Your 2020 guide to water birth in the Chicago area

When you imagine your ideal birth, do you see yourself in water? Water can offer warmth, buoyancy and support, as well as a gentle transition for your baby from the waters of your womb to the outside world. 

If this is something you might be interested in, you’ll need to do your homework. Not every birth setting offers these options, and there are trade-offs you’ll want to understand.

So before you decide where you’re going to give birth, here’s everything you need to know about Chicago-area options for laboring in water (“water immersion” or “immersion hydrotherapy”) and birthing your baby in water (“waterbirth”).

We cover:

You can also  listen to three families tell their waterbirth stories: Jaena & Doug (West Suburban ABC); Erika and Nick (AMITA Health Adventist Medical Center Hinsdale); and Rebecca & Sy (home birth).

What’s the difference between hydrotherapy and waterbirth?

Hydrotherapy means being in water during the first stage of labor, but not necessarily while you’re pushing or for the birth of your baby. Hydrotherapy can mean laboring in a tub, but it can also mean laboring in the shower. To make the distinction, some people refer to laboring in a tub as “water immersion” or “immersion hydrotherapy”. 

Waterbirth means actually giving birth to your baby underwater — usually in a large tub designed for this purpose. After you deliver your baby’s head and shoulders, your baby will slip out into the water. You or your provider can then lift your newborn out of the water and into your arms or onto your chest, where they will take their first breath. 

Anywhere you can give birth to your baby in a tub, you can also labor in a tub. The opposite is not true, though: many hospitals offer the option of water immersion during the first stage of labor, but require you to get out of the water as you begin to push.

The benefits and risks of hydrotherapy and waterbirth overlap, but there are also some differences. To keep it clear, we’ve broken the discussion down into two sections:

  • What you should know about laboring in water (“water immersion” or “immersion hydrotherapy”)
  • What you should know about giving birth in water (“waterbirth)

Why you might look for a birth place that offers labor tubs

Many women seek out a hospital or birth center where they can labor in water. Some choose to birth at home so they can use a labor tub. Here are some reasons you might follow their example.

You are drawn instinctively to the idea of water – it just sounds like it would feel good

Many women are attracted to the idea of laboring in water, and for good reason.

Being in water, especially in a large tub, is physically and emotionally soothing. Because you’re partly floating, you can move from one position to another easily. The warmth is relaxing. Your weight is supported. Being in a tub can help you stay calm and cope with contractions, and can be a great way to get some rest in a long or difficult labor. Those of us who love to take baths when we’re stressed or upset may be especially drawn to the idea of laboring in water.

Certified Nurse Midwife Annette Payot is the Directory of Midwifery at The Birth Center at PCC. She is a strong advocate for water immersion in labor. She describes it this way: “It’s just so powerful. Everyone is gathered around the birthing woman in a ring of support around the tub. You can imagine, it’s three o’clock in the morning and the lights are low. She’s in the tub and it’s quiet and serene. She’s in the zone and her partner is there and her family’s there and it’s just peaceful.” 

If you like the sound of that, you may want to seek out a birth place that has labor tubs.

You’re planning a natural childbirth and want to avoid the use of pain medication.

If you’re planning a natural childbirth, having the option to labor in water can be a big help in avoiding pain medication. “Some women find that warm water is really relaxing,” says Certified Nurse Midwife Sarah Stetina, who attends births at AMITA Health Adventist Medical Center Hinsdale. “That helps labor be more effective and less painful. For clients whose goal is unmedicated childbirth, using this tool during labor can be very, very helpful.”

Major maternity organizations support water immersion during the first stage of labor as a means of managing pain without medication.

