This week Alex and I filmed interviews with Barbara Harper and Dianne Garland, two of the world’s leading experts on waterbirth.
Barbara Harper is the founder of Waterbirth International and author of “Gentle Birth Choices” book and DVD. She was once referred to in The Oregonian newspaper as “the Billy Graham of waterbirth” for promoting waterbirth with “missionary” zeal. She has lectured in 43 countries on waterbirth and recently made a guest appearance with Dr Lisa in the US daytime talk show “The Doctors”.
Dianne Garland is a UK-based freelance midwife lecturer and internationally renowned author of “Waterbirth: An Attitude to Care”, an essential text for midwifery practise.
Having filmed two waterbirths myself for my previous documentary film “DOULA!”, I have seen with my own eyes that waterbirths can help make a birth beautiful.
So I was really interested to hear about Dianne Garland’s research study into waterbirth:
Here is a link to download the PDF of the UK Collaborative Hospital Audit of Waterbirth – 2001 Dianne Garland (MIDIRS)
If waterbirth is so beneficial, then why aren’t birthpools more widely available in hospitals? Here’s what Barbara Harper thinks?
One of the most common fears associated with waterbirth is infection. What does Barbara Harper think about this issue?
Here is a link to more research articles on waterbirth – thanks to Waterbirth International.
We’ll be releasing more video clips from these interviews in the coming months on the One World Birth site.
But what do you think? Should waterbirths be available for all women? Is waterbirth an option where you live? We would love to hear what you think!
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The issue seems to be ‘why is waterbirth controversial in the US?’. In the UK where I live it’s not controversial at all, but one of a range of accepted forms of pain relief and physical support that a labouring mother can choose if appropriate and available. I have had two children, one in hospital with augmentation and epidural after ‘failure to progress’, one at home in a pool, both within the public healthcare system and with expert, supportive care from practitioners both times. I don’t know anyone who thinks waterbirth is wrong or weird – although there is still a strong public perception that to birth without drugs is either brave or insane, when you could make it ‘easier’ on yourself. Fortunately, caregivers take a more balanced view.
I am one of the few obstetricians in India who have started offering patients the option of labouring and delivering
in warm water.I started on 20th of november 2011,so far we have had:
7 water births out of which:
1 was a VBAC,
4 primips AND 3 multips.
5 more laboured in water,
3 came out on request,
1 we brought out for slow progress
1 was too agitated in water.
the single most factor for a good outcome is the weight of the baby all other things being the same{the same care provider}.
Giving birth in water is more and more frenquent nowadays. And it’s certainly because it’s a good opportunity for women and babies. Women are more quiet and relaxed and babies are lass shocked.
I think it should be developped
My sister-in-law is an OB nurse and in a conversation about waterbirth, I remember her saying something about the shoulder of the baby being affected (caught, collarbone broken ???) and complications ensuing due to waterbirth…??? and wondered if someone could shed some light on this for me.
(expecting mother, researching waterbirth)
Hi Collo,
it sounds like your sister-in-law is referring to shoulder dystocia, a complication which occurs when the anterior shoulder of the baby becomes impacted under the pubic bone during the birth of the baby, resulting in delayed and difficult delivery.
This can occur in any birth, it is not the water which has caused it, and trained birth professionals are taught and practice maneuvers to deal with this situation. There are a few signs which may mean shoulder dystocia is a possibility, large baby, prolonged 2nd stage, previous forceps delivery etc.
If the second stage is not progressing as expected most birth practitioners would probably ask the woman to leave the pool in order to better asses the descent of the head, fetal position etc.
As far as I know, all the research into waterbirth has not shown a link between the use of water and shoulder dystocia, and probably the reverse is true, as women tend to be more active and change position more easily in the pool.
Hope this helps, Lisa.
Having had a wonderful water experience myself, I can say that I would not have labored any other way. The comfort and calm I got from the water was passed to my baby and the team around me and I had the most wonderful birth experience, and healthy baby boy at the end of it all.
My favorite saying about water birth is this – The vagina is not a straw. When you sit in water your vagina does not suck it up inside. Therefore the whole matter of water being unsafe due to intrauterine infection risks is bogus.
i am a midwife who has been attending waterbirths for 10 years. Our practice has attended about 800 waterbirths with no adverse outcomes associated with the water. We are very careful about who has a waterbrth and i would stop in an instant if I had a shred of evidence that showed waterbirth with skilled professionals is not safe for my clients. One of the most common themes among the medical community is that we midwives care more about the birth than about the outcome, nothing could be further from the truth.
Well, I just couldn’t read all the comments about this issue. I read the first 10 or 15, then it was simply too much. Curiously, the last message (Moya) comes from someone who lives in Lisbon like me, altough I’m not portuguese. What I’d like to focus, rather than safety of wbirths itself is something that M. Odent, who can be considerered the father of birth pools, is very clear about: don’t make a goal of it, don’t stay too long in water, don’t heat the water above 37ºC. Otherwise, a lot of complications may derive from this practice.
Besides this, there is something I’m unconfortable about, although it’s not only about water birth. All those birth videos…all those people around the woman and the baby…cameras, fotos, flashes, noises…I know it’s good to show a different picture of birth, but is it really necessary to destroy so much the privacy of birth?
Some women feel more comfortable having their support network around them: midwives, doula, mother and sister in this case. Photographs and video were taken at her request and the birth went beautifully and smoothly as she had the birth that she wanted with the people she wanted to have around her.
I gave birth to my beautiful 8 month old daughter in a tub, and I am currently doing a research paper on making waterbirths an option in U.S. hospitals. Nearly every possible aspect of my birth was chosen by me- the attendants, birthing tools, location, even having it video taped. There were no surprises- except maybe the pain
!
My hope is to empower women in our country and worldwide with full disclosure on all birthing options and make these options available in our hospitals.
An interesting article I found
“What prevents a baby from taking a breath under the water? There are several factors that
prevent a baby from inhaling water at the time of birth. These inhibitory factors are normally
present in all newborns. The baby in utero is oxygenated through the umbilical cord via the
placenta, but practices for future air breathing by moving his intercostal muscles and diaphragm
in a regular and rhythmic pattern from about 10 weeks gestation on. The lung fluids that are
present are produced in the lungs and similar chemically to gastric fluids. These fluids come out
into the mouth and are normally swallowed by the fetus. There is very little inspiration of
amniotic fluid in utero. 24-48 hours before the onset of spontaneous labor the fetus
experiences a notable increase in the Prostaglandin E2 levels from the placenta which cause a
slowing down or stopping of the fetal breathing movements (FBM). (1) With the work of the
musculature of the diaphragm and intercostal muscles suspended, there is more blood flow to
vital organs, including the brain. You can see the decrease in FBM on a biophysical profile, as you
normally see the fetus moving these muscles about forty percent of the time. When the baby is
born and the Prostaglandin level is still high, the baby’s muscles for breathing simply don’t work,
thus engaging the first inhibitory response.
