Pain Relief and Positions in Water

The birthpool isn’t just somewhere comfortable to be — it’s active pain relief. The research backs up what women have been saying for decades: being in water during labour helps with pain. Not eliminates it — helps. And the way it helps is well understood.

How water reduces pain

Two mechanisms work together. Buoyancy reduces the effective weight of your body by about 75%, taking pressure off your pelvis, lower back, and joints. Muscles that are working to support your weight on land can relax in water. Position changes become easy — you can float, turn, and shift without effort. That freedom of movement is itself one of the most effective coping strategies in labour.

Warmth at 36–37.5°C relaxes skeletal muscles, reduces muscle spasm, and dilates blood vessels. This triggers a reduction in stress hormones and supports oxytocin release — the hormone driving your contractions. Less stress, more oxytocin: labour progresses and pain perception drops.

There’s also a sensory component. Water provides constant, even pressure across your skin — a form of stimulation that competes with pain signals at the spinal cord level. Your brain can only process so many inputs at once. Warm water flooding your nerve endings with non-painful sensation reduces the intensity of the painful ones.

The Cochrane review on water immersion found that it reduced reported pain intensity and reduced the use of epidural analgesia. Water is not an anaesthetic — it doesn’t make contractions painless. But it consistently makes them more bearable, and for many women that’s the difference between coping and not coping.

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Positions that work in the pool

The pool makes positions possible that would be exhausting on land. Buoyancy does the work of supporting your body.

Kneeling, leaning forward over the pool wall is the most common position — arms resting on the wall, head down. Good for all stages of labour. All fours — hands on the pool floor, knees down — is particularly helpful for back labour and encouraging a baby in a posterior position to rotate. Squatting, holding the pool handles for support, opens the pelvis to its widest diameter; it’s hard to sustain on land but much easier in water.

For resting between contractions, semi-reclined against the pool wall with legs floating works well, as does side-lying. Standing in the pool — with water at waist or chest height — suits some women during contractions, sinking into the water between them.

Asymmetric positions — one knee up, one knee down, or lunging against the pool wall — can help if progress stalls, encouraging the baby to shift into a better position.

The key is to move freely and follow your body’s instincts. If a position feels right, it probably is. Don’t lock into one position for hours. Movement is part of the process.

What else works alongside water

Gas and air (Entonox) is the most commonly used pharmacological pain relief for water birth. It’s self-administered through a mouthpiece — you inhale during a contraction and the effect is almost immediate. It doesn’t affect the baby and doesn’t impair your ability to move. The cylinder sits outside the pool; your birth partner or midwife holds the mouthpiece within reach.

TENS machines can’t be used in the pool (electricity and water don’t mix), but they’re useful in early labour before you get in. Many women use TENS during the latent phase, then remove the pads before entering the pool. The two methods cover different phases without conflict.

Massage and counter-pressure work in and out of the pool. Firm pressure on the lower back during contractions helps with back labour — your birth partner can press on your sacrum while you lean forward over the pool wall. Hip squeezes — pressing the hip bones together from the sides — also relieve pressure.

Breathing is the most accessible technique of all. Slow, rhythmic breathing through contractions prevents hyperventilation, keeps oxygen flowing, and provides a focal point. If you lose your rhythm, your birth partner or midwife can breathe audibly with you to help you re-establish it.

Vocalisation — low-pitched moaning or humming — helps release tension. High-pitched sounds tend to create tension. Vocalisation is instinctive; it doesn’t need to be taught.

Movement — rocking, swaying, circling the hips. In the pool, buoyancy makes this effortless. Staying still is almost always worse than moving.