The Rise of Gentle Births

Disclaimer: Graphic photos ahead.

In recent years, a serene and holistic approach to childbirth has gained popularity among expectant mothers around the world—water birth (also known as gentle birth). This gentle and empowering method, once considered an alternative, has become a symbol of the natural birth movement. We feature an expert and moms who have gone through it, as we delve into the exquisite world of water birth—exploring its benefits, the relaxed settings it offers, and the profound connection it fosters between mother and child.

First, let’s define what it is. According to Irina Otmakhova (talk about having a prophetic name), a Certified Childbirth International Doula practicing in Manila and Founder of Conscious Birth Manila, “Water birth can refer to the actual fact of pushing and releasing the baby into the water, but it can also mean the process of labor and delivery with the possibility of using water immersion at any point of labor for the mother’s comfort.”

A Rebirth of Tradition

Water birth is not a new concept; it draws inspiration from ancient cultures that revered water as a source of life and purification. Irina affirms these facts and adds, “Water birthing is definitely not a new ‘invention’ as there are accounts of women laboring in the water from Ancient Egypt to Minoan civilization, to the Chumash Indians of California. Historically speaking, from the Southern Islands of Japan to the Panama Indians, to the Maoris of New Zealand, water birth appears as not an innovative practice but rather an ancient one.

In the 20th century, water birth made a comeback as a practice under the guidance of Russian and French obstetricians who used water as a pain control measure. From then on, it only gained popularity among home-birth midwives, and later, selected hospitals followed suit by establishing water birthing suites and regulating the practice. Despite recognition as beneficial for mother and babies and solid research data to support it, the practice still remains on the margins of the obstetrical profession. In the Philippines, I can count a maximum of 15-20 medical professionals who are skilled in water birth deliveries.”

A Gentle Option

I wondered why there are only a handful of water birth professionals in the country, and Irina had so much insight to share. “When it comes to birthing, there is no ‘one method that should be’ or that ‘one-size-fits-all’ rule. High-risk pregnancies are best handled by competent doctors with all the due monitoring, medication, and when absolutely necessary, a Cesarean delivery. But it is a different discussion altogether when it concerns healthy pregnancies and healthy spontaneous labors. The reality of mainstream births in the hospital setting is that they are ruled by the ‘routine for the sake of the routine’, namely, the medical procedures that may be unnecessary. Mothers are immobilized, isolated, deprived of food and drinks despite the best evidence to the contrary, the labors are timed, scheduled, medically managed with or without regard to the personal preferences of the mother. ‘Bawal this, bawal that’—not allowing mothers to bring in a companion of choice, not allowing them to move around when they want to, not allowing them to stand when the water breaks, not allowing to remove external fetal heart monitoring device even when there is no clear indication for continuous heartbeat monitoring, pushing only on the back with legs up in the stirrups, routine episiotomies whether needed or not needed, routine fundal pressure despite proven dangers of the procedure, and so on. This is not to say that a respectful gentle birth is not possible in the hospital setting. It is very much possible, but it is not a given. One has to go out of their way to find an OB who will respect the mother’s preferences for an unmedicated gentle birth, which includes freedom of movement, a companion of choice, presence of a doula, water immersion, and delivery (if the facility is properly equipped for that), and many other freedoms that should be a standard but are not.” 

I also got the opportunity to talk to Ams Macaraeg, a mother of three, who opted to do a gentle birth for her second-born. “When I was pregnant with my eldest back in 2012, I initially wanted to have a Lamaze birth. But I was still a young wife then—I had so much to learn, and resources were scarce compared to today. Since it was my first time, I didn’t know what to expect, and we were more concerned about our baby's safety. I went to the hospital too early, and despite having a birth plan, the long hours of waiting eventually caught up to me. During my labor at around 7 cm dilated, I gave in and asked for an epidural. At that time, I just desperately wanted to have our baby in my arms. I knew the risks, but I never really understood them fully until I experienced them first hand. I had terrible side effects from the anesthesia which is very rare. Upon administration, I had chills, my blood sugar spiked, and was in and out of consciousness. The worst part? I was totally numb—almost as if paralyzed—from the waist down. I had a very hard time pushing during delivery because I couldn’t feel any contraction. I almost had a C-section, but by God's grace, I was able to have our eldest via normal delivery. But sadly, the side effects continued. My bladder got so relaxed from the anesthesia that I couldn’t feel the urge to pee. I was in pain because my abdomen was really distended. This caused my bladder to retain 2 liters of urine, and we only found out when the catheter was inserted. I had to go home with a bag that collected my urine for over a week until I could recover. Experiencing this made me all the more dedicated to have a natural birth the second time around.”