A second inhibitory response is the fact that babies are born experiencing acute hypoxia or lack
of oxygen. It is a built in response to the birth process. Hypoxia causes apnea and swallowing,
not breathing or gasping. If the fetus were experiencing severe and prolonged lack of oxygen, it
may then gasp as soon as it was born, possibly inhaling water into the lungs. (2) If the baby were in
trouble during the labor, there would be wide variabilities noted in the fetal heart rate, usually
resulting in prolonged bradycardia, which would cause the practitioner to ask the mother to leave
the bath prior to the baby’s birth.
Another factor which is thought by many to inhibit the newborn from initiating the breathing
response while in water, is the temperature differential. The temperature of the water is so
close to that of the maternal temperature that it prevents any detection of change within the
newborn. This is an area for reconsideration after increasing reports of births taking place in
the oceans, both now and in eras past. Ocean temperatures are certainly not as high as maternal
body temperature and yet the babies that are born in these environments are reported to be
just fine. The lower water temperatures do not stimulate the baby to breathe while immersed.
One more factor that most people do not consider, but is vital to the whole waterbirth and
aspiration issue, is the fact that water is a hypotonic solution and lung fluids present in the fetus
are hypertonic. So, even if water were to travel in past the larynx, they could not pass into the
lungs based on the fact that hypertonic solutions are denser and prevent hypotonic solutions
from merging or coming into their presence.
The last important inhibitory factor is the Dive Reflex and revolves around the larynx. The
larynx is covered all over with chemoreceptors or taste buds. The larynx has five times as many
as taste buds as the whole surface of the tongue. So, when a solution hits the back of the
throat, passing the larynx, the taste buds interprets what substance it is and the glottis
automatically closes and the solution is then swallowed, not inhaled. (3) God built this autonomic
reflex into all newborns to assist with breastfeeding and it is present until about the age of six
to eight months when it mysteriously disappears. The newborn is very intelligent and can detect
what substance is in its throat. It can differentiate between amniotic fluid, water, cow’s milk or
human milk. The human infant will swallow and breathe differently when feeding on cow’s milk or
breast milk due to the Dive Reflex.
All of these factors combine to prevent a newborn that is born into water from taking a breath
until he is lifted up into the air.” http://data.memberclicks.com/site/wi/FAQ_Handout.pdf
1 Johnson, Paul (1996) Birth under water – to breathe or not to breathe. British Journal of Obstetrics and Gynecology, Vol. 103, pp.202-208
2 Fewell, JE, Johnson, P (1983) Upper airway dynamics during breathing and during apnea in fetal lambs. Journal of Physiology Vol 339, pp 495-504
3 Harding, R., Johnson, P., McClelland, M. (1978) Liquid sensitive laryngeal receptors in the developing sheep, cat, and monkey. Journal of Physiology, Vol 277,
pp 409-422
Unfortunately, none of it is true.
Let’s look at each claim individually.
1. Prostaglandin E2 causes a slowing down or stopping of the fetal breathing movements.
This is both untrue and irrelevant. It is untrue because there is not a single study on humans or animals to support it. It’s irrelevant because fetal breathing movements (practice breathing in the womb) are NOT the source of a baby’s initial drive to breath. Lack of oxygen and build up of carbon dioxide stimulate neonatal breathing.
2. Hypoxia causes apnea and swallowing, not breathing or gasping.
Another claim that is flat out false. Hypoxia (lack of oxygen) makes it MORE likely that a infant will try to breath, not less.
3. So, even if water were to travel in past the larynx, they could not pass into the lungs based on the fact that hypertonic solutions are denser and prevent hypotonic solutions from merging or coming into their presence.
In chemistry, the suffix “tonic” refers to the concentration of electrolytes and other dissolve components of cellular fluids. Isotonic is the the same concentration as cellular fluids; hypertonic means higher concentration (such as seawater), hypotonic mean lower concentration (such as freshwater).
The water in the tub at waterbirth is hypotonic; that much is true. All the rest is a complete fabrication. Lung “fluid” is isotonic, not hypertonic. The tonicity of a fluid has NOTHING to do with what can be mixed with it. Seawater is hypertonic. Fresh water is hypotonic. If this claim were true, you couldn’t add freshwater to a cup of seawater because the seawater would prevent the solutions from merging. You don’t even have to try that experiment for yourself to know that is absurd.
4. The last important inhibitory factor is the Dive Reflex.
The dive reflex exists, but it is not operating during waterbirth. The dive reflex is the reason that people sometimes survive long immersion in icy water. The extreme cold suppress breathing and slows down heart rate, decreasing the body’s need for oxygen. The dive reflex works in COLD water, not warm water, and, of course, the water in the birth pool is warm, not icy cold.
As I have already pointed out, and as this excerpt about waterbirth demonstrates, claims about physiology that underlie waterbirth have no basis in science.
Amy,
I think maybe you should spend some time abroad. Nearly every hospital in Germany not only has laboring tubs, but birthing tubs. Water-birth is an option for most laboring mothers in Germany (better make sure you’re in the right tub – I know a mother who thought she was laboring in the birthing tub and when she started to push, was informed she was in the wrong tub for delivery and had to get out. Germans have very strict rules). Every German woman I have spoken to who has had a baby knows about it – even if they haven’t done it.
I recently had a water birth at home, in Germany, with a midwife who has been practicing for over 23 years. My midwife informed me that nearly all home birthing midwives are trained in water birth – it’s just part of what they do. I’ve had two water-births now and even though I read information on your blog before the last water birth, I was not swayed. You’re so full of sh*t. Move on from this fight. It’s beyond old and evidence is mounting against you.
I wonder if you knew that midwives deliver babies in Germany – hospital and home. OB’s, generally, do not (c-sections aside, obviously). I suppose that’s scary in your book too. So, I bet you’ll come back and say that the entire country of Germany is a great big fail or you’ll find “proof” that water birth isn’t common in Germany. Or make up something about midwives not commonly delivering babies. Whatever. Come to Germany and explore their hospitals, birthing centers and spend some time at home births-maybe the medical community here will shut you up for good.
Exactly the same in New Zealand. The obstetricians are ‘specialists’ in abnormal birth (inductions, c-sections, etc) and are not consulted otherwise. Midwives (Read: Autonomous midwives, with direct entry university degree education & prescribing rights) deliver (or rather, catch) over 70% of NZ babies, and do a damn good job. I am constantly glad that I am a woman in this country – at some point countries like these will be the majority and are already being modeled by developing countries.
