Birthing in Water
There was simply no way. It was imperative to seek out other birth choices. My second birth experience comprised all the traditional cocktails a modern childbirth has to offer. Induced, strapped to a bed, denied food with a painfully neglected IV stuck up my arm, it was nothing short of a miracle I wasn’t sectioned. My daughter arrived, unscathed by the harsh pitocin, but not the pulling and tugging of rough hands, and I endured the whole thing without pain medication. The memories surrounding what should have been a peaceful introduction of a beautiful child, are filled with degradation, belittle-ment, and resentment. Never have I felt so mistreated and violated in such a personal way. I spent that first and last night in that hospital in full defense mode. I fended off nurses who cited hospital policy while bringing bottles of formula and seemingly sadistic ideas on how to keep baby awake. Not until my third pregnancy did I understand the gravity and risks of pitocin (so much for informed consent) and other typical interven-tions. Yes, there was simply no way, I was staying home to birth baby number three.
With a womb full of life, my husband and I eagerly pored over books and videos given to us by the midwife we chose to share our birth with. The waterbirth videos were intriguing. We watched, almost in a trance, baby after baby born with ease underwater, emerging from the glittering liquid to trium-phant waiting arms, like a baptism. After our third or fourth video, my husband voiced an unspoken agreement, ”This is what we’re going to do.” So began our tradition of water birthing, the first of five.
That was twelve years ago.
History
Today, the concept of water birthing continues to intrigue and cajole women across the globe as an therapeutic option for pain management and easy transition for the child. Although water birthing may be shocking to modern, medical consciousness, the practice is certainly not new and has been increasing in popularity in America since the ‘90s. Birthing in water is the practice of laboring and delivering in a tub of warm water (98 to 100 degrees Fahrenheit). It has been said water birthing has been around for a millennia, but there is little concrete evidence to show for this. The first modern water birth, as documented, took place in 1803, in France, in a French Medical Society Journal. We know water birthing has a lengthy history because of stories and legends told. The Chumash Indians of central California birthed in water. Chumash elder Grandfather Semu, who passed in 2004, would recall as a child, seeing women going to the beach to labor and birth their babies. Indian tribes in North, Central, and South America as well as Maoris of New Zealand may have given birth in ocean or river environments. Until 1960, reports of these types of births were scattered. Igor Charkovsky, a researcher, birth assistant, water trainer, and inventor of the Russian Birth method, documented his observations with water and the healing of sick infants. Charkovsky assisted in 2,000 waterbirths. Here, in the United States, the first birth center to offer this choice appeared in 1985. The Family Birthing Center of Up-land, located in California, was owned and operated by Dr. Michael Rosenthal. Rosen-thal’s clinic was inspired and modeled after Dr. Odent’s work in France, a champion for water birth, who offered this option to women in his own practice. By the time The Family Birthing Center closed in 1995, nearly one thousand women had birthed in water at the clinic with zero complications and infection, in the mothers or their babies.
How Does It Work?
A water birth is pretty straightforward. It takes place in a tub, jacuzzi, pool, or any container large enough to accommodate a laboring mom and/or her partner and family. The water should be between 98 to 100 degrees Fahrenheit, the same body temperature as the mom, and high enough to cover the belly. The temperature is regulated by a disposable thermometer, cooking thermometer, or by the mom herself. If the birth is taking place in a freestanding container, the water is usually kept warm by heating pots of water on the stove. My midwife provided a horse trough for my first three waterbirths, but the last two took place in kiddie pools. When using containers that need to be pumped, the sides should be sturdy enough to support the mom. Some moms just use the warm water for purely therapeutic purposes, and get out of the pool for the actual birth (“land birth.”) I loved laboring in the water and birthing in the water, it provided a wonderful, natural alternative to drugs. During one of my labors, I remembered feeling as though the warm water wasn’t helping the pain and decided to leave. As soon as I stood up, gravity, weight, and a major contraction hit all at once. I quickly got back into the warm water and appreciated the difference between land and water births!
Advantages & Disadvantages of Water birth
The advantages of the water birth are numerous, but in my experience and opinion, the main advantage leads to other advantages which encompass the goal of whole-some birth. The warmth, fluidity and ease of the water promotes relaxation, the key to a smooth birth. When the mom is relaxed, she is better able to concentrate. The buoyancy of the water contributes to the ease of movement, providing consistent relaxation throughout the labor and birthing process. Pain is drastically reduced, and in some cases eliminated, thus promoting relaxation. The responses of mom and babe are an intimate dance of hormones. Emotions felt by the mom are felt by the baby because of the hormones her body secretes in response to her emotions. Therefore, the laboring mom’s ease is transferred to the baby. The warmth of the water (and I believe a relaxed mom) promote blood flow to the uterus, providing oxygen to the uterine muscles and the baby.
