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Sunday
Apr222012

Waterbirth Revisited

Let’s just say, I’ve seen some awesome water births. Peaceful, lovely… the baby sliding out of mama and being caught in her hands just before total ejection… then being lifted to –and out of- the surface, pulled into his or her mother’s breasts for safekeeping. Heartwarming at the very least.

But, as I’ve been re-evaluating all the different aspects of home and hospital birth, I couldn’t let water births go without examination.

There is no doubt that being in the water is calming for a mom, allowing the uterus to “float” off the nerves, diminishing pain considerably. “The midwife’s epidural” it’s been called and I would attest to that many times over. But what of the ick that is a common and pervasive part of birth? “Ick” being bodily secretions like urine, feces, and mucous. We might include blood, sweat, tears and possibly even saliva, even though most people don’t think of those as being too icky.

Mind you, I’ve never had a problem with bodily secretions during birth. (Well, except for that one time when I co-barfed in a metal bowl during one woman’s transition.) Poop, pee, vomit, sweat, saliva, tears, blood, mucous… none of them remotely bothers me… so while I use the word “ick” it isn’t so much that I think of them as icky, but know that, as we delve into the topic, many reading will find some of the normal bodily functions icky, especially when discussed in conjunction with birth.

During birth, it behooves a woman to abandon any societal restrictions she has about bodily functions. That requires a trust in her care providers and a belief that everything she might emit is normal, unless told otherwise (too much bleeding, for example). In fact, midwives are a hilarious bunch that find bodily functions applause-worthy. “You threw up? Fantastic!” or “You’re having lots of loose stools? Great!” And that isn’t to help a woman feel comfortable in her emissions, but because the various actions are positive signs regarding the progression of her labor. Loose stools can herald impending labor and throwing up can be a sign of transition. Women like to be told they are progressing in their labors; bodily secretions can give everyone wonderful clues about those progressions.

But what if the poop and vomit were in the birth pool? Oh, women don’t vomit in the pool, you say? True enough, but they do vomit in the toilet (or whatever is barfed into a bowl goes into the toilet). Poop and pee go into the toilet usually, too. But, in birth, both of those can –and often do- happen in the pool.

This is where I started re-thinking waterbirth.

If mom pees and poops into the pool… and a baby is born into the pool with poop and pee… is that gross or is that not gross? For ages, our birth kits included a fishnet to scoop poop out of the pool, but hasn’t the poop already contaminated the water? And there isn’t a fishnet small enough to get liquid poop or urine out of the water… what of that?

When women have asked these questions, we’ve appeased them with, “it’s diluted to almost nothing” or “it’s only yours,” but are these adequate? Or even true? What if dad gets in and can’t get out to pee? And does dilution make it any better? All kinds of stuff can be in poop and pee, including e coli and group b strep. Do we want to dredge our newborn child through those possibilities?

We poop and pee in the toilet every single day. Would we dunk our child in that water… even after flushing? The thought is nauseating. Why then is it okay to have our newborn come out into the ick of a birth pool?

Suddenly, I understand the requirements of so many birth centers and hospitals to only allow labor in the tubs, but birthing out of the water. I always thought that was a dumb rule and even heard the arguments about why without really thinking the whole thing through; the baby is born in a toilet bowl. Isn’t that kind of gross?

I remember one dad who was in the pool with his wife and as soon as she let him get out, he ran to take a shower even though he had a newborn to cuddle with. We all thought it was kind of silly, but on second thought, did he have the right idea and the rest of us were somewhat deluded?

I used to think I’d love to have a waterbirth. Now, not so much. How have you been able to wrap your head around birthing in a tub with poop, pee, mucous and blood? I look forward to what folks have to say.

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Reader Comments (34)

I have 6 children, labored with them all but one in the water. I only birthed 2 in the water. You do what feels right in the moment. The only excrements I would be concerned about are poop and possibly vomit in the pool. Urine and Blood should be sterile unless you have an infection. You are also not leaving the baby underwater for long. If the babies skin is intact then there should be little avenue for disease to transmit. Vomit should also be disease free unless there is some other infection going on. Stomach acid kills most everything. There is evidence based research that exposure to the vaginal canal helps to colonize the babies GI tract. These babies suffer from fewer cases of asthma and allergies. So what is any different then a few seconds/minutes in a very diluted pool of those same excretions?