This model is also the one practiced in the UK and most of Europe, ‘Dr’ Amy needs to realise that the US is not the centre of the universe and as a country the whole business of birth needs to be reorganised to reduce the shocking statistics for maternal and infant mortality and morbidity in a developed country. Increasing the amount of intervention is not the answer and endless research can show this to be true.
1. on the temperature debate:
How then does my mother have a photo of a six week old me floating up to the surface while holding my breath in a WARM indoor swimming pool?
2. Amy is right about hypoxia vs dive reflex – every other article i have here explains that hypoxia actually overrides the dive reflex
- this is precisely why when we undertake waterbirths here we get women out of the pool if there is a non-reassuring FHR heard with the doppler (decent decelerations mainly), and also if there is SROM with meconium liquor – these are two signs of fetal compromise and we prefer women to be on land if those signs appear so that we can a) monitor the HR better, and b), not end up with a baby being born into water that may need resuscitation other than from it’s own cord (which supplies oxygen to the infant..- something that seems to have been missed here).
plus we do not want a baby with an overriding gasp reflex to breathe upon birth underwater, and we do not want a baby with meconium to swallow (or inhale, if on land) meconium if we can help it – so they come out.
but i’m sorry, the argument about babies being exposed to maternal fecal matter in water (when it will be diluted far beyond what the infant is exposed to during an OA presentation on land) is absolutely illogical.
we have strict and stringent cleaning and drying procedures for hospital pools here and portable homebirth pools have a disposable liner and sterile hose for filling that is used to prevent infection from bacteria on the pool surface.
It is true there are a few studies that have found that GBS mother to infant infection rate with waterbirth is actually lower.
Waterbirth is for low risk women – and for every woman i’ve had in the last few months that has begun in the pool, a good percentage have come out (some by choice), and some for clinical reasons. You may be surprised to learn Amy, that while you may think us cowboys, we do not take unnecessary risks with mothers and babies – here lies the same reason why we do not refer women for obstetric intervention or (say) early induction if the indication is not present – because medical interventions and sections carry huge risks too.
“but i’m sorry, the argument about babies being exposed to maternal fecal matter in water (when it will be diluted far beyond what the infant is exposed to during an OA presentation on land) is absolutely illogical.”
Really? Would you immerse your head in that water (eyes open of course)? If you wouldn’t do it why would you force your baby to do it.
Analysis of the water in waterbirth pools reveals heavy contamination with coliforms, E. coli, and, to a lesser extent, Pseudomonas aeruginosa. Both E. coli and Pseudomonas are known to cause pneumonia and other life threatening complications in newborns.
Waterbirth has nothing to do with physiologic birth; primates do not deliver in water. Waterbirth poses substantial risks to the baby and no benefits at all.
primates also do not deliver flat on their backs with an obstetrician between their knees either.
and no, i would not choose to put my face between a birthing woman’s bottom either, but babies born OA on land do, and are designed to do so – and that matter is un-diluted.
as i’ve said before, if babies were not supposed to be colonised by their mothers fecal organisms, nature would not have built the birth canal next to the anus. (i’m not the one who designed it ! – i’m just saying!)
“as i’ve said before, if babies were not supposed to be colonised by their mothers fecal organisms, nature would not have built the birth canal next to the anus”
And that betrays a fundamental misunderstanding of evolution as well as childbirth. Evolution does not produce perfection. It produces some individuals who are fitter than others, which implies that some individuals will die while others will live.
All animal reproduction has a high amount of wastage. Everyone has seen the nature films of turtle eggs hatching and the baby turtles scrabbling toward the sea before they are eaten by predators. Turtles lay many eggs because most turrle babie will not make it through their first day of life, let alone to adulthood.
The same principle applies in human reproduction. Women produce millions of ova that will never be ovulated; men produce billions of sperm that will never fertilize an egg. Even when a pregnancy is established, 20% will end in miscarriage. The fact that death of babies and mothers in childbirth is routine is completely consistent with evolution and reproductive wastage.
The vagina is near the anus not because that produces perfect birth outcomes, but because that produces enough successful outcomes for the species to survive. Infection with intestinal organisms are the leading causes of infectious neonatal death: group B strep is #1 and E. coli is #2.
Moreover, it is not true that fecal organisms are diluted in a birth pool compared to their concentration on the perineum. The warm water of the birth pool is the perfect temperature for bacterial growth and if a woman is pushing for hours, the colony counts will rapidly increase. That’s why cultures of the birth pool water routinely show heavy contamination with dangerous intestinal organisms.
Waterbirth is unphysiologic and dangerous to babies. That’s what the American Academy of Pediatrics says and that’s why waterbirth is controversial.
As much as I know Dr. Tuteur would LOVE to keep arguing this issue.. I think it’s best if we all just stop and agree to disagree. It’s obvious that midwives and doctors have VERY different views on birth (and everything else) but arguing over the internet is not going to do ANYTHING to change that. Amy is set in her ways and beliefs, even though they don’t seem to be backed by much substantial evidence at all.. and midwives/doulas ..etc. have their own beliefs as well. All I’m trying to say is that as much as we would like to change this doctor’s mind, there is no way she is going to stop arguing her point of view and there is definitely no way that she will ever admit that the medical industry is NOT PERFECT. (gasp!) I just believe that the endless arguing and debating will get us nowhere.
Not to say that we shouldn’t try to change the way things are done.. I just think in this particular instance it is not helping.
Check out this water birth literature review
http://data.memberclicks.com/site/wi/Literature_review.pdf
Thank you!
thanks hayley, i didn’t have this one !
I have actually found several articles refuting the exact case study Amy Tuteur is quoting. and they say exactly what another person here has explained – that individual case studies are not scientific research and alone do not prove anything.
Here are some direct quotes from some peer-reviewed and other recent articles Amy, since you so requested:
“The data of the present study indicate that water births in low risk women delivered by experienced professionals are as safe as normal vaginal deliveries (on land). Additionally, delivering in water is associated with beneficial effects such as a higher rate of an intant perineum, a reduced use of medical analgesia and oxytocin.” (Bodner, Bodner-Adler, Wierrani, Mayerhofer, Fousek, Niedermayr & Grunberger, 2002).