The American College of Obstetricians and Gynecologists (ACOG) is the leading professional organization of obstetricians. ACOG has published two position papers endorsing immersion hydrotherapy as a tool for coping with labor pain.  In “Approaches to Limit Intervention During Labor and Birth”, ACOG notes that “during the first stage of labor, water immersion has been found to lower pain scores without evidence of harm.” And in “Immersion in Water During Labor and Delivery”, ACOG states, “Immersion in water during the first stage of labor may be associated with shorter labor and decreased use of spinal and epidural analgesia and may be offered to healthy women with uncomplicated pregnancies between 37 0/7 weeks and 41 6/7 weeks of gestation.”

The water birth position statement of the American College of Nurse Midwives (ACNM) likewise recognizes that water immersion, including laboring in water, “may be particularly useful for women who prefer physiological childbirth and wish to avoid use of pharmacological pain relief methods.”  

So if you’re aiming for a natural childbirth, choosing a birth place that has tubs for use during labor can be a big step towards achieving your goal of giving birth without pain medication.

 “I got to climb in the tub and labor in there, breathe through contractions and move into different positions. The water really helped with the pain. It was relaxing. . . . It was way easier than my first birth.”

You’re planning an epidural but like the idea of being in the water in the early stages of labor

Even if you’re planning an epidural, you may still value having the option to be in water for the early stages of labor.  

Mary Saracco is a CNM at Elmhurst Hospital, and has been using hydrotherapy as one of the tools in her toolkit for almost 20 years. She notes that women who are planning an epidural often overlook the benefits of having a labor tub available. “Remember that you won’t get an epidural until you’re in active labor. So being in water in early labor can be a great choice for relieving pain and anxiety during that time.” 

Many first-time mothers, in particular, may not be aware that there can be a significant delay between the time you request an epidural and when your epidural is actually administered. Being in the water can help you manage your contractions while you’re waiting.

Just keep in mind that once you’re ready for your epidural (and your epidural is ready for you!), you’ll need to get out of the tub. 

You want to minimize the likelihood of certain interventions

Most women want to avoid interventions such as c-section, instrumental delivery (forceps or vacuum assisted) and episiotomy, if possible. 

There is some evidence that waterbirth can reduce the likelihood that you’ll need these inventions and that these benefits are partly attributable to laboring in water. See Evidence Based Birth, Evidence on Waterbirth (“Normal Vaginal Birth”, “Episiotomy”)

 “I’d highly recommend the pool to anyone thinking about it. The best way I can describe it is you’re floating, there’s no pressure from anything touching you’re [sic] body, the water keeps you cool, it helps with what’s going on down there also! For me it was the best decision.”

Why you might choose a birth place that offers waterbirth

Think of waterbirth as an add-on to immersion hydrotherapy during labor. Any birth place that lets you give birth in water will also let you labor in water. So if you seek out a hospital or birth center that allows waterbirth (or if you rent a birthing tub for a home birth), you get all of the benefits of laboring in water, and you get some additional benefits as well. But there are also some additional risks you’ll want to consider.

You won’t have to get out of the tub when your baby is coming

In a setting that only allows you to labor in the tub, you’ll have to get out as soon as you start to push. Some women find that really hard. 

As Hinsdale midwife Sarah Stetina puts it, “We know that getting in a body of warm water will slightly lower your blood pressure. It will relax your muscles. It promotes a sense of relaxation in general and can help with pain management and some of the tension we have in labor that can impact our progress. So it’s not surprising that often once clients get in the water, they really want to stay in!”

Gayle Riedmann is the founder of West Suburban Midwives, and initiated the creation of the Alternative Birthing Center at West Suburban Hospital in 1999. She explains how she came around to the idea of waterbirth for this very reason: 

I will tell you when waterbirth first started gaining in popularity, it looked to me like just another fad. I was very skeptical. I thought, ‘Babies are generally born on land. So why are women suddenly wanting to deliver their babies underwater?’ This did not make sense to me. 

But then I saw my first water birth, attended by another midwife, and I thought it was pretty magical. The woman was getting extraordinary pain relief from being in the water. And I had to ask myself the question, “If this is such a great tool for pain management, why would you get her out of the water to have her baby if it’s safe to let her stay in?”