April 22, 2012 | Unregistered CommenterRachael

There was a celebrated case a few years ago in the UK when a baby died after aspirating fecally-contaminated water from a birthing pool. The two attending midwives were charged with manslaughter, and when they attempted to defend themselves by claiming that the mother refused to leave the pool in spite of their urging, they were told by the court that they should have physically hauled the woman out [!!] and so failed in their duty.

To me, waterbirth is just a gimmick. Humans do not, nor ever have, delivered in water. Even being born with intact membranes ["a caul"] is relatively rare, and the membranes are always instantly ruptured lest the baby aspirate amniotic fluid [sterile] with its first breath.

The more extreme the gimmick, the more some women feel they have to singularize themselves by adopting it, I suppose for bragging purposes because I can't see any other reason for it.

The use of showers, jacuzzis, pools in LABOR, as long as the membranes are intact, is indeed calming and beneficial. Delivering a baby underwater has no intelligent rationale at all.

April 22, 2012 | Unregistered CommenterAntigonos CNM

My hospital gave the option of water birth, but I elected to just labor in the tub and get out for serious pushing. I wasn't so much put off by the bodily fluids (thoug that was a factor) as I was horrified about being totally exhausted and having to worry about keeping the baby clear of the water. It just seemed like an unnecessary thing to have to think about- I wanted to be DONE once I got him out... concentrating on learning to nurse, not concentrating on avoiding accidentally drowning my baby.

April 22, 2012 | Unregistered CommenterMeagan

Before I started attending births through water, I felt the same way. Why would anyone want to immerse themselves in THAT?? But the births ARE so beautiful, gentle and peaceful (generally speaking, anyway). The women I care for who do birth in the water are almost invariably happy with the experience. And surely that is what I am here to do - provide information to allow women to make their own decisions about their births and keep them and their baby safe?
But I agree with all you have said - I still have doubts. I don't think I would want to birth through water (although my daughter had my grandson in the birth centre birthing pool). To date we have had no instances of infections being linked to birthing in the pool, but is it simply a matter of time?

April 22, 2012 | Unregistered CommenterSuz

Really? Have we not established that birth is messy and 'icky', no matter where or how it's done? I watched a birth video recently( hospital birth, mind you) and the mom was pooping as she pushed her baby out. So basically, her baby's face was about an inch or less away from poop as it was being born. You really believe that no babies born in hospital beds, are coming in contact with poop? Their little noses are RIGHT THERE. This mother's poop was loose ( sorry tmi) and there is no doubt some came in contact with the baby's face. Also, what about vernix? Doesn't it have certain anti-microbial properties? So, our only concern is that the baby inhales the water, and how often does that happen? Many hospitals are starting to now allow waterbirths and there is no way that would happen if baby's were inhaling water, even occasionally. There is no conclusive evidence that waterbirth is dangerous, so who cares about the ick factor?

I had a waterbirth. There was no poop, no vomit and almost no blood. The water was remarkably clear. And Antigonos, CNM, I find your comment incredibly insulting. You think we do this for bragging purposes? You obviously don't think very highly of women, do you? Do you want to know why I did a waterbirth? Well, for one, as a survivor of rape, I felt comforted by the privacy the water gave me. There is a little bit of distance given to you when you are in the water, and you just feel more safe and less vulnerable when you are in it, pushing a baby out of your vagina. I appreciate my midwives so much for not accusing me of bragging rights, because they are compassionate like that. Actually, they suggested waterbirth, because they knew my history and they are aware that it is a helpful tool for women who have been sexually assaulted. Furthermore, being in the water is incredibly soothing and helpful with the pain. Pain doesn't stop once you push, you know. what's the point of using water for pain relief during labor and not for pushing? Pushing was the only part of labor that was even painful for me and it was the only time I got in the water. The buoyancy the water gives is also very helpful for getting in a good positon and moving around.

Why do we have to judge women for something that is SO helpful in labor and birth, especially when there is no evidence that shows that it's harmful? I just don't get it.

April 22, 2012 | Unregistered CommenterAmom

I have been to many beautiful water births. I labored in the tub for my second birth, but birthed on the bed.

I am not going to unconditionally defend water birth. I can see definite issues with possible aspiration.

However, during vaginal delivery, the baby is born onto the perineum. There can be much more concentrated feces, urine, mucus and blood right there than there would be in a birth pool. OK, usually not vomit, but I have never seen someone vomit in the birth pool, and would have a problem with her staying in if she did. Once we start trying to "protect" the baby from the icky stuff that is found around the vagina, we are getting dangerously close to calling the non-sterilizable vagina as unfit for delivery versus the almost sterile cesarean section.