(A case controlled study on 140 women in Austria)
and
“A final inhibitory factor is the water itself. Water is a hypotonic solution, and lung fluids present in the fetus are hypertonic. So, even if water was to enter past the tongue, it could not pass into the lungs, since hypertonic solutions are denser than hypotonic solutions, preventing the hypotonic solutions from entering the lungs” (Harper, 2000, cited in Ros, 2009).
oh, and…
“The results of this (large case control retrospective) study indicate that water bathing during laour is not associated with the development of chorioamnionitis-endometritis” (Robertson, Huang, Croughan-Minihane, & Kilpatrick, 1997).
one more: “Waterbirth is a valuable alternative to traditional delivery. The maternal and fetal infection rate was comparable to traditional deliveries” (Zanetti-Daellenbach, Tschudin, Zhong, Holzgrev, Olav Lapaire, & Hösll, 2007)
Here are only a handful of articles I have at hand at present. (incl cochrane systematic review of RCT’s):
Geissbuhler, V., & Eberhard, J. (2000). Waterbirths: a comparitive study. A prospective study on more than 2000 waterbirths. Foetal Diagnosis Therapy, 15: 291-300.
Harper, B. (2000). Waterbirth basics: from newborn breathing to hospital protocols. Midwifery Today, 54: 1-8 Cited in Ros, M. (2009) Effects of waterbirths and traditional bedbirths on outcomes for neonates.
Forde, C., Creighton, S., Batty, A., Howden, J., Summers-Ma, S., & Ridgeway, G. (1999). Labour & Delivery in the birthing pool. British Journal of Midwifery, 7(3): 165-171.
Bodner, K., Bodner-Adler, B., Wierrani, F., Mayerhofer, K., Fousek, C., Niedermayr, A, & Grünberger, W. (2002). Effects of water birth on maternal and neonatal outcomes. Wien Klin Wochenschr 114(10-11):391-5.
Cluett, ER., Nikodem, VC., McCandish, RE., Burns, EE. (2002). Immersion in water in pregnancy, labour & birth. Cochrane Database Syst. Rev. 2002, 2:CD000111. DOI: 10.1002/14651858.
Robertson, PA., Huang, LJ., Croughan-Minihane, MS., Kilpatrick, SJ. (1997). Is there an association between water baths during labor and the development of chorioamnionitis or endometritis?.Am J Obstet Gynecol 178 (6):1215-1221.
Zanetti-Daellenbach, R.A., Tschudin, S., Zhong, XY., Holzgrev, W., Olav Lapaire, O., & Hösll, I. (2007). Maternal and neonatal infections and obstetrical outcome in water birth. European Journal of Obstetrics & Gynecology and Reproductive Biology 134 (1); 37-43.
—–
also below you can see some of the not so hot case studies Dr A T has been referencing: (and decide for yourselves how valid they are)
Robinson, J. (1993). A waterbirth death in Sweden. AIMS J. 5:7-8.
Nagai, T., Sobajima, H., Iwasa, M., et al. (2003). Neonatal sudden death due to legionella pneumonia associated with water birth in a domestic spa bath. Journal of Clinical Microbiology, 41:2227-9.
I have dozens more sitting in front of me right now but do not have the time or inclination to type them all out since the only person in need of reading them (Dr Amy) is likely not going to spend the time to do so.
The trouble I believe she has is that she has been surrounded in the american medicalised obstetric birth culture for so long, and may actually be unaware that other western countries are leaps and bounds ahead of the states on current evidence based scientific research on such topics (and respected autonomous midwifery education and practice) than is perhaps accessible or accepted in the US/ or to US women – THIS is where ONE WORLD BIRTH is going to have an effect and has the potential to change the face of birth worldwide – particularly i hope in the US.
Dr Amy might be beginning to realise (and feel threatened by?) this, and I imagine she is not happy with such changes to the status quo.
regards
Keri
NZ
apologies i forgot to mention,
in response to this study that Dr A. T referenced:
Kassim, Z., Sellars, M., & Greenough, A. (2005). Lesson of the week: underwater birth and neonatal respiratory distress. BMJ: British Medical Journal (International Edition), 330(7499), 1071-1072.
there is this (and about 3 others) refuting it’s usefulness:
Cluett, E., McCandlish, R., Burns, E., Nikodem, C., Kassim, Z., Greenough, A., & Sellars, M. (2005). Underwater birth and neonatal respiratory distress: case report does not constitute reliable evidence. BMJ. 2005 Jun 18;330(7505):1447-8; author reply 1448.
Thanks Keri for the citations: you gave me the answer my heart already knew. I think they lobbied against waterbirths in Sweden and used those 1 or 2 cases as escapegoats… Probably OBGYNs saw they were loosing epidural or c-sec patients…
Hey! My post (the first, if you scroll down… way down) was submerged by following battle-posts. I still would like to find out on what grounds did Sweden authorities reversed their pratice of allowing expulsion in water (they still recommend dilation in water). And if this is done only in hospital or by homebirth midwives there as well… Was it because of the misinterpretation of drowning cases or …?
Thank you
People seem to have forgotten the title of the article, which asks “Why is waterbirth so controversial?”
I’ve answered the question:
Waterbirth is controversial because of multiple neonatal deaths due to freshwater drowning, pneumonia and profound hyponatremia. I gave a citation for only one case, but the literature contains many more.
Waterbirth is controversial because bacterial analyis of the water in waterbirth pools shows a composition aimilar to toilet water.
Waterbirth is controversial because the dive reflex works only in very cold water, and not in warm water as claimed by waterbirth advocates.
Waterbirth is controversial because the American Academy of Pediatrics Committee on the Fetus and the Newborn opposes it on the grounds that it causes neonatal deaths.
“Over the last 30 years as water birth has grown in popularity, there has been very little research done to determine the risks of water birth. Some studies have been done in Europe demonstrating similar perinatal mortality rates between water births and conventional births. (1) According to an article written by the Royal College of Obstetrician and Gynecologists, there may be a theoretical risk of water embolism, which is when water enters the mother’s blood stream. (2) Though the British Medical Journal is 95% confident in water births, they do see a possible risk for water aspiration. If the baby is experiencing stress in the birth canal or the umbilical cord becomes kinked or twisted, the baby may gasp for air, possibly inhaling water into the lungs. (3) This would be rare because babies do not inhale air until they are exposed to air. They receive oxygen through the umbilical cord until they start to breathe on their own or until the cord is cut. The final potential risk to consider is that the umbilical cord could snap as the baby is brought to the surface of the water. This is preventable by using caution when lifting the baby up to the mother’s chest.” American Pregnancy Association http://www.americanpregnancy.org/labornbirth/waterbirth.html
1 Gilber RE, Tookey PA. Perinatal mortality and morbidity among babies delivered in water: national surveillance study. BMJ 1999; 319:483-7
2 LMM Duley MRCOG, Oxford. “Birth In water: RCOG Statement No. 1.” Royal College of Obstetricians and Gynecologist. January 2001.
