This results in a smooth and slow progression of the head, where the tissues are given time to stretch as much as possible.
Meanwhile I observe whether an episiotomy is needed or not. The local anaestethic can be administered without problems while the woman is in the water.
A discreet spotlight and the transparency of the bath both give a perfect visibility on the area. I obviously support the perineum during the expulsion of the head.
Once the head is born, gently help the rest of the body being born - for this, you sometimes have to wait for the next contraction. This situation, where only the head has come out, presents no danger whatsoever for the baby if it doesn't last too long. I never wait longer than two contractions.
During the whole process, I use my hands as gently as possible. When the umbilical cord is loose round the neck, I just pull it over the head and proceed like in a normal delivery; when the cord "strangulates" the baby, I also proceed like in a delivery above the water, meaning I directly start to clamp and cut the cord under water.
Once the baby is born I slowly bring it to the surface, after a few seconds to one minute.
It mainly depends on the reaction of the baby, this requires experience in the matter: Some babies I see, move a lot and already want to be lifted slowly out of the water after a few seconds. Others are more relaxed, once born in the water, and even open their eyes to look around. They can stay under to up to one whole minute. However, there is a difference between a "relaxed" baby and a baby with too little muscle-tonus; the latter will need oxygen soon.
I see no reason why "records" have to be broken in keeping the baby as long as possible under the water! According to me, this is absolutely useless.
We just have to keep in mind that the baby experiences his birth as less traumatic as possible. Keeping him under too long, just creates more stress again.
Once brought to the surface, the head must stay above the water, so that aspiration of water is prevented as soon as the breathing starts. The rest of the baby's body is best kept as much as possible in the water, to prevent cooling off.
While the baby is still under water, we often urge women to take their baby out of the water themselves, in their arms ... an unforgettable moment.
While mother and baby and are getting to know one another, we help the baby to start breathing - clearing mucus out of mouth and nose. Under water babies usually keep their blue-ish colour a little longer because of the slower transition from foetal to definite circulation.
This is of course, due to the slow and relaxed adaptation of the baby to the outer world, this being caused by the aquatic medium. After more or less 4 minutes the umbilical cord is clamped and cut - this preferably happens immediately if the mother is rhesus negative and in case of an umbilical cord that's relatively short.
Therefore it is also very important to keep the water not deeper than two feet, 60 cm. A little while later, the time has come to help the woman to get out of the water and help her on the examination table, where suturing and examination can start, if necessary.
The expulsion of the placenta preferably takes place on the table, out of the water. It does not only give a better idea of the quantity of the loss of blood, but it also minimises the risk of post partum bleeding, due to an atonic uterus.
Nevertheless, you cannot sometimes prevent the placenta being born in the water. I have never experienced complications in such cases.
We certainly see no more infections due to water births. Mother and child are healthy individuals with normal immunity - systems. If we let nature do its work and if all precautions previously mentioned are respected, no extra risks are implied neither for the mother, nor for the baby.
It speaks for itself that little complications such as strangulation by the umbilical cord, slight meconial amniotic fluid or a minor shoulder distocia mean more stress for the newly born delivered under water. Therefore these babies have to be brought to the surface sooner because they might need respiration in an earlier stage.
If there is blood, mucus or faeces in the water, I use a simple but effective aspiration system.