The Power of Water

Immersing oneself in warm water during labor has been found to offer numerous benefits. The buoyancy provided by the water helps alleviate the pressure on the mother's joints and muscles, promoting relaxation and reducing discomfort. The warm water also encourages the release of endorphins, the body's natural pain-relieving hormones, which can facilitate a smoother and more serene birth experience. “The immediate pain reduction felt upon entering the bath is quite noticeable, we call it the ‘ahh effect.’ The smiles, the sounds, and the inner peace that mothers display are unmistakable. This response can happen at any point in the labor, but most notably when contractions are long and strong and close together. Some doctors/midwives who assume there is little or no progress in dilation because the mother is not displaying any outward signs of discomfort are often surprised to find rapid dilation in the first hour of immersion. The water creates a wonderful barrier to the outside world. It becomes the woman’s nest, her cave, her own ‘womb with a view,’” Irina shares.

As for her first gentle birth in 2015, Ams narrates, “It was so much more relaxed that there was no need for intervention. I was given the freedom to move, find a comfortable position, eat and drink to have the strength I needed to push later on. Going into the water gave me immediate relief. Though the waves of each contraction intensified more as the labor progressed, the warmth of the water and my continuous movement in it made the pain more bearable, as you can float, sway, and move through the contractions and that makes all the difference. You know that feeling of going into a hot tub after a long and tiring day? It’s like that. It was almost relaxing. Sometimes, moms get too relaxed that the labor progresses really slowly. This happened to me! I was then asked by my doula to stand for a while. True enough, when I did, my labor got more painful and intense that it eventually caused my bag of water to finally break at 9 cm dilated. I immediately sat down again in the birthing pool, and that's when I felt ready to start pushing.”

Creating an Oasis of Tranquility

Upscale maternity clinics and birthing centers have embraced water birth as a way to enhance the overall experience for expectant mothers. Birthing suites, adorned with soothing colors and soft lighting, create a tranquil ambiance that invites relaxation. Each suite is equipped with a spacious birthing pool, complete with temperature control and water jets, ensuring optimal comfort during labor. But water births are not limited there, “As long as there is at least a minimal space for the birth tub, access to water supply, and a place for the mom to rest, it can be done on literally 5 sqm of space. We have done it in small condo units and narrow compact homes. I have yet to see a space which cannot accommodate 1.5 meter-wide birthing pools!,” Irina states. 

The Doula’s (or Midwife's) Touch

The presence of highly skilled midwives or doulas is paramount during a water birth. Midwives are medically trained, while doulas are not, although both are highly certified professionals. A doula (doo-la) is a trained professional who provides continuous physical, emotional, and informational support to the mother before, during, and just after birth. Doulas are also called labor coaches, birth companions, or labor assistants. A doula is a valuable member of a mom’s birthing team to help them stay centered and confident through the varying intensity and different scenarios of their birthing time.

These compassionate aids guide and support expectant mothers throughout the birthing process, ensuring both their safety and that of their babies. Their expertise in water birth techniques, combined with their holistic approach to childbirth, creates an environment where the mother feels empowered and nurtured. “As a doula, I start working with my clients prenatally. We have regular meetings and catch up sessions where we discuss different birth scenarios and go over the details of the birth plan,” Irina expertly shares, as she’s attended to approximately 500 births in her career. 

“The labor dynamics depends largely on the fetal position and presentation. Hence, a good part of prenatal preparations is dedicated to special exercises to ensure the mother’s uterus is well balanced and spacious for the baby to favor the most optimal presentation—head down with the back on the frontal left side. If the client is planning a home birth, we will visit several times for prenatal check ups, and figure out all the logistical arrangements. In case the client is preparing for a hospital birth, ideally, we also meet with the attending obstetrician and go through the birth plan together. Further, we practice relief measures, different labor positions, and breathing techniques to be well prepared for the birthing journey,” Irina further explains.

Good Preparations are a Must 

As for Ams’ 3rd baby, she surely wanted another gentle birth, but this time, at the comfort of her own home. “The experience was so much more relaxed and at the same time required a lot more faith compared to the water birth I had in the hospital. Since this happened during the height of the pandemic (May 2020), I was laboring in my own home with my husband and a midwife, attending to my kids in between contractions. The only back-up plan we had in case of an emergency was to rush to the nearest hospital.

During my labor, I was able to distract myself with chores and the preparations needed, like inflating the pool, strictly monitoring the temperature of water (37 degrees is the magic number), preparing food since I was in labor during my husband's birthday, and at the same time making sure that everything we needed was ready for baby Marcella's arrival. We truly praise God that I was able to deliver her normally after about 40+ hours from the onset of labor. It really pays to be prepared spiritually, physically and mentally for it. Giving birth is more like a marathon than a sprint, so making use of your energy wisely is really important.”