So then I went to a waterbirth conference and learned about the risks and benefits and decided this is something I wanted to offer. And that’s when the waterbirth program started at West Suburban — 20 years ago! 

As a mother looking at your options for childbirth, this is the important point to keep in mind. If you choose a birth setting that offers waterbirth, you can get in the tub at any point in labor and stay as long as the water is helping you. If you turn out to be one of those women who finds that being in the water as you push just feels right, you’ll be very glad to be able to stay right where you are. In fact, women who have waterbirths tend to be very satisfied with their births. In one study, 72% of women who gave birth in water said they would choose waterbirth again (Torkamani et al. 2010). For comparison, the American Society of Anesthesiologists reports that about 60% of women who had an epidural report that they would choose an epidural again.

PCC midwife Annette Payot is a fan of waterbirth not just as a clinician but as a mother as well. “I’ve had two water births. It’s just so relaxing and lovely. With my second baby, it took a while to get the tub full. I was in a panic to get in the tub. I felt like I couldn’t do it without the water!”  

She is not alone. In fact, three of the four midwives we interviewed for this article themselves chose to have waterbirths.

I labored in a pool with my first. It made a huge difference when I arrived at the hospital I said to the midwife if the pain got much worse I wanted an epidural, she persuaded me to try the pool first and I got through labor with no medication.”

 

You want to minimize the likelihood of certain interventions and complications

Like water immersion in labor, waterbirth is associated with lower rates of interventions and complications in birth. 

The organization Evidence Based Birth (EBB) — a leader in promoting evidence-based maternity care — publishes a free in-depth review of the medical evidence bearing on the benefits and risks of waterbirth. While noting that it can be difficult to separate out the effects of laboring in water from the effects of giving birth in water, the EBB review summarizes the potential benefits of waterbirth for the mother as follows:

    • Less pain and higher satisfaction with the birth experience
    • Less medication use for pain relief—this may be important for people who want or need to avoid epidurals or narcotic medications during labor
    • Less use of artificial oxytocin and possibly shorter labors
    • Higher rates of normal vaginal birth [no instrumental delivery or c-section]
    • Possibly lower rates of postpartum hemorrhage
    • Lower rates of episiotomy

So if you want to maximize your chances of having an uncomplicated vaginal birth, with minimum use of medications and interventions, it can be a smart move to choose a birth place that allows waterbirth.

You like the idea of your baby transitioning first from womb to water

You may share the intuition some people have that being born into warm water may benefit your baby, easing the transition from watery womb to airy world.  That could be an additional reason you might want to have the option of a waterbirth.

You want the first moments with your baby to be very calm and “hands off”

A seldom discussed benefit of waterbirth is that those first moments after a baby is born in water tend to be very calm and quiet, with less of the postpartum bustle that can characterize “land birth”.

As Gayle Riedmann explains it, waterbirth is a very hands-off approach.  

When a woman is immersed in water, the depth of the water provides a counter pressure, just like when you dive deeper into water, you start to feel pressure on your ears. And that pressure of the water supports the perineum against the pressure of the baby’s crowning head. So the midwife doesn’t have to put her hands in the water to support the perineum, it just happens naturally. The head will emerge, and then the mother will pause, and then she’ll be ready to push out the shoulders. You get to watch the complete restitution of the baby, the turning of the baby, and as it comes out in the water, because you’re not reaching in and doing a lot of manipulation. You’re letting it all happen on its own. 

Sarah Stetina sees a connection between that “hands off” approach and a peacefulness in the birth room in the first moments after birth. 

Waterbirth can be really empowering because it’s so easy for clients to catch their own babies. And because we can be hands off, the moments immediately post delivery tend to be more peaceful, more mellow. No one’s rushing over to rub the baby, no one’s grabbing at wires and cables and cutting things off to make room.  And it takes a little bit longer for the baby to cry. Overall babies born in water do just as well as other babies, but it’s a slightly slower transition. It reminds everyone to be patient, there’s no rush to use the bulb suction, no rush to get the baby crying. So it’s all just a little bit more peaceful.

