Water Birthing

[Magnetek Blue]

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This randomly came up when talking with a few friends: how long can a newborn stay under water after a water birth? I attempted to find the answer elsewhere, but I couldn't.

 

[Toohotinvegas33]

Excellent question, why dont you go find a bunch of new mothers that are willing to see if they want to drown their infant? Water birthing is not recommended due to increase risk of neonate meningitis/encephalitis.

 

[Magnetek Blue]

Thanks for the response, but I'm just asking out of curiosity, not because I plan on being part of one.

I found out that the blood vessels of the umbilical cord will collapse within five minutes of birth due to a drop in temperature, but what if the temperature of the water bath is the same as in utero? Would the newborn continue living off the mother until other unrelated issues arose (infection, solute imbalance)?

 

[Toohotinvegas33]

Theoretically if you created an environment similar to in utero I guess it could be possible, but why? Im sure you could take an animal model, suspend the mother in a amniotic bath with a fetus still attached to its umbilical cord and the cord still attached to the mother through a small c-section opening that has been closed around the cord.

 

[ceg]

Water birthing is not recommended due to increase risk of neonate meningitis/encephalitis.

Just curious if you can provide any sources or data to back that up? It isn't true, you see. That's why I ask 😉

 

[MJB]

Just curious if you can provide any sources or data to back that up? It isn't true, you see. That's why I ask 😉

I don't know if it's true or not, but can you explain to me the advantages of water birthing?

 

[tootsweet]

This randomly came up when talking with a few friends: how long can a newborn stay under water after a water birth? I attempted to find the answer elsewhere, but I couldn't.

I don't have the answer to your question but waterbirth option was definitely an important factor in choosing a place to deliver. Warm water is wonderful pain relief, especially around transition..

I chose not to have an epidural because I didn't want to be paralyzed and catheterized. Anecdotally (multiple sub-Is on ob) it just seemed that patients who had them were more likely to go to section and have engorged labias that resulted in greater tearing.

I highly recommend waterbirth for pain relief for those low-risk patients looking to labor naturally.

 

[ceg]

I don't know if it's true or not, but can you explain to me the advantages of water birthing?

Laboring in water provides excellent pain relief. It reduces tears. It lowers BP. It can assist in rotating a malpositioned baby. It reduces use of narcotic and epidural pain relief and all of their associated risks as well as those that go along with them- i.e. pitocin, continuous monitoring (which can be done in the water, just generally isn't), IV fluids, etc. It allows for great freedom of movement for the mother. Reduced rates of assisted and surgical delivery.

As for the actual birth, many people think that water birth provides a gentle transition for baby. I think the issue is more that after laboring in water it is unappealing to get out of the water to give birth. There is also some evidence that it reduces the risk of shoulder dystocia and is helpful in vaginal breech delivery by reducing pressure on the head as it delivers. The incidence of tears (and obviously episiotomies) is reduced in water births but the same effect may be achieved by the water labor.

There is some info at Waterbirth International (www.waterbirth.org). It's an organization that promotes waterbirth and assists practitioners and facilities in developing protocols. There's also some info on safety on the site. Aspiration is obviously the main concern along with maternal/neonatal infection but neither have ever been demonstrated in large trials, mainly in other countries, obviously.

I am clearly biased in favor of waterbirth having personally had one of my kids in the water and delivered babies in the water (which is really a non-event since they pretty much deliver themselves).

There are some youtube videos if anyone is very interested. I have heard there is one where the baby is left underwater for a long time- that is not standard. Typically the baby is immediately brought to the surface. But check them out if you are interested.

 

[ceg]

Thanks for the response, but I'm just asking out of curiosity, not because I plan on being part of one.

I found out that the blood vessels of the umbilical cord will collapse within five minutes of birth due to a drop in temperature, but what if the temperature of the water bath is the same as in utero? Would the newborn continue living off the mother until other unrelated issues arose (infection, solute imbalance)?

The placenta shears away from the uterine wall as a result of involution. So, no.