April 22, 2012 | Unregistered CommenterMomTFH

I was grateful to be able to labor in the tub with three of my children, but I always needed to get out before it was time to push. It stopped being soothing -- I needed my feet on the ground. Maybe I needed gravity too?

My midwife is not in favor of birth in poop-contaminated water, FWIW. (I don't know what she would do with a woman who was adamant about staying in the water.)

April 22, 2012 | Unregistered CommenterJamie

Suz, why is "beautiful, gentle and peaceful" worth ignoring the possibility of serious infections?

You say "And surely that is what I am here to do - provide information to allow women to make their own decisions about their births and keep them and their baby safe?"

Yes, that is your job. But risking serious infections isn't keeping them safe. Icky discussion certainly isn't a reason to avoid a practice, but it is a reason to seriously look at the risks and benefits and make a reasoned decision about the practice rather than handwaving away risks because "oh it's so peaceful!"

April 22, 2012 | Unregistered CommenterWhatPaleBlueDot

I found water to be a remarkable tool for pain relief during active labor/transition. I would never agree that women shouldn't have access to water during this part of birth. As for actually birthing in the water, I didn't find it necessary. Water was no longer helping me when I got to the pushing stage of labor, so I got out and delivered on the bed. The water in the pool was clear, though. No pooping or vomit in the tub and the midwives had nets at the ready to remove any debris should it have occurred. If the pool was particularly contaminated or cloudy I don't think I'd want to be in it as a laboring woman and would switch to the shower. I don't see why a hospital or birthing center couldn't develop a set of guidelines for water birth that would promote healthy labors and infants. It doesn't have to be "any type of birth in the water is appropriate" or "no part of labor/birth in the water is appropriate".

April 22, 2012 | Unregistered Commenterhwar

I've been to a lot of water births. When I first started attending them, I worried about infection risk due to fecal contamination, but then I did my research. According to http://www.ncbi.nlm.nih.gov/pubmed/16147851 , there is not an increased risk of neonatal infection during waterbirth. And, according to http://www2.cfpc.ca/local/user/files/%7BE757C7FC-F557-4CED-A956-D73E666774C0%7D/ACOG%20Waterbirth%20%20GBS.pdf, "A single case of early onset newborn Group B Strep was documented among 4,432 hospital births into water in the absence of GBS prophylaxis, suggesting that low risk women giving birth into water have a 300% lower rate of newborn GBS disease newborns than dry, full term births delivered by current GBS guidelines." This information helped me to feel much more comfortable about infection risk in water birth.

April 22, 2012 | Unregistered CommenterKim Pekin, CPM

WhatPaleBlueDot- if we are going to by the science, than we will wait until some legitimate studies have be done before we start condemning waterbirth for what we "think" is icky and risky. Waterbirth is done all over the world now, if it was really that dangerous, we would have case, after case, after case, of babies dying from infections and aspiration. What do we have? Possibly ONE case that is connected to waterbirth. And even that one case is not definitively a result of waterbirth.

April 22, 2012 | Unregistered CommenterAmom

http://www.ncbi.nlm.nih.gov/m/pubmed/21322437/

I found the above study to be a positive, as I have always been GBS positive for each of my 4 pregnancies.

April 22, 2012 | Unregistered CommenterTrish

One thing I've never understood about waterbirth is that it would seem to counteract a couple of the mechanisms by which the baby starts breathing. One is the sudden expansion of the lungs after being squeezed by the birth canal- it's helpful when air rushes in rather than water. Another is the shock of a temp change. I'm not saying a 50 deg room is good, but even a warm 75 deg is a big change from 98.9. The temp change triggers a gasp. These things work together to help the baby take its first breath. Certainly if the first "breath" is fecally contaminated water, it's probably... not good? And then there's the need for a baby to be warm. Harder to maintain in a pool.

However the research I'm aware of doesn't reflect an increased rate of pneumonia, sepsis, low APGARs. So I'm not sure what to think in terms of wb and risk to the baby. There seem to be a number of benefits for the mom. I wonder if some of the benefit to perineal integrity isn't simply that the caregiver is forced to be hands off!

