SingaporeMotherhood | Pregnancy

November 2013

Water Birth: A Gentler Birth

Birth in water, known as water birth, is one of the gentlest ways for a baby to be born. This ancient practice, which has been revived by birthing mothers today, encompasses the physiological, psychological and spiritual aspects of birth. In water birth, a mother labours and gives birth underwater, in a birth pool. The newborn is brought out of the water within a few moments after birth. See water birth from the perspective of those who are directly, intimately involved in it.

The Mother

Water birth offers mothers a positive birth experience. As Associate Professor Chong Yap Seng, Senior Consultant at the National University Hospital’s Women’s Centre says, “Mothers who choose water birth are seeking a natural birth experience with minimal medical intervention.” Being immersed in warm water gives mothers a sense of buoyancy and freedom of movement, enabling them to move or get into helpful positions. Water birth also decreases the chances of needing an induction to speed up labour or other interventions.

Many mothers are also able to relax deeply in the water, reducing discomfort and promoting labour progress. Associate Professor Chong explains, “The warm water relaxes the muscles, particularly the pelvic floor muscles. There is less resistance in the birth canal for the baby during delivery. Thus, labour might proceed a little faster during the second stage of delivery.” The release of hormones like oxytocin and endorphins further promotes relaxation.

The water also creates a barrier from the outside world, offering privacy and a ‘nest’ to labour in. If the husband accompanies the mother into the pool, the couple are able to experience labour together. Many mothers also describe a special connection with their babies.

There is also less risk of tearing. “The relaxing of the pelvic muscles, the softening of the skin underwater and being able to find delivery positions that are more mechanically advantageous mean that water births reduce the risks of perineal tearing. Any perineal tears are also likely to be less severe,” says Associate Professor Chong.

The Baby

Studies in prenatal psychology show that how we are born can directly affect our life’s patterns and our personalities. Could the way our babies are born make a difference to their lives? The baby’s experience of birth and arranging birth circumstances to ease shock for the newborn were explored by Frederick Leboyer in his landmark 1975 book Birth Without Violence. He suggested placing a newly born baby into a tub of warm water to ease his transition out of the womb. Water mutes the loud sounds of the world and is a familiar medium for the baby, providing him with a buffer for a gentle transition from womb to world.

The Doctor

Associate Professor Chong says that mothers who are undergoing water births are required to have one-to-one labour support either in the form of a doula or a midwife from the hospital’s EMMa Care programme. Your contractions as well as your baby’s heart can be monitored by a wireless, waterproof CTG monitor.

Medications for pain relief are not advisable. According to Associate Professor Chong, “Epidural analgesia involves a puncture into the body. This can become a source of infection, and the mother’s limbs will not have full motor power and sensation, increasing her risk in the water. Other medications may affect her consciousness level and also pose safety risks.”  

baby in pool
“Women with ailments like high blood pressure, mothers pregnant with more than one baby or those with high-risk pregnancies requiring intensive monitoring are not suitable candidates for waterbirth. Vaginal Births After Caesarean (VBACs) are not contraindications for water births. We have had several successful VBAC water births in NUH. However, mothers need to be fully aware of the risks,” says Associate Professor Chong.

The Concerns

Risk of Drowning

Before birth, your baby receives oxygen through the umbilical cord. Although he practices for future breathing by moving his rib cage up and down, he breathes in very little amniotic fluid. Immediately after birth, hormones inhibit his muscle movements. He will still be getting oxygen from the pulsating umbilical cord.

The ‘dive reflex’ also inhibits underwater inhaling. Your baby’s larynx is covered with chemoreceptors, or taste buds. When a solution is swallowed and passes the larynx, the chemoreceptors identify the substance and your baby’s windpipe closes. Thus, the baby born into water is prevented from inhaling until he is lifted up into the air!

Risk of Infection

Taking a bath does not pose any infection risk to a labouring mother, even if her membranes have broken. As the baby is descending and moving outwards, potential infectious agents will not be moving up. The same goes for water births!

In hospitals, strict infection control protocols ensure that all equipment used for water births, including hoses and filter nets, are thoroughly cleaned. Disposable liners are used with some birth pools, preventing infection.

While insufficient research studies have been done to conclude that water births are completely safe, water birth is carried out according to established safety guidelines.
Associate Professor Chong recommends that women opting for water birth have a backup plan, in case complications arise during the pregnancy or if the baby shows any signs of distress during birth, and water birth does not occur.

Practical Considerations

Depth of Pool

Labouring mothers can get the best benefits with deep immersion. This means with the water reaching above breast level and completely covering the belly.


The water temperature should be between 35 and 37 degrees Celsius, and checked every hour. The mother’s temperature should also be taken hourly.

Timing of Entry into the Water

If a mother enters the water too early, her labour may slow down or stop. It is recommended that you only enter the tub when your cervix has reached 5 cm dilation or more.

Preparing for a Waterbirth

“Women who want water births should be thoroughly prepared and educated about natural childbirth,” says Professor Chong. “They should be fully aware of the process and of how their body works. They should attend antenatal classes and discuss their plans with their obstetrician. Water birth is a personal choice that’s totally dependent on the individual mother and her expectations of childbirth.”

Where can I have a Water Birth?

Water births are available at National University Hospital (NUH), Mount Alvernia Hospital, Thomson Medical Centre, and Raffles Hospital. The cost of using water birth facilities ranges from $400 to $3,000. This is in addition to the maternity package fees.

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Water Birth: A Gentler Birth