3 “Perinatal mortality and morbidity among babies delivered in water: surveillance study and postal survey.” British Medical Journal. August 21, 1999.
I would appeal to everyone not to give Amy any more entertainment. This site is for evidence-based information about birth, not exaggerated fear-mongering from someone who is famous for her love of whipping midwives, mothers and doulas up into a fervour. This is a woman who regularly uses the term ‘madwife’.
Amy doesn’t even appear to know that babies will only gasp when the head is born if there has been some lack of oxygen in the womb before birth. That is why, if a midwife is concerned about the baby’s heart rate, a mother will be asked to leave the pool. She also is astonishingly ignorant of the importance of reasons why babies need to be exposed to the mother’s bacteria at birth – beautifully explained elsewhere in these comments.
This thread is distracting from the good work of this site – which is to present the evidence: the pros and cons based on solid research and long experience from birth practitioners who actually know what they’re talking about. Even Amy’s peers distance themselves from her extreme views – views which she only shares all over the internet in order to cause distress and controversy, not in order to support mothers’ informed decision-making.
Where is the ‘Like’ button when you need it!
For those of us midwives involved in waterbirth for nearly 20 years, fearmongering and people expressing opinions based on prejudice and misinformation are what we have been trying to fight for a long time. I trained and worked as a midwife in UK for 16 years before emigrating to Canada, I now work as an OB RN in a unit that has banned waterbirth. One of our midwives did inservice education, all research and evidence based, all the nurses (some very reluctantly I have to say) and even the peadiatricians were on board, then at the last minute, the OBs decided this wasn’t going to happen in ‘their’ hospital, so waterbirth is banned.
The last birth I did as a community midwife in England was a beautiful, calm, amazing home waterbirth.
I saw some comments referring to studies that have shown water birth as a risk and thought I could help those studying this in the right direction. As a mother and an advisor on Legionnaires’ Disease in hospitals, I read up on in the potential risks associated with water births a few years ago. There have been a few incidences where newborn babies have died from Legionnaires’ Disease following water births. I would like to stress that this is very rare and totally preventable. But because it is preventable, it is important that people know about it.
Legionnares’ Disease is an atypical pneumonia that can be contacted when water contaminated with Legionella bacteria gets into the lungs. This usually happens by breathing in contaminated droplets but can also happen by aspiration (essentially choking on water). In the few instances where babies died from Legionnaires’ Disease, the water in which they were born contained high levels of Legionella bacteria. These bacteria are normally present in water in very low levels but can multiply if conditions are favourable, such as warm temperature and water stagnation.
In the cases where babies dies of Legionnaires’ Disease following water birth the water quality of the birthing pool was poor. Therefore, where I advise hospitals, I make sure that the right procedures are in place to ensure the water in birthing pools is of a good quality and that the pools are used frequently. I don’t know what the advise is for home births. Personally, I would make sure that bath is cleaned and filled with fresh water at the start of the labour and that any water coming from a boiler is hot before it is mixed (at least 55C).
If you want to find the studies, just Google Legionnaires’ Disease water birth. These are just the ones on Legionnaires’ Disease. There might be others but I didn’t study that.
I’d be happy to debate the scientific evidence about neonatal death due to waterbirth, the causes of death, the bacterial analyses of the water in waterbirth tubs, and the physiology of the dive reflex (which works only in very cold water, not in warm water), but that will require waterbirth advocates to respond with actual scientific evidence, not their personal beliefs, and not insults. So far I’ve seen no scientific evidence of any kiind. And be advised that presenting scientific evidence means quoting relevant passages from relevant peer reviewed publications, not simply offering citations.
I’ve had a quick read through the debate playing out here and I’d like to ask Dr Tuteur a simple question. Given you damn water birth as being unsafe because of the single tragic death you quote, are you prepared to damn Caesarean Section or Induction in the same way because of the hundreds or thousands of deaths to mothers and babies such birth methods have caused and continue to cause ?
Yes, I’d have to agree with the comment by Hannah. Granted that cesareans can be useful and life saving procedures, quite a lot of them are done unnecessarily. Managing birth is always a balancing of this risk vs that risk. So many hospital procedures are done without necessity, causing real problems. While trying to avoid one set of risks, the highly medicalized approach to birth causes other risks. Morbidity and mortality rates are higher for mothers and babies who have unnecessary interventions than those without interventions.
So in saying that water birth is not safe, the other side is that birth in hospitals that overuse interventions is massively more unsafe.
I also wonder about the case you cited where the baby inhaled meconium, he could have had the same outcome if he wasn’t born in water.
I would be extremely concerned if I had to restrict my midwifery practice to using only techniques, drugs and equipment that had never been linked to even ONE baby’s death.
Low risk land birth – out. Caesarean – out. Vaginal examination – out. ARM – out. Prostin – out. Syntocinon(Pitocin) – out. Need I go on?
I certainly don’t intend to cease supporting women to birth in water because of the tragic death of a baby who inhaled meconium – undoubtedly whilst still in utero. How many babies has Dr Tuteur birthed who have aspirated meconium? I doubt that it is none, despite (presumably) a 100% land birth rate. My intention is not to cast doubts on the quality of care provided by Dr Tuteur, merely to highlight the fact that babies DO sometimes aspirate meconium at or before birth – rarely, fortunately.
As an aside, I am unsure that the dive reflex does work only in very cold water. I wouldn’t resubmerge a newborn after birth, though, so for me this isn’t so relevant to this debate.
Increased medicalization of birth is not the way of the future and women deserve more choices; However: defensive and antagonistic communication is not the way to engage people to work cooperatively!
I do not know her (have never met her), but I am sure that Dr. Tuteur, having been trained under a medical model, believes very much that a medicalized birth environment is the highest level of care she can give her patients. Likewise, practitioners trained in WB believe that waterbirth is best practise. I the end, I believe we all want the best for mums and babies – we just have different ideas about how to get there.
I am happy to see such passion in these comments, but disappointed to see that they are not particularly respectful (So much so that I feel the need now to put in the caveat that a) I am a doula; and b) I am an advocate for WB both in and out of hospital!)
How can we progress if we cannot engage in mutually respectful and informed dialogue? When it’s a continual case of “them” vs. “us”….! How can we hope to move forward and shrink the gap between “medical” and so-called “alternative” ideas about birth unless we can engage in meaningful conversations with one another? Unless we respect one another? If we have nothing but contempt for one another!
If we don’t shrink that gap, we cannot hope for great change. Without respectful and engaged dialogue, our efforts will do nothing to shrink the gap – indeed- they may even widen it (which would do nothing to improve the situation for mothers to be, who already have to navigate a choppy sea!)
