Thursday, August 14, 2008

Why Waterbirth Is So Great for Women of Size

[Part Two in a Series on Obesity and Waterbirth]

As we discussed previously, some birth facilities have restricted fat women from having access to water during labor and/or birth. On the other hand, some are very supportive of it, even in very large women. It all depends on the facility and the provider.

I believe that waterbirth is uniquely beneficial for women of size because it offers a number of advantages over "dry" labor and birth. For example:

  • Waterbirth makes women of size much more mobile and buoyant, so they are able to change positions easily and quickly

  • Waterbirth helps women assume a variety of positions, which may help create more room in the pelvis and help big moms labor and push more effectively

  • Waterbirth lessens the need for pain medications/epidurals

  • Waterbirth often shortens labor

  • Waterbirth makes you less likely to have an episiotomy
The Mobility Factor

The mobility factor is one of the best things about waterbirth. Being hugely pregnant at term is a challenge for women of ANY size, let alone a woman who already started out larger than average. Being in the water makes you feel lighter and more mobile, and fat works to our advantage in water, making fat women particularly buoyant. That's why swimming and water aerobics are so frequently recommended for women of size in why not use the same thing to our advantage during labor and birth?

If you are in a bed and you want to change positions during labor, you have to haul yourself up and over.....not the easiest thing to do when hugely pregnant! And especially so for women of size. But if you are in water, it's simply a matter of shifting position a little; the water supports your weight and makes it easier to move.

Furthermore, there is less risk to the backs of support personnel when helping you shift because, in effect, you "weigh less" in the water than you would on land due to buoyancy.

Position Changes May Open Up The Pelvis More

Waterbirth makes it easier to change position so you can create more room in the pelvis for the baby to come out.

In the water, it's easy to sit upright, kneel, get onto hands and knees, have one knee up/one knee down, stand, or even float on your back. These position changes tend to reduce pain and give the baby more room to descend than the usual semi-sitting position we see so often in typical hospital bed births.

Think about it.....the tailbone is one of the most mobile joints in the pelvis. If the woman is semi-sitting or on her back, her weight rests against the tailbone and presses it into the pelvic outlet, reducing the space available for the baby. But if the mother is upright or on hands-and-knees, the tailbone and the sacrum actually move outwards with the descent of the baby, allowing more room.

Being in water facilitates this kind of positioning much more easily than being on dry land, and allows mothers to change positions quickly in response to the baby's needs during pushing.

Many doctors believe that in women of size, extra fat "pads" the pelvis of the mother, reducing the space for the baby to pass through. Although I personally think this is highly dubious, if so-called "soft-tissue dystocia" were real, wouldn't getting a little extra space from opening up the tailbone area be particularly important in women of size?

If waterbirth can help women of size into "non-traditional" positions more easily, then it may just help create more pelvic space for their babies too.

Less Need for Pain Medications

Being in warm water helps lessen labor pain a LOT. This is one of the best parts about waterbirth!! You step into that lovely warm water when you are in serious labor and your body just goes, "Ahhhhhhh!" Think of how relaxing sitting in a hot tub is; consider how good this might feel during the strongest labor contractions!

To be fair, laboring in water doesn't take away all of the pain, and mothers should maintain realistic expectations about it.....but it does help lessen the pain, and more importantly, it helps you cope with it more constructively.

Research supports this; several studies show that laboring in water results in "reduced analgesic requirements" (less pain meds and epidurals). Studies also show that upright positions (which are easier to assume in water) tend to reduce pain also.

There's a reason why laboring in a birth-tub is jokingly called "the aquadural" by a lot of moms! It's sort of like an epidural....but without the risks.

Remember, all medications present potential risks. Narcotics can cause respiratory depression in the baby, epidurals can cause a mother's blood pressure to crash, and there are small but real risks of rare events like paralysis, infection, and even death.

Furthermore, epidurals are particularly difficult to perform adequately in women of size and tend to be less effective; therefore, wouldn't it make sense to encourage these women to be in the water and thus lessen their need for medications/epidurals?

A Shorter Labor

Several studies also show that being in water may shorten the length of labor, especially the first stage of labor (dilation). On average in these studies, being in water shortened the first stage of labor by an hour to an hour and a half. Remember, every little bit helps when you're in pain and waiting anxiously to meet your baby!

Furthermore, other research shows that women of size tend to have longer labors. If simply putting fat women into water could help their labors progress more efficiently, wouldn't that be worth trying? Seems like a low-risk intervention that might help prevent some cesareans for "failure to progress."

Less Chance of an Episiotomy

Waterbirth also significantly lessens the chances of episiotomies (deliberate cuts made by doctors to widen the vaginal opening, which often result in significant perineal trauma to the mother).

One study found a 0.38% episiotomy rate in the waterbirth group (less than one-half of one percent!) vs. a 23% episiotomy rate when birthing in a bed.

