Water births have been in the news recently. Here's what you need to know.
While women have been giving birth in tubs for forever, water births have gained popularity in the last 30 years, even in hospitals, as women all over the world realize the benefits: Water reduces stress, relieves pain, and may help uterine muscles contract more efficiently. Besides, what's not to love about a warm bath?
Not everyone's excited to dive in, though. The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists have a committee opinion statement on water birth that nods to the benefits of being in water during the first stage of labor, but says that immersion in water during the second stage of labor hasn't been proven to be a.) safe and b.) beneficial for either mother or baby.
Pediatricians are worried about babies drowning or inhaling water that could cause infections, and some obstetricians are concerned that water births might prevent healthcare providers from effectively monitoring mothers and babies.
Why Get Wet?
Water birth increases buoyancy, which promotes more efficient uterine contractions and improved blood circulation, which may result in less pain for the mother and more oxygen for the baby, says the American Pregnancy Association. Water also reduces stress-related hormones, producing endorphins, which serve as pain-inhibitors.
During second stage (the pushing/birthing stage), the perineum may be more relaxed and stretchy, reducing tears and allowing mothers to maneuver into better pushing positions. Plus, studies show that low-risk women who use water birth take less pain medication, don't use epidurals, and have fewer C-sections.
Behind the Statement
"Pediatricians who've never encountered water births are terrified they're going to get called in to deal with drowning babies, and that they're going to be held responsible," says Duncan Neilson, MD, OB-GYN, and Chief of Women's Services at Legacy Health Systems in Portland, Oregon. "They never hear about the successful water births."
And most are successful. A review by the not-for-profit Cochrane Collaboration looked at over 3,000 births in which women spent time during labor and/or birth in the tub. They concluded that immersion in water during the first stage reduces reported maternal pain (and the use of pain killers), without prolonging labor, resulting in a C-section, or harming the baby. And women who spent the second stage in water (the part that really scares the ACOG-AAP) reported that they were more satisfied with their birthing experience, as compared to women who weren't in water. Mothers in water also reported a higher sense of control.
Despite the ACOG-AAP's concerns, none of the research done so far has indicated any increased risk of infection, and there's no evidence of increased respiratory complications, either. "This just isn't a problem we're seeing in hospitals that offer water birth to their patients," says Dr. Neilson. In fact, water birth is practiced and recommended by obstetricians in many parts of the world that have far better maternal health outcomes than we have here in the U.S.
Even though large-scale studies indicate water birth doesn't harm mothers and babies, the ACOG-AAP says more randomized clinical trials are needed. (The gold standard of experiments, clinical trials are studies in which one group is subjected to the experimental procedure—water births, in this case—and the other group serves as a control—regular births.)
Problem is: You can't tell some women to have water births, and others not to. You also can't conduct a real non-biased study because women know if they're part of the experiment, and that changes perceptions. They know if they're in the water or not.
Should You Worry?
While the ACOG-AAP statement cites concerns about the potential for water inhalation and infection, complications are rare, and not backed by strong research. In some cases, researchers can't even accurately blame water births for the complications.
"The article that really got me was titled 'Water birth, a near drowning experience,'" says Dr. Neilson. "Near-drowning is associated with specific changes in the blood, but these researchers didn't do the lab work to support a drowning diagnosis. They also didn't document any other aspects of the mother's care or delivery. That's about as unscientific as you can get." Essentially, this article seemed to presume that if the baby had trouble after a water birth, it must have been the water that caused the complications.
Dr. Neilson's water birth program has documented more than 1,000 in-hospital water births with no significant adverse effects associated with water. In this nurse's experience, the water births I've attended were accidental ones where the baby arrived too quickly to get mom back to bed before baby arrived. (The hospitals I've worked in didn't officially "do" water births, though they did have bathtubs in which women could labor). The women I've seen have water births loved it. And soaking in the tub did seem to move labor along quite nicely. When done correctly, I believe water births are safe. For those of you who are considering having one, check out hospitals and birth center with well-established water birth protocols—and be prepared to climb out of the water if problems arise.