Visualising the perineum during birth has a traditional history which travels back in time to 17th and 18th century. A time when medical practitioners started to become involved with birth and wished to see what was happening. It was also the time of the introduction of forceps which required the mother to be laying down, a complete change to midwifery births which were upright or on traditional birth stools.
This visualisation which included semi recumbent position and a “hands on“ controlling the head during birth technique all became standard care. So what does this history have to do with 21st century waterbirths. Some colleagues seem to have transferred traditional care of watching the perineum and controlling the head to waterbirths.
In my opinion they have lost the concepts as to why women choose water as an option for their labour/birth. Water offers women a choice where they can regain control and feel empowered with their birth. Water encourages women to be mobile, change position, regress in a private quiet and dark environment. This is the dilemma midwives have – they may be used to seeing the perineum and yet women alternate their position and want privacy. Colleagues ask how to “see” what is happening without lighting in pools.
If, as my American colleague Barbara Harper says, we “watch the hole” without utilising other skills, the woman’s hormonal balance is interrupted. Much is written about the hormones of labour and birth. Sarah Buckley in Australia calls it the ecstatic hormonal cocktail. A fine balance between reducing adrenaline (hormone of excitement), increasing endorphins (hormone of pleasure and transcendence) which leads to the production of Oxytocin (hormone of love or “cuddle” hormone).
The newest hormone we are learning about is melatonin (hormone of relaxation and sleep). A simple explanation is we need to create a birth environment, in a similar one which created the baby, will bring the baby to the world. When a birth environment is bright, unfamiliar and the mother is being watched, more adrenaline is produced (animals will not birth with cameras and film crews watching them – they retreat to a quiet dark environment). If lights are positioned at certain points in a pool, what happens if the mother moves away from the light beam.
Does a midwife ask her to move back into the light – taking away her innate choice and desire to move. What if the woman moves onto all fours or squat – where is the light beam shining now!
If lights are added to pools does it increase initial design and build costs, installation cost,
cleaning or maintenance...Making a very simple choice into a complex situation? In summary my concerns are about trying to control this birth experience, altering the hormones of birth, disempowering women and introducing medicalised birth concepts.
So I do not feel it is necessary to have built in lights, we just need to learn or relearn traditional midwifery skills to assess progress in labour or birth.