Other advantages include:
- Reduced stress-related hormones/ Blood Pressure
- Elasticity of the perineum
- A protected space
- Faster labor
- Conservation of energy
- Reduced cesarean section rates
- Lesser shock and sensory overload for the infant
There was a marked difference between my land and water births, and that is in the behavior of my babies themselves. After my land births (first and second babies, born in a birth center and traditional hospital setting respectively), my new-born daughters were extremely agitated, crying, and highly upset. However, my water babies behaved calmly. Absolutely no crying was heard upon their immediate arrival. They were alert, conscious, and actively looking about, as if to say, “Where the heck am I?” Their first breath came quietly, usually with a gasp or a hiccup without fanfare. Their first cries only came when they became uncomfortable in some way (chilled or hungry), and these cries were usually gentle (opposed to being inconsolable, screaming cries). My seventh child was a lotus baby and did not cry at all until she was separated from her cord, which occurred a few days later. Since my first water birth, never again have I looked at screaming, newborn baby being jostled about, as depicted by media in hospital settings, as a “successful” birth. From what I’ve experienced, that is a traumatized baby and a counter-intuitive way to introduce a conscious newborn to the world. While water birth has significant advantages for the mom, a gentle introduction is the ultimate advantage and I hold it in high regard.
“The safety and efficacy of immersion in water during the second stage of labor have not been established, and immersion in water during the second stage of labor has not been associated with maternal or fetal benefit. Given these facts and case reports of rare but serious adverse effects in the newborn, the practice of immersion in the second stage of labor (underwater delivery) should be considered an experimental procedure that only should be performed within the context of an appropriately designed clinical trial with informed consent.”
While their argument against water births is due to “unestablished” safety, the safety of water births have been firmly established by many reputable experts and studies. Dr Michel Odent was the first physician to keep water birth statistics, he reported that no episiotomies were performed in 100 attended births in 1983. In 1989, a nationwide survey was published in the Journal of Nurse-Midwifery that produced favorable statistics. Dr. Rosenthal published a study of 483 water births in 1991. In 1994 the Royal College of Obstetrics and the Royal College of Midwives released statements endorsing water-births. In 2009, a study of 3,243 women conducted by Cluett and Burns showed that “There is no evidence of increased adverse effects to the fetus/neonate or woman from laboring in water or water birth. However, the studies are very variable and considerable heterogeneity was detected for some out-comes. Further research is needed.”
Neonatal Infection and Aspiration Concerns
Concerns of neonatal infection and water aspiration stemming from water birth are cited by ACOG, AAP, and other oppo-nents of water birth. However, a study of 1,600 water births conducted by the Department of Gynaecology and Obstetrics in Vipiteno/Sterzing, Italy, showed that birthing in water does not increase the infection rate if regular hygiene rules are respected. Cluett and Burns showed “no difference in infection rates” between land and water births. In labor, everything moves down and out. The mom’s vaginal ecosystem colonizes the baby and provides the gut flora and immunity it needs. A high quality, certified organic, non-GMO probiotic throughout pregnancy (many probiotic products on the marketplace are genetically engineered) can support a balanced ecosystem. Observing commonsense rules of a clean tub and clean bodies (children, partners who join mom) should be observed.
The chances of the baby aspiring water are very small, although it can happen if proper procedures aren’t followed. The baby in utero receives oxygen from the placenta and continues to receive oxygen throughout birth from a pulsing umbilical cord. What’s known as the diving reflex prevents a healthy baby born in water from drowning. When the baby’s nose and mouth is exposed to air it initiates the complex physiological process that results in baby’s first breath. It should be noted that water babies are slower to start this process because their entire body is exposed to air at once. Babies must be lifted out of the water, slowly, gently, and soon after birth, being mindful of the length and placement of the umbilical cord at all times. Some parents and midwives allow the baby to stay immersed for a few minutes, all the while, monitoring the pulsing umbilical cord. In my waterbirths, I preferred to bring my babies out of the water as soon as they were born. Naturally, babies should not be re-immersed once exposed to air.
