NHS should encourage waterbirths, study urges

Giving birth in water may be better for mother and baby and cheaper for the health service, a study has found.

Giving birth in water may be better for mother and baby and cheaper for the health service, a study has found.

Women who spent part or all of labour and delivery in water had a much lesser incidence of Caesareans, inductions and other interventions, and used fewer pain-killing drugs. The findings of the study, funded by the Department of Health, are to be published in a book next month. They could lead to renewed demand for waterbirths.

Ministers have called for greater choice in childbirth, but the popularity of waterbirths, at its height in the early 1990s, has declined as hospitals turned away from providing the service. More than 90 per cent of maternity units have birthing pools or baths suitable for waterbirths, but only 2 per cent of women use them.

The study compared 589 women booked for the Birth Centre at Edgware Hospital in north London with 19,500 similar low-risk women who gave birth in the North Thames area in 1997-99. Only low-risk women are suitable for waterbirths, but they have high expectations of a natural delivery with minimal intervention.

Jane Walker, the centre director, said: "There seems to be some affinity between human beings and water. Once you have been with a woman labouring in water the evidence is overwhelming, because it helps so much."

The centre, part of the NHS, was set up to evaluate a range of options, including waterbirths. It is run by midwives. Of an average of 240 women who give birth there each year, more than 70 per cent spend part of their labour in water and halfdeliver in water.

Results show that the centre has one of the lowest bills for pain-relieving drugs and rarely uses epidurals. One per cent of births require an episiotomy (a cut to allow delivery of the head) compared with 11 per cent nationally for low-risk births. "We hardly use anything [for pain relief] except gas and air. Sometimes just the sound of the water filling the pool will make the woman's cervix dilate really quickly," Ms Walker said.

Selene Daly spent most of her four-and-a-half-hour labour in body-temperature water before emerging to deliver her son, Ben. Apart from occasional gas and air, she managed without painkillers. "It was very comforting and very soothing. There was clearly still intense pain, but the water was very useful." Ms Daly, 38, chose the Edgware Birth Centre because she wanted individual care. "I got keen on the idea of having the birth I wanted to have rather than what the doctors wanted."

The Association for Improvements in Maternity Services wants to see greater use of the pools. Beverley Beech, the chairwoman, said: "Women still want waterbirth but hospital staff oppose it by various devious means. They got the pools in as a mechanism to encourage women to come to their hospitals, but then they failed to introduce a training programme for the midwives.

"It is astonishing that so many obstetric units are unwilling to encourage a form of pain relief which has no sideeffects and has been shown to be wanted by many women, while the staff are only too keen to subject the women to a wide range of drugs."

Professor James Drife, spokesman for the Royal College of Obstetricians and a consultant at St James' University Hospital, Leeds, said hospitals had not changed their minds on waterbirths. "Some people do like to be in the water for labour and that can be beneficial, but they prefer to be on dry land to deliver. It is like having a bath - it is relaxing.

"But there are some problems with baths. They can be really deep and there is the sheer practical question of how the midwife gets access to the mother and baby.

"Obstetricians shouldn't have to apologise for erring on the side of safety, but the debate has become too polarised."