 

[jvarga]

Although I am not against alternative treatments, I do have a problem with water births. My main beef is not with the water birth itself, but in that it has gained such mainstream acceptance and popularity despite having very poor science to support its propronents' claims. In fact, the few "true" scientific studies that have shown supportive results have been massively misquoted and the data erroneously extrapolated. For example, a review article published in 2004 revealed that immersion in water during the first stage of labor did significantly reduced women's perception of pain and their use of epidural analgesia, but there was no data to support its use during the second or third stage of labor. When you go to the pro-water birthing sites, books, or propenents, they are quick to quote that water birthing decreases pain and therefore prevents epidural usage (a partially true statement as detailed previously), but they are not so quick to spell out the "true" scientific data as this would not be convenient to or supportive of their stance. As we all know, the devil is always in the details!

More concerning than the exaggerated benefit claims, is the inherent risk to the infant. In one report, the water from the 1,500 birthing pools at several sites (home, birthing centers, hospitals, etc.) was analyzed prior to anyone entering the water. Not surprisingly, a veritable bacterial jungle was found in the water of these pools (especially the home pools). However, on the surprising side, even the water from the pools in the supposedly "clean" hospital and birthing centers also had evidence of contamination with deadly bacteria. The report showed coliforms in 21% of the samples, enterococcus in 19%, Legionella in 12%, Pseudomonas in 11%, and E.coli in 10%. Installing filters diminished the levels of contaminants, but did not eliminate them. Essentially, these patients are giving birth in the equivalent of toilet water. Keep in mind that these pools are kept at body temperature, which just happens to be the optimal temperature for bacterial growth. In a study published in 1999 that followed over 4,000 water births, it was noted that 35 infants suffered serious morbidity and 3 died (causation of these deaths could not "clearly" be linked to the water birth). 32 were admitted to the NICU and, of these, roughly one half had significant respiratory problems, including pneumonia, meconium aspiration, water aspiration, and drowning. Five babies suffered severe hemorrhage secondary to "snapped" umbilical cords. All in all, 18 babies had serious complications directly attributable to water births and many more had complications that were not "clearly" attributable to the water births.

Putting all of this information together, there can only be one reasonable and logical conclusion. Water birthing definitely has some advantages and some glaring and dangerous disadvantages. It shows plenty of promise for the future but more honest scientific studies are needed before its practice is to be continued. The Academy of Pediactrics said it best in their 2005 advisory:
"The safety and efficacy of underwater birth for the newborn has not been established. There is no convincing evidence of benefit to the neonate but some concern for serious harm. Therefore, underwater birth should be considered an experimental procedure that should not be performed except within the context of an appropriately designed randomized clinical trial after informed parental consent".

To answer the OP original question, I am not aware of any study that has looked to see how long the infant can safely stay underwater and I do not believe that said study would ever be approved. As someone previously mentioned in this thread, the usual practice at water births is to take the infant out of the water immediately after birth as there is no benefit to leaving the infant under water.

 

[MJB]

Laboring in water provides excellent pain relief. It reduces tears. It lowers BP. It can assist in rotating a malpositioned baby. It reduces use of narcotic and epidural pain relief and all of their associated risks as well as those that go along with them- i.e. pitocin, continuous monitoring (which can be done in the water, just generally isn't), IV fluids, etc. It allows for great freedom of movement for the mother. Reduced rates of assisted and surgical delivery.

As for the actual birth, many people think that water birth provides a gentle transition for baby. I think the issue is more that after laboring in water it is unappealing to get out of the water to give birth. There is also some evidence that it reduces the risk of shoulder dystocia and is helpful in vaginal breech delivery by reducing pressure on the head as it delivers. The incidence of tears (and obviously episiotomies) is reduced in water births but the same effect may be achieved by the water labor.

There is some info at Waterbirth International (www.waterbirth.org). It's an organization that promotes waterbirth and assists practitioners and facilities in developing protocols. There's also some info on safety on the site. Aspiration is obviously the main concern along with maternal/neonatal infection but neither have ever been demonstrated in large trials, mainly in other countries, obviously.

I am clearly biased in favor of waterbirth having personally had one of my kids in the water and delivered babies in the water (which is really a non-event since they pretty much deliver themselves).

There are some youtube videos if anyone is very interested. I have heard there is one where the baby is left underwater for a long time- that is not standard. Typically the baby is immediately brought to the surface. But check them out if you are interested.

