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

Why use Water?
There is lots of evidence to show that water can be a huge benefit to a woman in labour.

• Immersion in warm water can lower blood pressure during labour.
• Buoyancy in the water assists the woman to maintain active birthing positions
•  Water relaxes the pelvic floor muscles, it also softens the skin tissue reducing the chances of tearing during labour.
• Water supports the mother reducing the pressure during labour.
• Women have used water as a form of pain relief for hundreds of years. 
• Warm water on the lower back (which is the area of the spinal cord that receives the nerves from the lower abdominal region) can reduce labour pain.
• 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)

How long can I be in the water?
If your labour is progressing well you can stay in the water as long as you wish or as per your birth plan. If being in the water has slowed your progress down, your midwife may ask you to get out for a period of time to walk about and stimulate your contractions. After a short period you should be able to re -enter the pool.

Why might my midwife ask me to leave the pool?
There are occasions when the midwife might require you to leave the pool:

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

Your midwife is there to assess that your labour is progressing normally, and if its not to take appropriate steps. Most midwives are keen to assist in giving you the birth you want and will pay great attention to your birth plan. However they will not allow anything to happen which will put either yourself or your baby at any kind of risk.  It is important that you ask for her rationale in asking you to do something you might not want to do, and to expect a reasonably detailed explanation. Your partner (and/or doula) can assist here in helping you take in the information.

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?
Most midwives will recommend you can enter the pool once you are in established labour (approx 3-4cm dilated). However there is nothing to stop you from getting in the pool when you feel that you need it. You can get in and out of the pool as often as you wish, so use the pool as its intended – a form of pain relief!

Once in, will I be able to get out again?
You can get in and out as often as you need to. The temperature of the pool is constant there is no need to get out while the pool heats up. A plastic stool is provided to help you get in and out.

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

• A significant drop in temperature
• Having received some distress during delivery
• Excessive handling while still underwater

The 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 the baby does not need to breathe until after the cord is cut.

Can I deliver the placenta in the pool?
Some midwives may prefer you to leave the pool for the third stage because it is very hard to assess blood loss in the water. You should discuss this with your midwife either before or during the early stages of labour. 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.

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 a woman in labour does not become overheated as this may be a factor which can cause distress to the baby.
The recommended range is between 34 - 37.0 degrees C during the first stage of labour and 37.0-37.5 in the second stage. If a baby is delivered in water it must not be cooler than the average body temperature.

Can I use other forms of pain relief while in the pool?
Use of other forms of pain relief such as massage, acupressure, homoeopathy, aromatherapy, breathing techniques, encouragement and support from your birth partner or midwife will all help throughout your labour.
There are no side effects connected to the use of water as pain relief so it does not preclude any other form of analgesia (gas and air, meptid, pethidine) that may be appropriate at a later time.