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What is the importance of the water temperature?

Discuss this with your birth partner and midwife team beforehand. UK guidelines from the RCOG and Royal College of Midwives are that the pool should be between 34C and 37C. There is a good rationale for avoiding temperatures above 37C - the baby is trapped inside your body and cannot dispel excess heat, and this can lead to distress. However, there is currently no evidence for having any minimum temperature, and waterbirth research in Germany suggests that lower temperatures than 34C may actually be helpful.

Some people automatically assume that the pool should be at blood temperature throughout. While it is one option (not the only one) for the moment the baby emerges, it doesn't apply to the first stage of labour. In fact, for most women, this would be far too hot during the first stage of labour. Because your muscles will be working hard, and generating quite a lot of heat in your body, you may want it cooler. If your birth partner sticks a hand in the water, it may feel quite cold. Make sure that the temperature is adjusted to whatever feels comfortable to the labouring woman, and not to other people's assumptions! It has been known for labouring women to leave their spacious birth pool to use the cramped bathtub, where they can choose the temperature themselves, when well-meaning helpers have made the water too hot!

Safety issues concerning temperature

The main safety concern is that the water should not be too hot, at any point in the labour, as this can send the baby into distress. 37.5 C is the usual maximum recommended. If you stay in the water for the second stage, you may want it warmer than during the first stage - but you may not be able to tell your birth partner this, so it may help to discuss some way of communicating it beforehand. Your midwife may want to ensure that the temperature for the second stage is 36-37C. If you give birth in the water, there are concerns that cool water could trigger the baby's breathing reflex before it comes to the surface. However, this is speculative and there have been no known cases of this happening, despite the fact that in Germany, for instance, waterbirth experts have written that they believe babies born into water at 35C or below are more vigorous and quicker to breathe.

For discussions on water temperature, see the 'Association of Radical Midwives page on waterbirth' (http://www.homebirth.org.uk/water.htm)

Barbara Harper of Waterbirth International wrote a detailed article challenging ideas about minimum temperatures for birth in water, and discussing birth in seas and rivers. This was published in MIDIRS January 2003, and is reproduced on the Birthing Alternatives site. It's well worth a read, especially for any midwives who've not come across it:
'Taking the Plunge: Reevaluating waterbirth temperature' by Barbara Harper (http://birthingalternatives.com/Resources/Waterbirth/Water%20Temp.pdf)

Guidelines for midwives

The joint statement on waterbirth from the Royal College of Midwives and Royal College of Obstetricians and Gynaecologists includes this guidance on water temperature:

Practice issues

There has been much controversy over the temperature of the water of a birthing pool, with strict criteria recommending differing estimates ranging from 34 to 37 degrees Celsius to a Swedish study which recommended that women be encouraged to regulate the temperature of the water to suit them selves. Given these large discrepancies, it would be difficult to agree strict temperature restrictions. It may be of more benefit to allow women to regulate the pool temperature to their own comfort and encourage them to leave and re-enter the pool in the first stage of labour as and when they wish. Birth attendants should ensure that the ambient room temperature is comfortable for the woman and should encourage her to drink to avoid dehydration.

Immersion in water for labour and birth
Royal College of Midwives/ Royal College of Obstetricians and Gynaecologists
Joint position paper, May 2006

Also found on the RCOG site: Immersion in water for labour and birth
Royal College of Midwives/ Royal College of Obstetricians and Gynaecologists
Joint position paper, May 2006



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