Are the claims you make backed up by studies/data?

Thank you for the info. I'll look into it further. I didn't find much evidence when I looked before, so that's why I ask.

 

[ceg]

Are the claims you make backed up by studies/data?

Thank you for the info. I'll look into it further. I didn't find much evidence when I looked before, so that's why I ask.

If you go to the www.waterbirth.org website they have a section of references. I unfortunately don't have time to look for any now, but I am almost positive there is a page there. If not and you get to pubmed try looking in the European journals- there won't be much in american studies because of the $$ issue.

 

[ceg]

More concerning than the exaggerated benefit claims, is the inherent risk to the infant. In one report, the water from the 1,500 birthing pools at several sites (home, birthing centers, hospitals, etc.) was analyzed prior to anyone entering the water. Not surprisingly, a veritable bacterial jungle was found in the water of these pools (especially the home pools). However, on the surprising side, even the water from the pools in the supposedly "clean" hospital and birthing centers also had evidence of contamination with deadly bacteria. The report showed coliforms in 21% of the samples, enterococcus in 19%, Legionella in 12%, Pseudomonas in 11%, and E.coli in 10%. Installing filters diminished the levels of contaminants, but did not eliminate them. Essentially, these patients are giving birth in the equivalent of toilet water. Keep in mind that these pools are kept at body temperature, which just happens to be the optimal temperature for bacterial growth. In a study published in 1999 that followed over 4,000 water births, it was noted that 35 infants suffered serious morbidity and 3 died (causation of these deaths could not "clearly" be linked to the water birth). 32 were admitted to the NICU and, of these, roughly one half had significant respiratory problems, including pneumonia, meconium aspiration, water aspiration, and drowning. Five babies suffered severe hemorrhage secondary to "snapped" umbilical cords. All in all, 18 babies had serious complications directly attributable to water births and many more had complications that were not "clearly" attributable to the water births.

Putting all of this information together, there can only be one reasonable and logical conclusion. Water birthing definitely has some advantages and some glaring and dangerous disadvantages. It shows plenty of promise for the future but more honest scientific studies are needed before its practice is to be continued. The Academy of Pediactrics said it best in their 2005 advisory:
"The safety and efficacy of underwater birth for the newborn has not been established. There is no convincing evidence of benefit to the neonate but some concern for serious harm. Therefore, underwater birth should be considered an experimental procedure that should not be performed except within the context of an appropriately designed randomized clinical trial after informed parental consent".

.

Studies have shown a million times over that hospitals, public restrooms, door handles, etc are covered in harmful bacteria. Just because one study showed the presence of bacteria, there is no demonstrated increase in infections for the mother or baby.

I daresay 18 babies of 4000 suffering complications clearly attributable to waterbirth is far and away below the number of babies who suffer complications from garden variety obstetric procedures every day (in particular elective induction) in my hospitals. Snapped umbilical cords are an unfortunate risk of waterbirth but not exclusively of waterbirth- I have seen snapped cords in "traditional" births as well. I don't have the data, nor the time to find it, how does 4.5/1000 complications compare to non-water deliveries? And what was the definition of complication in your study?

AAP may have a policy statement that is unsupportive of waterbirth, but that doesn't necessarily reflect the evidence. I think both AAP and ACOG have shown us that their policies are little more than opinion.

Cochrane has a different opinion
"Authors' conclusions
Evidence suggests that water immersion during the first stage of labour reduces the use of epidural/spinal analgesia. There is limited information for other outcomes related to water use during the first and second stages of labour, due to intervention and outcome variability. There is no evidence of increased adverse effects to the fetus/neonate or woman from labouring in water or waterbirth. The fact that use of water immersion in labour and birth is now a widely available care option for women threatens the feasibility of a large, multicentre randomised controlled trial."

We could make an extensive list of practices introduced into OB without appropriate evidence. How about electronic fetal monitoring?

I'm sure we'll continue to agree to disagree on this issue. In the end I believe it is about the risk you as the practitioner are comfortable with. I will not perform elective inductions but I will perform waterbirth. Obviously many others disagree with how I feel, but that is my level of comfort.