Why shouldn’t waterbirth be available? Birth is an incredibly intimate moment between a women and her baby and whomever else she chooses to involve. To me birth has no place to have people involved that are not 100% supportive of the mother as this causes problems with labour (the doctor knows better than me attitude is dangerous). I have definite plans on having my baby in my bathtub in December. If I feel like getting out I will get out. If I feel like staying in the tub I will. If it feels good to sit on my toilet I will. It is my choice to keep myself calm and relaxed and comfortable; something I would never be able to achieve in the hospital laying on my back with people telling what I can and can’t do. I don’t think that all doctors and nurses are out to harm the mother or baby I believe that their intensions are probably good but then again who knows what each individual doctor or nurse actually thinks about a birthing women (for all I know they could look down on a birthing mother or worse). Doctor Tuteur understands medicine/medical intervention not woman or the spirit of a woman. In the end they have to follow protocol even if it means putting mother and baby in harms way. Perhaps having forcepts used on a women that causes her to hemorage and then have to have a c-section which leads to years of problems for the mother with post-partum depression, pain, no breast milk, and a lack of bonding with her baby is the “Safer” route to take. Or maybe I can go have a doctor tell me to push and I can then rip from you know where to you know where. I had a horrible birthing experience with my first child at the hospital attended to by so called well meaning people. All the intervention was incredibly damaging to me. I now know better. I am looking forward to my home birth to actually be healing for me and to be the most incredible experience my family has ever had. I have no fear of my baby or body (I do however have a great fear of doctors, nurses and hospitals). I have everything I need to have this baby safely and calmly at home. Most doctors do not believe in nature. Doctors are above nature. No one is above nature. I have been able to make a tremendous shift in my beliefs about my body and having a baby. I believe 100% that it was designed to have a baby (no doctor needed). I am not handing myself over to anyone this time. I do think that you have to believe in the devine in order to know fully what the human body is capable of. The same devine creator that makes my period come every month without a doctor telling it to come is the same creator that will work with me and my baby to make my baby come. I or no one else needs to intrude. I look forward to warm water being around my body in my tub. Having a bath is one of the most relaxing things I do for myself in my life. My husband will help bring our baby out of the water to set on my chest and my 6 year old daughter gets to get the towels for the baby. I can’t wait.
There isn’t room in one comment to list all the case reports, papers, and, of course, the American Academy of Pediatrics position paper opposing waterbirth as dangerous to newborns, I will offer one paper that has a good summary of the cases and issues.
The paper, Forensic Issues in Cases of Waterbirth Fatalities, in the September 2010 American Journal of Forensic Medical Pathology discusses the tragic case of a term newborn who died of Pseudomonas pneumonia and sepsis as a result of waterbirth. The authors review the existing literature on fatalities associated with waterbirth and the underlying processes leading to neonatal death.
The case report:
“A normally formed 42-week gestation male infant was born underwater in a birthing tank to a 29-year-old primigravida mother. The Apgar scores were 9 and 10 at 1 and 5 minutes, respectively. The infant was covered with thick meconium and demonstrated intercostal recession with peripheral cyanosis. He was transferred to hospital where his respiratory status worsened and a chest x-ray demonstrated generalized opacity. Presumed sepsis was treated with broad-spectrum antibiotics. There was no evidence of hyponatremia. Despite maximal therapy he developed respiratory failure with disseminated intravascular coagulation and died at 4 days of age.
… Death was due to extensive P. aeruginosa pneumonia and sepsis associated with meconium aspiration and water birth.”
The authors reviewed the literature:
“Underwater birth has been promoted as a means of improving the quality of delivery… While the benefits of immersion are said to include increased comfort and relaxation for mother and infant, with greater maternal autonomy, fewer injuries to the birth canal, reduced need for analgesia, with decreased instrumentation and operative intervention, this has been disputed with no clear advantages or disadvantages over conventional births being demonstrated. In addition, other reports of underwater births have documented significant morbidity and even death. Problems have included infections, near drowning/drowning, hyponatremia/water intoxication, seizures, infections, respiratory distress, fevers, hypoxic brain damage, and cord rupture with hemorrhage.”
According to waterbirth advocates, newborns will not attempt to breathe while immersed in warm water and will wait to take a first breath until they are in direct contact with air. That theory has no basis in neonatal physiology.
“It has been postulated that newborns will not breath or swallow while immersed in warm water, and that respiration will only be initiated on exposure to cold air. This has been used to support assertions that drowning and aspiration of water cannot occur with underwater delivery. However, animal studies have demonstrated that this reflex can be over-ridden, and given that respiratory movements occur in utero, it is difficult to see why this process would not continue in a neonate delivered into water. The documentation of cases of near drowning and respiratory distress with apparent aspiration of fluid would also be supportive of the occurrence of breathing under water. In addition, the finding of hyponatremia in certain of these infants would be in keeping with inhalation of fresh water, as lowered sodium levels have resulted from fresh water drowning.”
There is copious evidence, and there have been a series of deaths, demonstrating that waterbirth is non-physiologic and dangerous, leading to deaths from drowning, pneumonia and hyponatremia from ingesting too much freshwater.
This is one paper, not “numerous published reports.”
All I’ve gathered from the comments you’ve written is that you are extremely ignorant and uneducated about water birth and any kind of natural birth at all, for that matter. I’m sure if you took the time to attend a few natural births you’d come to understand how things REALLY work. We should all be working together to make birth better, safer, and less scarring (literally and figuratively) for mothers and babies. Your attitude (which seems fairly common among doctors, but you certainly take it to another level) is dangerous for everyone involved.. GET INFORMED. Support progress. The US certainly needs it, based on our infant mortality and Cesarean rates.
If the baby was covered in thick meconium we can assume that this was present in the labour meaning the woman should not have been in the water at all, because as you would know, thick meconium is often a sign of a baby that is distressed or has experienced a stressful event. Even post term babies who are often seen to have mec liqour usually only have light, thin staining. As with all birthing practices there are contraindications to water birth and in Australia, meconium stained liquor is one of them.
You state that animal studies have shown that the dive reflex could be over-ridden and a baby could in fact attempt breathing under water. If this is possible it is reasonable to assume that this is most likely in cases where a baby is already compromised as we often see them gasping at birth.
I’m curious if you have ever attended a water birth? You obviously do a lot of reading and research but i think we can all find research to back up our own personal points of view. Have you read any studies that support the practice or do you discount them immediately? Especially if they’re written by midwives?