If that picture appeals to you, consider finding a birth place that offers waterbirth.

 

“My first was a hospital based water birth. It was lovely. I labored at home for a while, then went in. Had to be on the monitor for something like twenty minutes. That part was no fun. Then I was able to get in the tub and it was wonderful! The rest coasted by. We played music, kept the lights low. We were talking and joking between contractions. And my guy was born peacefully in the water.”

You just like to keep your options open

Even if you’re not particularly attracted to the idea of a waterbirth right now, you might choose to keep your options open. 

Gayle Riedmann tells the story of a client who was actively hostile to the idea of water birth at all her prenatals. “She kept saying, ‘That’s gross, who wants to be in the pool with all that mess?’” That changed, though, when she arrived at the hospital in very active labor.

As Gayle tells it,

We bypassed triage. She was in a wheelchair. We went straight into the ABC room. I had gotten there before her as I always do: I get the bed ready, I put things in place. And I hadn’t been thinking about the fact that she was not interested in a waterbirth, so I had started the tub filling. And when we got to the room, she stood up out of that wheelchair, stripped off her clothes, got in the water and delivered her baby. And then, when she had the baby in her arms, she said, ‘ Oh my God, I told you every visit, I didn’t want a water birth.  I can’t believe I came in here and saw that water and all I wanted to do was get right in!”

Is waterbirth safe?

Waterbirth is likely safe for both mothers and infants, although some research remains to be done

ACOG, the leading organization of OBs, is neutral on the question of whether waterbirth is safe, taking the position that “there are insufficient data on which to draw conclusions regarding the relative benefits and risks of immersion in water during the second stage of labor and delivery.”  ACOG notes that there have been case reports of serious neonatal complications but acknowledges that “the actual incidence has not been determined in population-based analyses.” Because the evidence is inconclusive, ACOG recommends that “birth occur on land, not in water.” But ACOG also supports continued study of waterbirth safety, and acknowledges that “a woman who requests to give birth while submerged in water should be informed that the maternal and perinatal benefits and risks of this choice have not been studied sufficiently to either support or discourage her request.” 

ACNM’s position is similar, although stated more affirmatively:

  • Results from observational research on warm water immersion hydrotherapy during birth are less conclusive. Researchers indicate that women who experience uncomplicated pregnancies and labors with limited risk factors and evidence-based management have comparable maternal and neonatal outcomes whether or not they give birth in water.
  • Women should be given the opportunity to remain immersed during labor and birth if they wish to do so within the context of a shared decision-making process with their health care providers. This process includes ongoing maternal and fetal assessment as labor progresses.
  • To make an informed choice for the use of hydrotherapy, women should have access to information regarding the state of the science, including strengths and limitations, and documented benefits and risks of available pain relief options including water immersion and or water birth as demonstrated in the published literature.

To help you make your own determination, here’s a quick overview of some of the medical evidence on safety outcomes for mothers. You can 

And here’s an overview of the medical evidence on outcomes for infants:

While the evidence is still accumulating, the evidence we have does not suggest that waterbirth is dangerous for either mother or baby. 

When waterbirth can be riskier

It’s important to understand that waterbirth is not for everyone. As Elmhurst Hospital midwife Mary Sarocco stresses, the safety of waterbirth depends on appropriate risk assessment. “Waterbirth is for the truly low-risk. I personally had a waterbirth. I’m very in favor of waterbirth. But not everyone is low risk. Childbirth is just part of the life process, but complications do sometimes arise. I think it’s important that parents understand that waterbirth is really for the lowest of low risk patients. So your labor has got to be going smoothly. Things really have to be going your way. ”

Some indicators that might prevent you from having a waterbirth include:

  • fever
  • hypertension 
  • active infection 
  • BMI over 40
  • baby passing meconium during labor 
  • stalled labor or prolonged pushing stage  

There are additional factors that might lead your midwife to counsel against planning a waterbirth but perhaps not rule out the possibility. For instance, according to Sarah Stetina, “if you have a history of shoulder dystocia, we would usually advise against a planned waterbirth. We would suggest water immersion as a tool for labor, but would recommend getting out prior to pushing. We wouldn’t prevent you from attempting a waterbirth, but we would go over the risks and would likely not recommend it as the safest option.”

