of the midwives to gain knowledge in this area in order to offer it as part of normal practise.

What you can do is

1) Make sure that the Community Midwives office knows that you are intending to use water. And to request that an adequately knowledgeable midwife attend you.

2) Give an unfamiliar midwife a chance to extend her sphere of knowledge by accepting that she has limitations, but negotiating to go beyond them together

What is the importance of water temperature?

It is absolutely fine to have the water at any temperature comfortable to you using the pool before labour for relaxation. However, it is very important that the labouring mother does not become overheated as this may be a factor which can cause distress to the baby.

Taken from Midwifery Guidelines for Use of Water in Labour, Burns and Kitzinger. 2000

However, remember that it is nigh on impossible to get readings accurate to half a degree in a constantly moving body of water. The important thing is to observe the floating thermometer , the thermostat and the labouring woman together.

You may need to lower the set temperature of the thermostat.

What are the benefits of delivering the baby in water, to me? To baby?

Benefits to you include you or your partner may be the first to hold your baby, look at his/her face, and discover his/her gender. (Of course these are not exclusively benefits of giving birth in water)

To the baby they may be more profound; The changes that take place in the baby's body when it is born are quite dramatic: Out of a dark, tightly fitting, warm noisy wet place where life support arrives through the umbilical vein to a different environment. It may still be warm and wet and rather dark, although the noises will be different, the sensations of not being tightly packed, and of gravity will be new.

Also new is the way the blood circulates round the body, that brave little heart now has that job to do all by itself, in some places, the flow of blood actually reverses to encompass this change.The umbilical vein, which supplied blood to the growing foetus from the mother, shuts down: and the umbilical arteries which returned blood to the mother for cleaning close. Suddenly there is a need for oxygen, to breathe.

Often babies seem to know what they need to do before they need it, sometimes they just start breathing, sometimes they gasp and cry: the lungs, which were like flattened sponges now expand.

The eyes open and totally new visual images enter the brain. The baby, like the mother, is experiencing a high level of oxytocin; Michel Odent suggests that this precedes the bonding process, the gazing, nuzzling, nipple searching and sucking reflex that is particularly acute in the first hour of birth.

In water, it is possible that these extraordinary changes can occur relatively slowly and distinctly from each other. It may be a little more gentle.

Are there any disadvantages?

Using the pool as one pain relief option among many means that you will use it to its best advantage.

Michel Odent warns against the determination to have a "waterbirth", he suggests that if a woman has a "script" for her birth she may miss the instinctual clues which her body is sending her, and perhaps stay in the water longer than needed for optimum use.

TECHNICAL QUESTIONS:

Were can we put the pool?

I would suggest that you put the pool where you feel safest and most comfortable.
The pool comes in sections and can be carried and assembled almost anywhere. A flat floor is preferable, with access to a power point nearby (not an extension lead).

Midwives like to have access to at least two thirds of the pool.

First and second floors are fine if you are happy about the weight load; full weight is about 650kg. If you are living in a conventionally built house, that has been well maintained and is not more than 150 years old, then problems with floor loading stress are likely to be minimal. If you do have concerns, then I would suggest that you seek further advice from a qualified structural surveyor.

Is a circulating water heater safe?

Yes. There has never been any instance of infection to either mother or baby that has been attributed to our pools. We take hygiene very seriously and our cleaning protocol has been devised by the Heath and Safety Executive. All equipment is flushed through using chlorine solution (which is the most effective disinfectant), drained and then stored dry.

How long are the hoses?

Each pool comes with two hoses that are each about 6 meters long. If you think that may not be sufficient, please measure the distance from taps to pool location adding at least 2 metres, for the drop and rise, and let me know. It is always possible to have more hose at no extra cost.

Will they connect to my taps?

Two types of tap connector come with the pool. They are Hozelock Universal (designed to fit mixer taps) and the Original funnel shaped, with jubilee clip to connect to single taps with smaller spouts.

You may have special taps which will not fit to the connectors, in this case, you may need to think of other taps in the house that could be used, or investigate other systems of connecting hoses to them.

Is it easy to assemble?

Yes, it is very easy to assemble and we offer telephone support.

How long does it take to fill?

It takes 10 -15 minutes to assemble, and filling depends on water pressure, the pool is usually ready within an hour

How do the temperature controls work?

When the pool is first filled, there is a period of adjustment before the water reaches a constant temperature. This is what happens; when the thermostat registers the water temperature at it's pre-set level, the heater element switches off. The element is still hot and the pump is still pumping water over it, so that the temperature continues to rise. It is important in labour to control the temperature and not to get overheated, so I would suggest that you set the required temperature slightly lower, maybe 35/36 degrees. You can do this by pressing the temperature switch on the control panel. Continual taps will move the thermostat control one degree at a time (you may have to go up the scale -as far as 40 degrees, before coming back down).

