Many families have a lot of questions about how a waterbirth works at a homebirth when you borrow or rent a tub. Common questions include: How do you fill the tub? How do you keep it warm? Will the weight be too much for my floor? More importantly, how do you empty it? (and the secret worry is “am I going be sucking on the end of a hose, to siphon it, with that water with all the birth stuff coming at me from the other end?”).

Let me put your mind at ease!

Having a tub is a great tool for labor and if you want to birth in the water, great! While the safety of waterbirth was recently questioned, midwives have known for decades the benefits and the safety of waterbirth. The deep water immersion can give birthing people buoyancy and that can take away some of the pain of labor and makes it easier to move around. Many people worry about the logistics of it and I am here to give you the lowdown.

In our practice we usually drop off the tub at the time of the home visit at around 36 weeks. At this visit we look at where you are thinking about putting the tub. When choosing where you will put the tub, try and find a location where the tub will fit with at least a little bit of space on all sides of it. Most floors are well-equipped to handle the weight of a birth tub. If you live in a newer home and are worried about the quality of construction, maybe having the tub on the first floor is a safer option. At this point you have already purchased your birth kit and if you are planning on utilizing the tub you have also purchased a liner and a fishnet with your kit. A fishnet? You ask, what is that for? Don’t worry, we will get to that. At that visit we will give you written instructions on how to set up the tub as well as a quick orientation to the stuff that comes with it. We have two types of tubs in our practice, inflatable and AquaDoulas. Along with the liner and fishnet you purchased with your kit, you have also gathered a tarp or some other floor protection, a hose, and an adaptor for the hose to fit on a faucet or shower head close to the birth tub.

When the mama goes into labor you guys will set up the tub (don’t start filling it until midwives instruct you to). Lay out your tarp in your chosen location. If you have the inflatable kind this involves using the pump to inflate the tub, the sides and the floor. And if you have the hard sided kind, it involves putting the pieces together. Make sure your tub is set up on the tarp. You may have to work on it in between contractions if your partner needs you to rub their back during contractions. Please don’t forget the disposable liner you bought!

To fill the tub, you will attach your adaptor to your chosen faucet or shower head, then you will attach your hose. It is very important that you have tested this connection before showtime! It is also important that you have made sure that the hose is long enough to reach from your chosen faucet to where you will set up the tub.

Start by running a few inches of cold water in to the bottom. This prevents the really hot water from melting the liner. Then once you have a little cold water in the bottom, turn your water all the way to hot and run it until you run out of hot water. Don’t forget that you are filling the tub and allow the water to get cold and run into the tub. It is much easier to cool a tub down than it is to heat it up. Don’t worry that your tub isn’t filled up all the way. Cover the tub with a blanket (inflatable) or with the cover provided (AquaDoula) and wait until your hot water heater refills. At this point it can be helpful to start some pots of water boiling on the stove if things appear to be moving quickly. Most of the time, though, you have time to wait until the hot water heater refills. When you have hot water again, depending on how much you have filled up, you can start adding warm (not hot) water to fill it more and then you may have to add cold to get it to the right temperature. The correct temperature for a birth tub is about body temperature or just a few degrees warmer. About 97-100° F. Once the tub is filled, if it isn’t time to get in it yet, cover it to keep the heat in (blanket or included cover). If the tub cools off during the course of labor, we can always add more hot water from the hose or from pots on the stove to get it more comfortable for your partner.

Your partner may or may not end up birthing in the tub, but whether or not they do, there is often stuff that comes out as they labor: bloody show, mucous, and sometimes poop as they push. The fishnet helps get the poop out of the tub. But don’t worry, it won’t be you that has to deal with it, the midwives or an assistant will scoop it out and whisk it away.

Sometimes placentas are born in the tub after the baby and sometimes people get out to birth their placentas. If your partner births the placenta in the water, it may look really bloody in the water. Blood comes out with the placenta and it looks worse in water than it actually is. Your midwife will be watching closely to monitor how much blood loss is actually happening. Then your midwife will help you and your partner and your new baby get to the bed or a couch or wherever your landing spot is. After she assesses the mom and baby the midwives will take care of the tub.

We use a pump attached to your hose to empty the tub into the toilet and then we throw away the disposable liner, wipe down the tub and take it away when we leave.

It is that easy! If you have questions about your tub setup, check in with your midwife!

Here is a step by step list if you are a list person:

Supplies for waterbirth:

• Birth tub
• Tarp
• Disposable liner
• Air pump (if inflatable tub)
• Hose
• Faucet adapter

Steps to set up and fill your tub:

1. Turn your hot water heater all the way up
2. Lay out your tarp
3. Set up your tub according to the instructions – inflate with air if inflatable, or put together if hard sided
4. Put tub on tarp
5. Put disposable liner in tub (DO NOT FORGET THIS STEP!!!)
6. When midwives give the OK: start filling the tub, first with a few inches of cold water, then hot until your hot water heater runs out, do not leave tub alone for too long during this step, you want to make sure you don’t end up running cold in when your water heater runs out
7. Cover tub and wait for hot water heater to refill, start pots boiling on stove if things appear to be moving fast
8. Add in warm water to fill more then add cold to adjust to correct temperature – about 97-100°
9. Cover until time to get in

Some additional notes:

• If you have an inflatable tub and have cats, you may want to have the tub in a place where you can shut the door to keep the cats away from it.
• I will reiterate – DO NOT FORGET THE DISPOSABLE LINER! If you forget and your partner ends up birthing in the tub, you may then have to purchase the tub.
• When you start filling the tub, make sure the hose will stay in the tub when water is running through it, without you holding on to it (Don’t ask how I know this).
• If you have a toddler, do not leave the toddler unattended at all when there is standing water in your house.
• If at any point you feel like you are uncertain, ask for help! I can guarantee your midwife has heard all the questions already and would much rather you ask then set up the tub wrong so your partner then can’t use it.
• If I can set up a tub, you can! I may be the least handy person in America.

Happy Waterbirthing!

Photo credits: CT Ryan Photography and Megan Crown Photography

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