Also, keep in mind that you may be able to labor in the water, even if you can’t give birth there. Mary Sarocco emphasizes that hydrotherapy for pain management “should really be available to nearly all women.”  Elmhurst Hospital, where she works, has telemetry units that are submersible in waters. “That means we can put almost any patient in the water during labor, even if she’s being induced or doesn’t meet the criteria for birthing in the water.” Other hospitals offer this option as well, so it’s something to ask about.

 

“I started off in the birthing pool with my daughter and the pain relief was amazing. As soon as I got in the water the pain lightened up so much!  Unfortunately for me, my daughter was sunny side up and I stopped dilating so ended up having to get out and have an assisted birth, however I really hope to do it again this time around. I’d definitely recommend if you want to try for an unmedicated birth.”

What else should I know?

You’ll have to get out after your baby is born but before you deliver the placenta

In all Chicago area hospitals and birth centers, third stage (delivery of the placenta) is not allowed in the tub. This means that after the intensity of delivery and some time holding and bonding with your baby, you’re going to have to hand your baby over to someone else and climb out of the tub so you can deliver the placenta on land.

“That’s one disadvantage of waterbirth,” acknowledges Mary Sarocco. “Having personally had a waterbirth myself I will tell you that it’s so great when you reach down into the water and gently bring up your baby. But after 5 or 10 minutes then you’re handing the baby off to the father, dragging the mother out of the water, and you’ve got the cord hanging down and it’s cold and she’s waddling across to the bed to deliver the placenta. It’s a disadvantage.”

This is so your midwives can manage any risk of post-partum hemorrhage after the placenta is delivered. As PCC midwife Annette Payot explains, “we want to be able to quantify blood loss, which is difficult to do in the water.  So unless the placenta’s coming so fast that you can’t really do anything about, standard of care is to move to the bed so we can deliver the placenta in a controlled environment. That way we can recognize and manage any extreme blood loss that might be happening.

Bottom line: Be prepared for the fact that you’ll likely need to move out of the tub shortly after your baby is born.

 

Water immersion is a tool to help you have an effective and satisfying birth

It’s important to understand that water immersion is not an end in itself. As Sarah Stetina puts it, 

Waterbirth is not a goal, it’s a tool. It might sound like something you’re really excited about right now. That’s great. We’re going to do everything we can to make sure that that’s an option for you. But you never know what’s going to work for you ahead of time. Once you’re in labor, that’s when you figure it out. You can think that having your baby in the water is a really nice romantic idea,  but then when you get in the tub and realize this is not working for you, well, you’re going to get out. Maybe you’ll end up delivering on hands and knees, or in a squat or standing up. You just have to do what works best.”

Gayle Riedmann echoes this point. 

Water immersion is one of many tools we have, like the birth ball, and the shower and changes of position and movement, and vocalizing and aromatherapy, along with nitrous oxide and pain medication — all tools to help you manage your labor and birth your baby. The tub is in the room. We will fill it. If you feel like getting in and that feels soothing to you and you don’t get out, you’ll have a water birth. And if you get in and then after awhile you don’t like it anymore, you’ll get out and have a birth in whatever other position you happen to choose: on the bed, hands and knees, on the squat stool.” 

In short, waterbirth is not an end in itself. Choose a birth place that allows waterbirth if it’s important to you to have the option of having your baby in water.