Hi, I read with interest this set of replies, and postulated research about waterbirth and comment as follows:
1))
“A normally formed 42-week gestation male infant was born underwater in a birthing tank to a 29-year-old primigravida mother. The Apgar scores were 9 and 10 at 1 and 5 minutes, respectively. The infant was covered with thick meconium and demonstrated intercostal recession with peripheral cyanosis. He was transferred to hospital where his respiratory status worsened and a chest x-ray demonstrated generalized opacity. Presumed sepsis was treated with broad-spectrum antibiotics. There was no evidence of hyponatremia. Despite maximal therapy he developed respiratory failure with disseminated intravascular coagulation and died at 4 days of age.
If a UK doctor wrote this and posted on the net, they’d be reported to the GMC ! , for issuing scaremongering and inaccurate information !
… Death was due to extensive P. aeruginosa pneumonia and sepsis associated with meconium aspiration and water birth.”7
My comments
Are they assuming that no other babies die from meconium aspiration syndrome, unless they are born in water ? Not accurate, no, this can occur on dry land births.
“Presumed sepsis”, what was the organism ? was it not something which could have been contracted during the pregnancy ????
hyponatraemia due to ingesting too much freshwater ?!!! this is ridiculous. Babies are delivered within a couple of minutes underwater, as on dry land, once the head delivers, how can hyponatraemia be associated with water ingestion from the pool ? ! unbelievable that someone with a medical qualification can give these ideas any credence. I am a registered midwife. Have you seen a waterbirth Dr ?
Most strange, I’d love to hear your rationale.
Leading to deaths from drowning>>>!!!!!! Again, how on earth can a baby drown during waterbirth ???
If the head delivers, and the body doesn’t with the next contraction, we ask the woman to stand up out of the water and onto the bed, if not delivered with that next contraction, never leave in the pool with a shoulder dystocia!!
This has to be a complete wind up, was it april 1st ?
Bring Birth tubs to US hospitals; there will be a waiting list and a line out the door. Women know what they want, they must learn to speak up, speak out, challenge old school way of ‘Managing Birth’. Raise the bar of expectation.
I would just like to say that I hope that everyone here does not view all American women due to Amy’s opinions. I am an American who is in favor of water births, and the more that I learn, the more I want to have a water birth for my third child. Yes Americans are seen mostly by OBs. But even my OB is in favor of water births, and he has been practicing for at least 20 years and his father taught him all that he knew before he passed. When I asked my OB if a water birth was an option with my first child he told me that unfortunately our local hospital did not even have laboring tubs. He even stated that he wished that it was an option for mothers. We now have a new hospital with laboring tubs, but women are not allowed to deliver in them. It is a start in the right direction, but I do believe that there should be more awareness to midwives and diverting from what the “norm” that has become here in America. I am looking forward to witnessing my friend’s water birth any day now, as is she! This will be her second water birth. She learned her lesson after having her first child at the hospital. After multiple unnecessary interventions she looked and felt like she had been hit by a Mack truck. After her first water birth she felt completely normal and quickly recovered. I have had both my children at the hospital. My first I had an epidural with no other interventions. My second child I was denied an epidural when I asked for it due to the nurse saying that “we need to wait for your contractions to pick up a bit first.” To make a long story short my daughter was born about 45 minutes later. After having my daughter naturally I realized “I am a strong and capable woman!” I have considered having a home birth, or even a water birth through a birthing center overseen by local midwives for my next child. I know that I would be more comfortable and relaxed being able to move freely as my body needs and directs me. A woman’s body is an amazing and wonderful creation. It DOES know what it is doing, and should not be confined to a hospital bed with you leashed to an IV bag as a “just in case” measure that is really just so that they can pump Pitocin into you to speed labor unnecessarily. I will admit that I live in an industrialized America where the labor process has become a business. They want the hospital beds full, but they also want to crank the woman out of the delivery rooms faster than necessary. There does need to be more awareness, and women in America do need to be more educated on what options really are available to them rather than blindly following what they are told to do. But also the woman’s partner needs to educate themselves and be an advocate for them! I could go on passionately about this, but I know that all of you have better things to do with your time. As for Dr Amy, I respect your views and understand that you are looking to have the best outcome for the child as well as the mother. It is commendable that you are so passionate about what you do and are so invested in your work. As there are risks with everything in life, however, I personally feel that the benefits of a water birth (in normal healthy conditions) outweigh the risks for me personally. But there are cases when a water birth would not be a responsible or healthy decision, and I believe that this is the view that is trying to be defended. Yes, there may be fears among American Obstetricians on the business aspect of midwives, ect. But if more obstetricians were more supportive of natural child birth and diverted from so many interventions (like the obstetrician in which I carefully and thoughtfully selected), then they would have nothing to fear. So I hope that those of you abroad understand, American women have been stereotyped, and in many cases nearly forced into their birthing situations, but there ARE becoming more and more of us who are speaking out and taking control of our care. We need to end our era of ignorance! (and I do direct that to us Americans. We need to know our options and make more educated decisions!!)
My midwife actually recently published a study on how waterbirth actually LOWERS the instance of infection, particularly GBS. The study found that out of 4000 women who gave birth in water, only 1 baby was infected with GBS, whereas the rate of GBS infections among “air birth” babies in about 1 in 1000.
My 2 week old baby was born in water.
Would love to see an interview with UK waterbirth expert Ethel Burns (Oxford University). Ethel has completed the largest waterbirth study ever and has some fantastic findings.
Tracy
‘Dr Amy’ – you uninformed twit. Have you ever actually SEEN a water birth? The water is usually crystal clear until well after the babe has been lifted to mother’s breast. Take a look at a few good water birth videos, attend a couple or speak with some amazing mummas who have birthed this way themselves and you might learn a thing or two
Anything solid in the water is usually removed via a sieve or similar by one of the birth attendants or a family member and any liquid in the water is diluted in the LARGE volume of water in the pool… there would be more germs and filth in your local swimming pool than most birth pools!!!
Why is waterbirth controversial? Because it is not safe for babies. There have been numerous published reports of neonatal death from freshwater drowning, hyponatremia when infants ingested too much freshwater, and pneumonia. Indeed, the American Academy of Pediatrics opposes waterbirth on the grounds that it is dangerous for babies.
A simple question for waterbirth advocates:
Would you completely immerse your head (eyes open, of course) in the fecally contaminated bloody water of a birth pool in the aftermath of a birth?
I have a second question:
If you wouldn’t for a moment contemplate immersing your head in a pool of water with feces floating in it, why do you think it is a good idea to force your baby to do so?
Do you have the names of those reports? I’m not clear whether they are of infants in general, or infants during waterbirth.