April 22, 2012 | Unregistered CommenterKatie

Dear Barb,

I agree with your thoughts and feelings about water birth. It's difficult for me to admit my concern about cleanliness when faced with how beautiful and emotionally engaging the birth can be, but it seems that it is everyone's (parent's and health care provider's) responsibility to "error on the safe side". I also used to think it was silly for hospitals to allow labor but not birth in the water (I think I thought it was just because doctors were uncomfortable with the mechanics of water birth), but I have to admit their point now. Why not be careful?

Thank you,
Mindy

April 22, 2012 | Unregistered CommenterRCPM

We do have case reports of pneumonia and water aspiration related to water birth.

http://cid.oxfordjournals.org/content/33/9/e103.full
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC154682/
http://www.ncbi.nlm.nih.gov/pubmed/15329532
http://pediatrics.aappublications.org/content/110/2/411.extract
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC557235/

We really need more, larger trials that sufficiently powered to detect differences in mortality before we conclude that water birth is safe. It certainly isn't natural for humans.

April 22, 2012 | Unregistered CommenterBecky

Also, this survey of GBS cases -- does it control for whether the reported studies excluded GBS+ women from waterbirth, as some places do? Is that CFPC link the whole of the article? If that is it, then it is horrible science. It doesn't control for any possible confounding factors, the author doesn't seem to understand some basics of disease transmission and GBS prevention, and is obviously biased. With whom would such drivel have any credence?

April 22, 2012 | Unregistered CommenterBecky

I'm not comfortable in the water...I get too hot, and want to be standing. Love the shower actually and yet am not comfortable dropping a baby in there. I know that I have had poop come out of me as I am pushing, I have felt it and felt the midwife cover it with a wash cloth type thing. I can only imagine how horrible I would feel seeing it float up by me in the water as my baby came out of me. But then again, my babies have been born in their own mec several times. I would love to know actual numbers...dry vs. waterbirth and infection...which is truly higher?

April 22, 2012 | Unregistered CommenterDawn

I feel like a perineum is going to have at least as much fecal contamination as a pool full of water.

At any rate, I am a midwife who does not love waterbirth, though I had two of my own. With my second I was determined to give birth on land, but once I got in during my super intense 2 hour labor I was not getting out. As a mom, what I did not like about my waterbirths was how my babies were "washed" before I could smell and touch them. I think we are countering some of the beneficial colonization that happens during a vaginal birth.

As a midwife, it does seem like more of a pain than its worth, sometimes, especially when birth is fast and care providers and sometimes dads are scrambling to fill the thing. I also don't like the somewhat awkward efforts to keep the wet baby warm while still allowing biological nursing to unfold. I have had a couple times where blood with the head made it more tricky than it needed to be to assist with sticky shoulders or unwrap a cord after the birth. I am a newer midwife and can say that unwrapping cords under water is not my favorite thing in the world, and I am not always as calm about it as the YouTube Midwives all seem to be. At the end of the day, I get it, I support it, I HAD it, but it feels awfully counterintuitive to me.

Also, I dislike the notion that waterbirths are somehow the MOST peaceful and gentlest kind of birth. I think the waterbirth craze has crested, and I am hearing less magical thinking about the wonders of waterbirth, but its still out there. Birth can be beautiful and amazing and perfect on the bed, in the shower, on the bathroom floor - wherever.

About 35% of my births happen in birth tubs. However, I have about 50% first time moms and I find that many of them get out after an hour or so of pushing and then go on and give birth quickly once they're out. But, small sample size and all, might not mean a thing :)

April 22, 2012 | Unregistered CommenterLinsey

Most Australian hospitals offer water birth and teach it in antenatal classes. I must say 2 thing about this. First, the video they show in class carefully avoids mention of any excrement or contamination. The water is crystal clear at all times. Secondly, I found water wasnt comforting at all - even for very early labour.

April 23, 2012 | Unregistered CommenterSnorkel

Aside from the contamination issue of waterbirth, what happens when a major complication occurs? Can you adequately manage a shoulder dystocia in the water? What about a pph? It's got to be extremely difficult to haul a woman out of the tub in either case.