Misconceptions, Safety, and Benefits of Gentle Birth

With mainstream birth as the more popular method, more mothers and advocates are sharing their knowledge on this option. When asked what’s the biggest misconception about gentle births, Irina shares, “The biggest misconception about water births is seeing it as a goal in itself. It isn’t. Birth of a healthy baby is the goal, as well as a healthy mama, who is happy with her birth experience. Water is a comfort tool for the mother to use at any given point in labor when she wants and chooses it. The baby may indeed get born in the water or may not, and either way is absolutely fine! Simply having access to the body of warm water and using it when needed will make a difference with the entire birth experience—it’s like night and day. 

In a culture where heavily medicated births have become a standard, there is a lot of fear of birth as a natural process. The common misconception is that birth equals constant pain. This is not true. Birth is so much more than possible pain. Yes, it is an intense experience any way you look at it. But with the right preparations, pain does not necessarily need to equal suffering. Joy, intimacy, sensuality, even sexual pleasure, can very much be rightful components of the overall birthing experience. When preparing for a natural water birth, you open up a possibility to experience birthing in all of its multifaceted manifestations.”

Some may be wondering if there are safety concerns or challenges with regards to gentle birth, but Irina lays down impressive facts:“There is available evidence that shows water birth is safe. Babies born in the water have had similar health compared to babies born on land. More than 28,000 water births have been observed in research studies. Although most of these studies were not randomized trials, results from multiple high-quality, large studies are reassuring. Harmful effects in large studies were either non-existent or very rare.” 

As for those with fears of their baby drowning, Irina gives a reassuring answer. “The baby will NOT breathe under water due to several inhibitory factors that are normally present in all newborns—hormonal, temperature, and dive’s reflex. All these factors combine to prevent a newborn who is born into water from taking a breath until s/he is lifted up into the air. The baby initiates the first breath only when fully transitioned into the air environment. As soon as the newborn senses a change in the environment from water into air, a complex chain of chemical, hormonal, and physical responses initiate the baby’s first breath. Several things happen all at once in the baby: the shunts in the heart are closed; fetal circulation turns to newborn circulation; the lungs experience oxygen for the first time; and the umbilical cord is stretched causing the umbilical arteries to close down.

Surprisingly, gentle birth has several benefits for the mom, too. Women who give birth in the water have a significant decrease or total elimination in the use of vaginal cutting with scissors (episiotomy) by their care providers.

Women who have gentle births also have:

• Higher rates of intact perineum (minimal to zero tearing)
• Lower rates of 3rd and 4th degree tears
• Less blood loss or no difference in blood loss
• Less use of pain medication
• Higher levels of satisfaction with birth experience (mothers feel they have more control of the whole birthing process)
• Less incidence of birth trauma (oftentimes, this feeling is caused by the situation of being out of control of what happens to their bodies)

• No difference in APGAR scores (points that are added up for a total possible score of 10. APGAR stands for Appearance, Pulse, Grimace, Activity and Respiration. The higher the score, the better the baby is doing after birth.)
• No difference in newborn infection rates (very rare)
• No differences in NICU admission rates
• Umbilical cord tears are rare (2.4 per 1,000 water births)
• No increase in mortality rates

Bonding in Water

One of the most profound aspects of water birth is the exceptional bond it fosters between mother and child, as the first person to touch the baby is the mother. The transition from the aquatic environment of the womb to the water birthing pool is gentle, allowing the newborn to experience a seamless entry into the world. The warm water envelops the baby, simulating the comforting sensation of the womb, which can ease the transition and promote a sense of security. Once the baby is out, the mom holds him/her onto her chest, for an uninterrupted hour of skin-to-skin therapy. “We do not cut the cord immediately. We wait for the placenta to be born first and then cut the cord, usually around 30 minutes to one hour after birth. All exams are delayed till one hour after birth to respect this initial bonding time. And as much as possible we practice baby-led latching or breast crawl,” Irina shares.

A Sacred Celebration of Life

Water birth or gentle birth is a profound celebration of life. The control and serenity it brings, combined with the exceptional care provided, make it an extraordinary choice for expectant mothers seeking a holistic birthing experience. It embraces the beauty and strength of the female body, providing an opportunity for mothers to reconnect with their primal instincts and welcome their little ones in an atmosphere of grace and tranquility.

It has evolved from a once-niche practice to a symbol of empowerment and serenity for modern mothers. With its exquisite settings, personalized care, and profound connection it cultivates, gentle birth offers a transformative birthing experience. As the world continues to embrace the beauty of natural childbirth, water birth shines as a beacon of gentleness and strength, reminding us of the innate power within every mother to bring forth new life.

Prices vary depending on where you conduct the water birth. Prime hospital facilities (ex. Makati Medical Center) can go from P150,000 to P200,000. If you are open to exploring other hospitals, clinics, and home birth options, they are priced at P100,000++, including the facility and professional fees.

For more inquiries, message Doula Irina on Instagram @birthing_gently.

Photos courtesy of Irish Planes (Photos by Hannah Reyes Morales) and Ams Macaraeg.