Alternatively if you leave the pool to settle for a day or two, (by this, I mean, keep the heater and pump on) it should maintain it's temperature at the regulated setting.

What if my domestic hot water is not adequate to fill the pool?

The heater can heat water to the required temperature from cold. However, it may take over 12 hours to do this. If you can use some hot water, then the time required will be reduced. Obviously using a pool with integral heater in this situation is the only way a pool could be available. It is advantageous that the pool can be kept heated, filtered and conditioned for up to 7 days.

How much electricity does it use?

To maintain the pool warm and filtered at maximum economy, it needs to be on all the time. It will use as much electricity as a light bulb. This is because the thermostat will switch off the heater when it reaches the pre-set temperature. the walls of the pool are made of high-density polystyrene, covered in a protective membrane. This is very good insulating material. In addition, the close fitting cover is lined with insulating material. Heat loss from the pool is minimal.
The cover also keeps steam from escaping and causing condensation problems.

What do you supply?

In addition to the pool we supply hoses, and tap connectors, a floating thermometer, a stool, which can be used to help climb in and out of the pool, or to sit on in the pool, the chemicals (see below) to condition the water. A filter, Submersible pump with connector

What else might I want or need?

You will also need a plastic sheet to protect the floor from drips, and a cheap strainer to remove detritus from the pool. A small mirror may be used to confirm arrival of the baby's head!

You might also like essential oils (check that the use of these products is OK in pregnancy), candle light and relaxing music. Please remember that any electrical item must be placed well way from the pool, and not to touch switches with wet hands.

Does the room fill with steam?

There will be some steam when the pool is in use, however the fitted cover means that no steam escapes when the pool is not being used, and that also reduces heat loss of the water temperature.

How do I empty the pool?

A pump is provided to empty the pool quickly and efficiently using the hoses.

Is it safe to keep the water in the pool for up to seven days?

Yes, it is, provided you use the filter and the conditioning chemicals according to instructions.

If your children are enjoying the pool and are jumping in and out a lot, bringing debris in, then it may be wise to empty the pool more frequently.

What is the chemical used?

Bayrol Bayroklar Spa & Bayroplus Spa

2-Part Active Oxygen system for domestic spas

Features Benefits:

• Alternative spa sanitiser "Gentler" approach to spa care
• No taste or smell Less irritating to bathers
• 2-part system Sanitiser tablet for bacteria control
• Liquid system activator and algae controller
• Unique product Market security
• High customer satisfaction levels

Characteristics:

• Sanitiser in tablet form
• System activator and algaecide in liquid form

Application: (Bayroplus Spa)

• Bayroplus Initial: Add 20ml per 1,000 lt of spa water.
• Bayroplus weekly: Add 20ml per 1,000 lt of spa water.

(Bayroklar Spa)

• Add one tablet per 1,000 lt of spa water before use.
• Add two tablets per 1,000 lt of spa water in case of high frequentation.

Dose Bayroklar Spa Tablets via a tablet buoy or skimmer to prevent bleaching of spa surface.

Will it affect the baby if I deliver in water?

No instances of sensitivity to the chemical have been noticed or recorded.

Can my birthing partner get in with me?

Of course. If invited.

OTHER QUESTIONS:

What if my baby comes before the pool?

The window of two weeks before and two weeks after the due date means that most babies will come during that time. However, sometimes they do come early.

For a baby that is very premature it is not advisable to have a home birth or to use the pool. In this instance the Conditions of Hire state that if a pool is cancelled with less than 2 weeks notice from the beginning of the Hire Period, we reserve the right to charge the full fee..

Because we are a small company, flexibility is possible; if there is any chance of getting the pool to you before baby comes, then we will look into it.

What if the baby hasn't arrived by the end of the hire period?

Again, everything possible will be done to ensure that you keep the pool for as long as you need it. Extensions to hire are available at a rate of £65 per week. However, there is no guarantee that an extension will always be available.

What if I can't use the pool for labour?

Unless the reason is through our fault, then no refund can be offered. It makes sense to get plenty of use out of the pool in the preceding days for relaxation and pain relief.

Can I get a refund if I send the pool back before the end of the hire period?

No, the way to look at it is that the 4-week window (approx 2 weeks either side of the due date) is the time frame within which you guess that your baby will be born. (This is correct for most people). If baby is born on day one, then you have achieved your expectation. If you no longer wish to use the pool after the delivery, it can be returned earlier but no refund is made.

Can I get a concession for being unwaged?

No, but it is possible to spread the cost over a longer time, please contact us to discuss scheduling payments.

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