April 23, 2012 | Unregistered Commentermoto_librarian

I have fast labors in general, and during both of them I spent a lot of time on the toilet. My last birth was 2.5 hours and it was a waterbirth, but there wasn't any fecal matter in the pool as I got out every time I felt like I needed to pee/poop. It never occurred to me that someone would urinate in the pool instead of get out...but even if they did, I agree with other posters who said that the water is probably not more contaminated than the perinium itself during the birthing process.
I do think that water birthing is a new idea, but probably because it's only been recently that we can afford to use so much warm water in such an endeavor. I know that my midwife worries about the temperature of the water affecting the baby's heartrate, and as a doula I have seen that happen, but I don't think that there is a higher rate of infections with birthing in water, or that we should be super concerned about that aspect of it.

April 23, 2012 | Unregistered Commentersara r.

I think there is no way, at this point, to know if the pain reduction benefits of waterbirth outweigh the risks, or even if there are risks, until someone actually devotes the time and effort to conduct a well designed study.

For a movement that likes to think it understands evidence and also likes to think that physicians ignore the evidence, I find it quite startling how many practices receive wide acclaim based on anecdote alone. There are examples of why water birth might be bad or good on this page in your post and the comments...but it's all speculation. The only thing we have to lose by actually studying the subject in a clinical trial or two is our ignorance.

April 23, 2012 | Unregistered CommenterTheAdequateMother

Amom - unfortunately, waterbirths are most frequently performed by providers who aren't widely known for seeking outside assessment and keeping meticulous records. You know, the kind who say "baby was grey and floppy but pinked up when mommy hugged her, so perfect birth!"

You're right, it might be good to do some controlled studies. But before that, it would be far more helpful to get some clear mechanisms by which birth in water versus simply labor in water might be beneficial.

And, as it happens, loads of hospitals now labor in water and a growing number do permit birth in water. So we'll probably have some good numbers in about 10 years. But they will be restricted to VERY LOW risk, which is not a restriction all providers will keep and many will handwave about variations of normal and how it's perfectly safe for all women.

Not that anyone is actually waiting for information on mechanisms or evidence of safety and efficacy before moving forward because it "is so peaceful."

April 23, 2012 | Unregistered CommenterWhatPaleBlueDot

With my last birth, I planned to labour in the pool and give birth on the bed. I wasn't interested in birthing in the water (not because of contamination, but just because it seemed slippery and awkward). But my daughter came without enough warning for me to get out of the pool, and she was born in the water.

The only reservation I had after the fact was this: a water-born baby comes out clean, without much of that delicious goo. I love the vernix and gunk of a newly-born babe, and was a little disappointed to have missed out on the feel and smell.

April 23, 2012 | Unregistered CommenterAnna

From watching YouTube videos and reading birth stories I think there are certain types of water birth that are unsafe. I think the fishy pool water births with the unheated shallow water is probably not the safest way to do it. I see on the videos how the mom goes on hands and knees and then everyone is trying to push her butt under the water so baby isn't bobbing in and out of the water as it's being born. I would not be surprised at all if those babies started breathing when they felt air hit parts of their skin and aspirated some water. Quite often the water seems too shallow and everyone is preoccupied with making sure baby is born fully under the water. I think the temp of water drops quickly and it seems like it would be dangerous to not have a heated pool. I think renting an actual heated birth tub is the safest way to go. This way you can keep it partially filled and heated before the birth (changing the water every few days to keep it clean) and then simply add a little warm water the day of the birth. This is so much less stressful, and it avoids the problem of the pool being too shallow and cold. This also ensures that baby will stay warm after birth by keeping it's body in the water until the mom and baby get out (because it's useless to put a wet towel on baby and think that is going to keep it warm). I've also seen the crazy videos where they actually hold the babies under water for minutes after birth. When I did research on water birth these were the only cases where aspiration was mentioned as a possibility. Everything I read on water birth said that lifting baby out of the water right after birth eliminated the risk of aspiration. Then there are also many videos of mom being in her after birth haze and no one else paying much attention either and baby starts to sputter on some water because it was handled carelessly in the tub after the birth. I could see aspiration happening in that case too. Also, my midwife told me to try not to lift baby out of the water after birth in a way where it's mouth is basically a ladle scooping up water. Of course, in the moment that is exactly what I did, but I recalled this warning and immediately tipped her forward so the water could drain out (as my midwives had told me to do if that happened). Those are all avoidable things though, and parents and midwives need to be aware of these things so babies aren't at risk of aspiration.

As for baby passing through a large amount of water that may have diluted bodily fluids in it, I just don't think that would be any more risky than land birth where there are concentrated bodily fluids right near baby. I think the only way there would be a risk is if baby aspirated the water, which seems like something that only rarely happens, and if precautions are taken maybe not at all?

