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What is an ideal temperature for labour in water?
Water should be kept as close to the normal body temperature as possible. For the thermostatically controlled pools, this temperature is set to fluctuate in a narrow range of about 35-38°C.
The ambient temperature should also be warm but not stuffy.
What is the problem of water being hotter (or colder, for that matter)?
Very hot water may bring about quick exhaustion to the labouring woman. It is important to remember that, for the majority of women, labour lasts several hours. Early exhaustion may lead to her having to leave pool.
There is evidence also that very hot water may diminish the strength of the contractions. In early labour, it can stop the contractions altogether.
When water is merely lukewarm, it will be uncomfortable and the relaxing effect will be lost.
When is the ideal time to got into the pool?
The optimal time is when the labour is established. This is confirmed by the presence of regular strong contractions as well as a cervical dilatation of at least 4 cm.
Too early an entry may lead to an apparent prolonged labour, which may lead to a forced abandonment of the pool, either for an alternative mode of pain relief or for augmenting labour with an oxytocin (Syntocinon®) infusion.
A very late entry into the pool will mean that she will not get the intended full benefit of labour in water.
Sometimes the latent phase of labour can be very painful. What is wrong with entering the pool then?
There is nothing wrong. However, the mother has to be aware of two important facts.
Firstly, that the latent phase of labour can last many hours, sometimes a good eighteen hours or more before true labour is established. The uncertainty of the duration of this phase should be made clear.
Secondly, if the latent phase of labour is found to be unbearably painful, it may imply that when actual labour commences, the soothing effect of warm water is unlikely to be sufficient to control the pain.
It is said that one of the main advantages of labour in water is that it reduces the rate of obstetric intervention. Is this proven?
Unfortunately not. Properly conducted studies indicate that there are no differences in the rate of intervention in the form of instrumental (forceps or ventouse) delivery or caesarean section.
Since infusions are prohibited if labouring in water, is there no risk of dehydration?
Not really, since drinking is allowed during labour. Eating has to be restricted to light snacking or, where possible, avoided altogether.
What additional pain relief can one get if labouring in the pool?
Many women find that the relaxing and soothing effect of water is sufficient. However, if additional pain relief is required, many units will allow entonox ("gas and air").
No injectable opiates such as Pethidine or Diamorphine can be administered. If this is deemed necessary, then she has to leave the pool and water birth is abandoned. An epidural in water is contraindicated, too.
What if pethidine or diamorphine have been administered in the latent phase of labour?
Then an interval of about four hours (or more) has to be ensured before she enters the pool. This is mainly because of the sedating effect of these drugs, a state which is incompatible with a prolonged stay in water, considering the additional relaxing effect of the water itself. The sedating effect of the drugs has to be allowed to wear off completely.