There are many, many more studies showing the safety of water births from the past twenty odd years, yet in 2005 the AAP first denounced water birthing and again, jointly with ACOG, early in 2014. It should be noted that the AAP and the ACOG’s statement is an opinion, as declared on their website, based on certain research and references. Opposing voices have challenged the references cited by the ACOG, stating that the research quoted by the ACOG are case studies (singular, individual outcomes,) and research that is unrelated to water birth. The Royal College of Midwives issued a statement in re-sponse to the ACOG and AAP’s joint statement, confirminging the safety of the use of water for birthing. What is truly unfortunate about the ACOG opinion statement is that some hospitals and birth centers have withdrawn the option of water birth in response, effectively limiting an already limited range of birth choices. Why, despite the established history of water birth safety, would they cite safety concerns?
Changing the Role of Providers
Childbearing women are a vast marketplace, and our babies have become products to deliver for us and to us. Childbirth is huge business and the ACOG and AAP are simply protecting their turf as more moms consider alternatives to hospital births.One of the many advantages of water births, it gives the laboring mom a protected space and gives her more control over her ex-perience. This drastically changes the role of the doctor and midwife in this scenario. They become observers and advisers as opposed to active participants. Dads can join the moms in the tub securing the birth as a natural, family event and not a medical experience or service.
References
• http://breechbabiesclub.org/perspective-breech-water-birth/
• http://www.birthspirit.co.nz/about-5/
• http://www.midwiferytoday.com
• http://www.theguardian.com/lifeandstyle/2011/jun/25/obstetrician-
frederick-leboyer-childbirth
• http://www.cdc.gov/nchs/fastats/inpatient-surgery.htm – Procedures
performed. C-Section 1.3 million
• http://draxe.com – C-Section 3rd commonly performed surgery
• http://www.cdc.gov/nchs/data/nvsr/nvsr63/nvsr63_02.pdf
• http://www.who.int/healthsystems/topics
• http://jama.jamanetwork.com/article.aspx?articleid=192908
• https://www.cia.gov/library/publications/the-world-factbook
Breech Water births
Breech births are typically considered high risk and the many studies that establish the safety of water births are focused on low-risk pregnancies. Research and studies on breech water births are miniscule at best. However, Dr. Hermann Ponette, a Belgian doctor, considers breech birth an “indication for water birth” and actively promotes it. He states that the greatest
advantage of these types of births is that the body floats up, supported by the water, minimizing dangerous manipulations and allowing the head to be born with ease. Maggie Banks, a former New Zealand midwife offers her perspective on breech water births: “The use of deep water immersion with mal-presentation [read: breech] is contraindicated in hospital clinical guidelines on water birth, and the use of water is absent as a modality in vaginal breech birth guidelines. Embracing these, giving birth in water to a breech baby would be out of the question for some maternity providers. Yet others are very specific in seeing breech presentation as a positive indication for water birth because of the buoyancy afforded to the baby and umbilical cord, both of which are kept warm in the water until surfacing into the cooler air.”
Statistics
Not only are cesarean sections high, averaging 33%, despite WHO’s (World Health Organization) recommended rate of 15%, but cesarian sections account for the 3rd most commonly performed surgery in the US today and are often unnecessary. For
African-American women, this rate is even higher, averaging at 36%.
Our infant mortality rate, often used as an indicator of the health of a country, is a sad, revealing statement when considering our high tech, industrial advantage. With 6.17 infant deaths per 1,000 live births, Serbia, Lithuania, Croatia and Bosnia fare better than us. Monaco leads the whole with just 1.81 per 1000.
In 2010, the leading cause of death in the neonatal (less than 28 days after birth) were disorders related to short gestation and low birth weight according to CDC’s National Vital Statistics Report. And, by the way, we ranked last (13th out of 13 industrialized countries reported by JAMA in 2000) in terms of low birth weight. If these stats aren’t disturbing enough, Iatrogenics, (harm, illness, or death caused by medical care) is the third leading cause of death in the United States, with a range of 200,000 to 400,000 fatalities a year. And I haven’t even mentioned the maternal mortality rate, a shocking 21 deaths per 100,000 live births. Again, the stats are higher for African American moms. We are 3 to 4 times more likely to perish in childbirth.
Our culture of birth is riddled with overuse of procedures and analgesics that relate more to business policies than evidence-based care. As a country with poor health statistics, it would make sense to embrace the peer-reviewed, water birth studies of our European neighbors who fare better in infant and maternal mortality rates than we do. (UK – 4.44 per 1000, France – 3.31 per 1000)