Also, I feel the need to point out that all pain relieving options for childbirth have risks involved. Risks to both the mother or the baby, and those risks even include death. Both women and the medical community are in agreement that pain relief in childbirth is worth the small risk that comes along with it. This is where informed consent comes into play. We don't take away the option of epidural because of the risks, we just inform women of those risks before they get it and allow them to decide if these are risks they want to accept. The same with narcotics or any other type of pain relief in childbirth. So, if there are certain risks in water birth, lets figure out what they are, how likely they are to occur, how to prevent them, and then inform women of this so they can choose or refuse the option of water birth for themselves. I don't feel the risks are any higher than other types of pain relief though because water birth is allowed in many hospitals in my area alongside other pain relieving options. It seems if the risks were much greater than other types of pain relief then hospitals would not be offering water birth as an option. Different women are going to make different choices for their birth. It is the woman's choice which set of risk factors she is willing to accept. I'm all for more and better studies on water birth, but I also don't see any reason for alarm.

April 23, 2012 | Unregistered CommenterJennifer Z.

2625 water births were compared outcome and safety with normal vaginal delivery. The microbial load of the birth pool water was analyzed, and neonatal infection rates after water birth and after land delivery were compared. Bacterial cultures of water samples obtained from the bath after filling (sample A) and after delivery (sample B) were analyzed in 300 cases. The pediatricians recorded signs of suspected neonatal infection after water birth and after conventional vaginal delivery.

In sample A, the isolated micro-organisms were Legionella spp. and Pseudomonas aeruginosa; in sample B, there was elevated colonization of birth pool water by total coliform bacilli and Escherichia coli. Despite microbial contamination of birth pool water during delivery, antibiotic prophylaxis, as indicated by clinical and laboratory suspicion of infection, was administered to only 0.98% of babies after water birth versus 1.64% of those after land delivery.

Water birthing was found to be safe for the neonate and did not carry a higher risk of neonatal infection when compared with conventional vaginal delivery.
http://www.ncbi.nlm.nih.gov/pubmed/20595945

April 24, 2012 | Unregistered CommenterOubli

With my second birth, I labored for several hours and did most of my pushing in the water. I had used castor oil to get things going, but just about everything was well out of my system long before I got in the water. I had one small poop that came out during pushing, which the student midwife scooped out with a fishnet. My first birth, on a hospital bed, I pooped TONS during pushing. There is no way the water was dirtier than my "dry" "land" birth. Personally, I found the water provided some relief from the pressure in between contractions and let me maintain a semi-upright position without getting tired out. I did not find that it provided magical pain relief. The main reason I stayed in the water as long as I did was that I was at the point in labor where moving anywhere seemed really unattractive.

Anyway, late in pushing, I decided I didn't actually like how I was, in a deep squat, and I wanted to get out of the water. When I stood up, I felt the baby drop straight down, a good ways, very quickly. Very shortly after I got out of the water, the midwife diagnosed a shoulder dystocia. So ... on the one hand, if that SD was developing no matter what, I am sure that I and my baby were better off on land. On the other hand, I feel it is very likely that standing up when I did actually caused the baby to drop in a way that created the SD. I have since read in several places that changing positions late in pushing - for example, standing up to get out of the tub - can be a risk factor for SD. At my postpartum visit, when the midwife showed me with the doll and the model pelvis, how a baby can fail to negotiate the turns correctly, I saw with my eyes what I felt inside me when I stood up.

I just wanted to throw that out there, since people are talking about laboring in the tub and getting out for the birth. Just one anecdote, but I wanted to mention it.

April 24, 2012 | Unregistered Commenterchingona

The first birth i ever got to see as a student was a home water birth. Very serene apart from a magpie tapping on the windows, as the mirror from the bottom of the pool was reflecting light...
I agree with everyone who's said that fecal matter can get at babies born vaginally no matter what.

I've looked after about 40 ladies birthing in the pool, and only one baby needed resuscitating/later had an infection. Maybe that one was the statistic; however, we'd need a big comparative trial on outcomes of other pain relief/epidurals/rates of intervention before we could say what works.

There's some research to say babies don't gasp underwater due to chemoreceptors in thier mouth and larynx, which are there to prevent them aspirating anything that comes up:: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000111.pub3/pdf/standard though this doesn't go for the compromised.