Because women of size tend to heal more slowly and have more wound infections than women of average size, avoiding surgical wounds like episiotomies whenever possible is greatly to their advantage.


If laboring in water could help you have a shorter labor, a less painful labor, could lessen your chances of an episiotomy, and help you be more mobile during the birth......all without the significant risks of epidurals and pain medications...........why wouldn't you be interested in that?

And why shouldn't fat women have equal access to such options? Especially when they offer fat women such unique advantages?


Zayna said...

I just wanted to let you know how happy I am to be reading this blog. I have used your website on plus size pregnancy as a resource.

I am a 30 year old fat woman who regularly exercises. I am trying to get pregnant yet I have a deep fear underneath my decision.

Of course the fear is that I will be mistreated because of my size.

A few years ago I dropped about 100 pounds on the low carb diet plan. I gained it back of course. Since that time I have embraced an active lifestyle (walking, doing the elliptical in my home, cooking my own healthy meals at home). I feel physically and emotionally ready. I do worry about my career ( I am a graduate student) but I feel that I have enough support.

I am prepared to look for a truly size friendly provider. I am in the Philadelphia/ South Jersey area. If you or anyone who reads this blog knows of anyone who can assist me it would be greatly appreciated. I have seen some recommendations for midwives & doctors in Central Jersey but none locally.

Once again I commend you for the work that you have done and that you are doing. You empower me to be my own advocate and to live my life proudly!

Anonymous said...

hey there kmom! you have an amazing blog here:) of course, you are an amazing woman! i had meant to birth in the water, (on the way back to tub from potty i just couldn't move anymore LOL) it was amazing to labor in though! your plus size pregnancy site was so very helpful to me (wow!) 5 years ago now! ((( Big Hugs))) sanQ

Anonymous said...

Why wouldn't a plus sized woman want a water birth?

As a plus sized woman, who's 30 weeks pregnant...

1-Because I *WANT* an epidural. I have ZERO desire to give birth without pain medication. Z-E-R-O. As someone who has undergone previous surgery, and has had her surgical consult, I feel that you are overemphasizing the risks of an epidural. Beyond that, episiotemies have generally gone the way of the dinosaur with around 80% of all births not involving one.

2-Because I have no desire to move around or change position or any other phrases that indicate anything other than a nice sterile hospital environment with me on a bed (where I WANT to be) surrounded by people with actual medical degrees being told when to push. I'm not interested in "breathing" in any other way than the way I've been doing it for 30 years, I'm not interested in deciding for myself when it's time for pushing---I didn't go to medical school, I went to a liberal arts college and have a masters in another content area. I believe in letting the professionals DO THEIR JOBS without some yahoo (me, the pregnant lady without a medical degree) try and dictate what's best.

3-While I am a huge fan of water, and often have to be dragged out of the water because I love it so much, I was disgusted by the videos I've seen of water births. I have zero interest in that.

I appreciate a blog with the mission of being fat friendly and empowering to those of us who are plus sized, but please remember that some of us are completely unromantic about this whole L&D thing and want to get the kid out with a minimum of pain. I wouldn't get a tooth pulled without drugs--why would anyone in their right mind want to shove an 8lb kid out of the vagina without them?

Well-Rounded Mama said...

Wow, anonymous, I'm sorry you felt attacked. That's not what this post was about.

It was about keeping waterbirth an option for women of size, and enumerating its advantages so that women of size who haven't considered it understand why it can be a good choice to have. It certainly wasn't about forcing all women of whatever size into one model of birth.

If you are fully informed about the risks of epidurals etc. and you choose to have one, more power to you. I actually do not have a problem with that. I had an epidural with my first, and I absolutely think they have a place in birth at times. It's good that option is available nowadays.

However, I could do without the sarcasm about women who do choose to birth without medication. If I were having a tooth pulled, absolutely I'd want pain meds. The difference is that in childbirth, there is a baby involved too. And while the risks of the epidural in some ways are smaller than with IV meds, there are still some risks. Women who don't want those risks shouldn't be required to assume them (some hospitals strongly pressure women of size to automatically have early placement of an epidural).

That's not to say that anyone who chooses an epidural or whatever is wrong or a "bad mom" or something. That's reading into this post something that was never there. If you are educated about the pros and cons and the alternatives and this is the choice you want, go for it. The whole point is for women to have real CHOICES, and that includes women of size.

So please, choose the epidural if you'd like it. You don't need my approval for it, but as long as you understand the pros and cons thoroughly, I'm okay with women choosing epidurals. Just don't deny the rest of us the choices we want, and don't deride us for those choices either.

We don't need the mommy wars here about unmedicated vs. medicated and who's a better mom because of it. It's all about CHOICES and making sure we all have them. That's what this post was really about.