Why few doctors attend waterbirths

You may wonder why only midwives seem to offer the option of waterbirth, and not doctors. The answer lies, at least in part, in the difference between the model and economics of care by midwives versus doctors. As PCC’s Annette Payot explains, “the way physicians tend to practice is that they come in periodically and check on a patient. But once a patient is in the tub, we are in the room with her, caring for her one-on-one. So waterbirth really has to work with your whole philosophy of care.” For most doctors, the economics of their practice require that they care for several patients at a time. That just doesn’t work with waterbirth.


Where can I have a waterbirth?

Just because facilities for water-immersion in labor exist at a particular birth setting does not mean that waterbirth actually happens there. So don’t assume that just because you see a tub on a tour, you’ll be having your baby in it!

Here is a complete list of hospitals and birth centers in the Chicago-area (Cook, Lake and Dupage counties) that offer waterbirth. These are the settings where you can both labor AND deliver in water. There are options within reach almost anywhere you live. 

You might also consider having a waterbirth at home. Some homebirth midwives provide tubs themselves, others will share with you their recommendations for where to rent or buy a tub you can set up in your own home for labor and birth.

COVID-19 UPDATE: We are not aware of any changes to the policies below as of 3/20/2020.

Near North Side

The midwife group at AMITA Health Saints Mary & Elizabeth Medical Center are part of the AMITA Health Medical Group. They have a portable tub that they can set up for qualifying mothers who want the option of a waterbirth, in addition to a permanent tub in one room that is used solely for water immersion in labor.

Downtown

The Northwestern Medicine Certified Midwives offer the option of waterbirth for qualifying mothers. There are two portable tubs which can be set up in any of four rooms equipped to handle them. The tub rooms and tubs are available on a first-come, first-served basis.

West Side / Near West Suburbs

The PCC midwives offer waterbirth for families delivering at the birth center, which is the only freestanding birth center in the Chicago area. Both the birthing rooms have tubs.

Two midwifery groups attend waterbirths in the alternative birthing center at West Suburban Medical Center, where all the birthing rooms have tubs.

West Suburban Midwifery Associates is an all-midwife independent practice that delivers at West Suburban Medical Center.

And the PCC midwives deliver both at The Birth Center at PCC, above, and at West Suburban Medical Center, where they can care for women who may have risk factors that disqualify them from care at The Birth Center at PCC.

Western Suburbs

There are 3 rooms with tubs at Hinsdale, where the midwives from AMITA Health Obstetrics, Midwifery & Gynecology offer waterbirth.  The midwives’ patients are given first priority for those rooms.

The midwives with Midwivery and Women’s Health of Elmhurst Clinic offer have priority use of the hospital’s two tub rooms, where waterbirth is supported.

South/ Southwest Suburbs

The midwives at OSF HealthCare Little Company of Mary midwives offer waterbirth in four rooms equipped with hookups for the portable birth tub. Available to patients who qualify.

Home birth

You can see a list of all licensed home birth providers by filtering for home birth on the Search Birth Settings page.


Where can I labor in water, even if I can’t have a waterbirth?

The following hospitals don’t allow waterbirth but do have tubs that you can use during labor:

Here are some resources that offer helpful information about waterbirth and water immersion in labor:

  • The Evidence on: Waterbirth : This article from Evidence-Based Birth offers a comprehensive summary of the available medical evidence relating to waterbirth and immersion hydrotherapy
  • Birth, Bath, and Beyond: The Science and Safety of Water Immersion During Labor and Birth : Another good review of the medical evidence, published in the Journal of Perinatal Education
  • Waterbirth.org: The website of Waterbirth International, a waterbirth advocacy organization that trains practitioners to attend waterbirths. One section of the website offers helpful resources “For Parents” (look in the top navigation bar to access).

 

The photos in this article document a waterbirth at AMITA Health Adventist Hinsdale Hospital attended by OMG Women’s Healthcare (now AMITA Health Obstetrics, Midwifery & Gynecology), and are used with the permission of Maggie Cuprisin. You can listen to Erica and Nick tell their story here