VBAC – Can I have a Water Birth?

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Planning a vaginal birth after a caesarean you might be told you’re not allowed to birth in water.

This is something I’m very passionate about sharing, so many families I work with are told they are not allowed a water birth. I had a water VBAC when I went into labour at 36 weeks and it was truly an incredible experience. Hospital guidelines recommend water births from 37-42 weeks but these are not legal rules.

When health care professionals might say your not allowed or they won’t let you labour and birth in water, what they mean is that their hospital policy doesn’t recommended it. These are not legal rules, they are guidelines which the hospital follow but you don’t have to. They should provide a clinical reason why they cannot support your birth in water with evidence to back up the risks. But if a pool or bath isn’t available then you can’t labour or birth in water.

The NG121 a guideline that influences hospital policies states:

1.19.7 Support informed choice of a full range of options for pain relief for women who have had a previous caesarean section, including labour and birth in water.

Why do they advise against a water birth for a VBAC labour?

Hospital policies recommend you labour and birth on a labour ward, with continuous monitoring and with an IV cannula fitted, just in case you need another caesarean. These things are optional, you can accept or decline them, but if you accept them, it should not prevent you from using water as a form of pain relief.

Continuous monitoring – CTG monitoring isn’t waterproof so can’t get wet, but they do have waterproof wireless continuous monitoring called Telemetry. Most labour wards have one but most of them are not always working. If you would like this monitoring check with your midwife.

Intermittent monitoring – Or you have the option of having intermittent monitoring with a handheld doppler, this is waterproof and they listen in every 15 minutes in active labour then every 5 minutes when you start to push. It can be used at home, in the birth centre/ midwife led unit and on the labour ward.

You can read my blog post on monitoring here

IV cannula – They advise that this can’t get wet as it can increase the chance of an infection, but you can keep you hand out of the water, or cover it with something waterproof.

Labour ward – Most labour wards will have a pool or 2 and all rooms have a private bathroom with either a shower or bath.

Your Rights to Access Water

You have the right to ask to birth in water, but the health care professional doesn’t have to grant the access, a pool or bath might not be available. If a pool or bath isn’t available when you arrive, get you birth partner to keep asking, one might become available during your labour and you can easily change rooms.

The only way to guarantee a water birth is to plan for a home birth and hire a pool or use a bath. Health care professionals cannot stop you being in water when you are at home.

You can also hire a pool, use it at home and then transfer to hospital when you feel ready.

Is there any increased risks for using water in a VBAC labour?

No, there is no increased risk of Uterine Rupture and it doesn’t increase the chance of an unplanned caesarean.

What are the benefits of a water birth?

Higher rates of vaginal birth.
Better birth satisfaction.
Reduces chance of a episiotomy.
Reduces chance of 3rd and 4th degree tears.
More likely to have an intact perineum.
Less likely to use medication for pain relief.
Reduces pain
Less use of artificial oxytocin
Reduces length of labour
Optional upright birthing positions
Hands off birth

Risks of Water Birth

Increased chance of 1st and 2nd degree tears.
Risk of cord snap – this is when the baby it taken out of the water too quickly.
Chance of waterborne infection.
Small chance of water aspiration.

One study says:

“No association between water birth & specific adverse outcomes for mother or baby” Aughey et al 2021