April 24, 2012 | Unregistered CommenterEllie

Right, there have been some studies showing no significant differences in overall rates, although some have raised concerns about particular problems like snapped cords, but all are relatively small to be sufficiently powered to detected differences, when considering the base perinatal mortality rate with modern medicine, and all have issues with the fitness of the control group and confounding factors. The question is, with the evidence we have now, is the conservative route allowing/encouraging water birth, or discouraging water birth? I tend to see encouraging water labor but discouraging water birth as the more conservative route. I definitely think it is misguided to promote water birth with no discussion of the potential problems.

April 24, 2012 | Unregistered CommenterBecky

Nah, not actual fecal matter on the baby's face, though i have seen this (short perineum/rather a lot of poo/fast birth) and so have a few of my mw on shift with me today (just back from night shift so i do apologise if there are spelling mistakes!).

Navelgazer; I'd suggest the perineum and anus are in close proximity so the bacteria can travel.
Women can get ecoli up there, and vaginal thrush is colonised from the bowel sometimes for instance...% wise i'd think that the microbes from poo floating around would be similar to the microbes as the baby crosses the perineum? ? All the studies i've scanned suggest the infection risk is low, if not equal to normal birth, ( e.g. Cochrane 2009 study...Cluett).

Overall, waterbirth = less pain, faster labours, less epidurals/instrumental births, so in my experience better outcomes for mums and babies.

Obstetrics and midwifery is all a balancing act, i'd say waterbirth offers a lot of positives but like everything else comes with some risks, but i don't think they're unreasonably high. Just my two pence worth.

April 25, 2012 | Unregistered CommenterEllie

I never *planned* to give birth in any particular place with my 2nd, having realized how unpredictable the experience might be after my first. It just happened, because she came so fast thee was no time to think about anything. However, I haven't peed outside of the toilet or pooped anywhere either time I was giving birth, so while I realize it's common, it doesn't really concern me with this upcoming birth. However, I'm not planning a water birth this time either, so maybe I'll actually have time to get myself out of the tub before I start pushing this time. If I did poop in the water, I would definitely get out. I wouldn't vomit in the pool, and blood and mucus from my body will wind up on the baby no matter where I give birth, so I'm not understanding the concern about those, especially the blood and mucus.

Of course, I don't want other people in there with me, because I don't want my blood and stuff all over *them*, since it isn't just going toinevitably wind up on them like it would the baby. I get really grossed out by the idea of people having their kids and/or partners in the water with them. I mean, I don't think there's anything wrong with it, but it definitely sets off my "ick" alarm.

I would Luke to point out to the previous commentor that I think it's odd to get Hung up on what is or isn't "natural". Many thugs aren't natural, but that doesn't mean they're too risky to do. Epidurals aren't natural either, but I'm guessing the person who mentioned that doesn't have a problem with *them*. We can't selectively attack practices based on how "natural" they are. That's silly.

April 25, 2012 | Unregistered CommenterDawn

I had my baby girl 4 weeks ago and birthed in a labor tub with a local CNM. Yes, I did poop in the water. I honestly didn't care and still don't care. I got the birth I had so desperately wanted. She was even born en caul which I was also hoping for because it sounded so cool.

My son is 5 1/2 years old and was born in a hospital with all the conventional hospital interventions except for a c-section. Which experience would I relive if I had to? My daughter's birth, for sure! Poop or no poop.

April 25, 2012 | Unregistered CommenterDawn R

I was the one that mentioned that waterbirth is unnatural. I agree that we need to evaluate things based on the evidence and not whether they are natural or not, for instance health authorities such as the WHO promote active management of third stage because it is shown to be better than what happens naturally, in terms of outcomes.

I mentioned that waterbirth is unnatural simply because I so often see it promoted as being natural, and as being better than an epidural, say, because it is natural and not unnatural. However, birth underwater is not "natural" for humans nor any other primates. We can't assume things about its safety or risks. Right now we have some studies, although to my knowledge all have some issues with the comparison group, which show no increase in infection or mortality, but we also have case reports of snapped cords, aspiration and pneumonia. I don't think it is right to be promoting it as perfectly safe, based on what we know now.

April 26, 2012 | Unregistered CommenterBecky

I have watched this kind of water birth before. and many moms who have tried this said that it was easier compared to the usual way of getting birth.
I really learned a lot form this and I'll keep visiting for more of your updates.

July 1, 2012 | Unregistered Commenterplumbing supplies

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