As I understand it, the baby is taken out of the water immediately after birth, not left in bloody water.
Such an ignorant response. Where are these numerous reports you speak of? You could provide a link to these to educate us further.
Your question relating to immersing ones head in contaminated water proves you lack understanding of birth in general, not just water birth. I personally wouldn’t shove my face between someones butt cheeks either but that’s exactly what happens when babies are born, they need to be contaminated by their mothers natural flora to prepare them for life outside the womb.
I work in a hospital that supports and facilitates water birth and have never seen any of the complications you suggest. Perhaps if the baby was left underwater for a ridiculous length of time these things could occur, however skilled practitioners wouldn’t allow this to happen.
Totally agree with you Annie. I have also attended numerous water births (as a midwife in the UK) and have never come across these complications. Dr Tuteur is an extremely ignorant obstetrician in the US who is against any form of birth which is not highly medicalised and attended by an OB (look at her website, its positively awful!).
Actually I would love the names of those reports as well. Both myself and my colleagues have researched looking for such articles and have only found a couple of reported incidences that have been published. I have been attending waterbirths for two and half years and our centre for fifteen and we have numerous births and no incidences of drowning, near drowning, aspiration, infection or any other such incidences.
Dr. Tuteur, as you very well know, inferring causation from case reports is extremely bad science, particularly when certain information is crucial to their interpretation: were those births attended by a birth professional trained to attend a waterbirth? Was the water clean and at the correct temperature? How quickly was the baby drawn from the water? One cannot prove that the pneumonia was caused by the waterbirth and not by other factors in the environment without an organized, high-quality, large-scale study.
Incidentally, one such study is discussed at length in this article (which you apparently did not actually read). It shows that there is no correlation between adverse outcomes (including neonatal infection or breathing problems) and waterbirth.
Feces are scooped out of the water as soon as they appear by the birth attendant (or partner or doula if the midwife is busy). The blood you mention comes out with and after the baby, meaning that the baby was actually in close contact with it before it ever came out into the water; and as you know, the blood and amniotic fluid are sterile. Babies are not left to float in the water indefinitely; they are usually scooped right out onto their mothers’ chests and warmed and dried.
Also, even if you must oppose the actual birth taking place in the water, it is a shame to ignore the numerous benefits of laboring in a bath or pool: a shorter, more comfortable labor; a more intact perineum; and a more relaxing and fulfilling experience for the mother.
It seems to be a common perception that moms who have definite ideas (or “non compliant” in terms of hospital staff expectations) about their birth plan are seen as “forcing” something upon their baby. As another respondent noted, many of the fluids floating in that tub are the same ones the baby has been floating in for 9 months, and I would guess that it certainly doesn’t share your aversion to bodily functions.
As others have mentioned, a follow up with actual studies on both sides of the debate might reveal some really interesting conclusions…and I wouldn’t say that the American Academy of Pediatrics opposition of water birth is necessarily evidence that it is unsafe….not all of their positions have been in the best interest of birthing mothers.
Dr. Tuteur, how is the environment of a birthing pool so outrageously different from the environment they live in within the womb? And as to your fear mongering with misinformation and threatening “neonatal death” without any substantial evidence, maybe you should take that wonderful degree you have and learn to uphold your hippocratic oath instead of making wild claims that go against everything the degree you hold is supposed to stand for.
Does a baby take breathes for oxygen while in the womb? Or do they get their oxygen from the umbilical cord? What makes you think the a baby is going to go from the womb, into water of the same temperature, never being exposed to the open air, and just miraculously start breathing in the water? This is ludicrous! The baby, as in any other birth, will not take that first breath until the AIR hits his/her face. And this has been well published. Look it up! Get informed! Start supporting progress! Quit it with the god complex already! You don’t know everything. Open your mind to some alternatives!
Dr Tuteur: I would like to see a comparison between infections in waterbirth vs. infections in c sections. I had a waterbirth 2 months ago, it was amazing, no feces floating on the tub, no complications at all. I know 5 other people that had their babies in water with no complications. If you find one case of complication, you would certainly publish that case as a proof of how dangerous water birth is, without specifying between how many water births this complication occurred. Have you ever published a case of a complication of a c/s or of a vaginal birth with a lot of interventions? Do you have papers proving that artificial pitocin is better than natural one? I would really love to read the papers you talk about. I only found ONE when studying my options for my vbac.
Great videos!!!! Thank you!!!
I birthed completly supported but on my own and was the first to catch my daughter after expulsion. I did tear but nothing serious.
I live in Lisbon, Portugal.
I had my daughter in a wonderful 9 hour labour (5 hour active labour, from which only 2h in water) at home in 2009.
During my pregnancy I sent letters (birth plans) to every public hospital in my residencial area and only 1 or 2 replied with a template answer, saying it was only posssible to bring one partner to birth…
At the private hospital I was followed troughout my pregnancy I discussed my birth plan with the head midwive: she was totally misinformed (uninformed) about water births… She said I could take showers, but although there was place in the room to put the birthing tub, it wouldn’t be possible because “how will we act if we have to use forceps?”. I was stupified. From there to prohibiting my doula from assisting me (she could enter, but only as “a friend”) and her describing how I would have to perform during expulsion (she sat on a chair, put her legs up as if they were on a stirrup and said I should push when asked to, then they would “just” do a small snip with the scissors and it would be over), among other things made me completely convinced I wanted a homebirth, with my doula and a midwife.
The waterbirth was never a priority: I would only go in if I felt like it and when the time came: I really DID want it. I was very confortable with it because both my doula and midwife had assisted various waterbirths before. It was great because I had full autonomy: not even one finger up my vageigei during the process
There are several hospitals now (private hospitals and a public one, but I never heard they used the tub at the public one) that offer waterbirths, allthough from testemonies, all very directed (“do this, do that”) and hands-on. There are also several midwives that do homebirths in Portugal and are familiarized with w-births.
I believe all women should be offered the option wbirth, because it gives such relief during contractions and allows to have a weightless feeling and change positions much easier. It shouldn’t be a goal, as Dr. Odent recommends, but it sure helps the process. I felt my contractions became more effective once in the water. I’m sure that if more anestetists learned the ways of waterbirths, less epidurals would be asked for (or, for that matter, offered). The lack of formation shouldn’t be an excuse not to offer this service: they should invest in wbirth courses for hospital staff.
There is a recent study in Sweden that reviewed wbirths as “very good” during dilation and “more riscky” for expulsion because of the danger of drawning for the baby, but I always heard that until the baby’s head emerges from the water for the first time, there is no risk due to the fluid density being the same… Can you talk about this on future videos? I have a friend that refused to wbirth because of this…
All the best,
moya