Understanding the Risks and Reality of Water Birth
There is increased risk with water births because the majority of them take place at home, where there may not be immediate medical help. One of the best-known studies on water birth trauma comes from the 1999 British Medical Journal, which found a similar perinatal mortality rate between water births and low-risk conventional births. The American College of Obstetricians and Gynecologists says that "although the absolute risk may be low, planned home birth is associated with a twofold to threefold increased risk of neonatal death when compared with planned hospital birth." But even though steps are taken to avoid these more serious outcomes, and advocates state that underwater birth is safe, Patrick Weix, M.D., Ph.D., an ob-gyn practicing in Irving, Texas, and contributor to the medical website healthtap.com, reveals that there have been "no adequate randomized controlled studies have been done on water births to demonstrate this."
The serious medical risks include pneumonia, the tearing of the umbilical cord, and drowning. "By virtue of the fact that water is utilized, there is a risk for drowning for anyone. However, with proper technique and attention, this risk should be exceedingly low," says Edwin Huang, M.D., an ob-gyn practicing in Cambridge, Massachusetts, and an assistant professor at Harvard Medical School. To prevent pneumonia, the water must maintain the correct temperature, between 95°F and 100°F. Using a trained and licensed midwife -- someone who is experienced in water births and has dealt with the situations mentioned above -- is important in achieving a successful water birth.
It is also important to remember that where there is birth, there are body fluids. During nearly all vaginal deliveries, women have a bowel movement. In a conventional birth, the feces are often wiped off the table by a nurse before the parents even notice. Similarly, if this occurs during a water birth, the midwife scoops out the feces as they enters the water. But with a water birth, it is harder to avoid the messier aspects of childbirth. Birthing in a tub means you will sit in blood, urine, and possibly feces. It is not a sterile environment, and the British Medical Journal study discusses the possible risks of water aspiration and infection for the baby. Once the baby is born underwater, he is immediately placed on the mother's chest to take his first breath. Although babies do not typically breathe until they reach the air, a baby that experiences stress in the birth canal might gasp for air in the tub and possibly inhale contaminated water. If this happens, you and your baby would need to be rushed to the hospital where a pediatrician could take a chest X-ray and blood cultures.
Before You Choose a Water Birth
You must have few to no risk factors in your pregnancy to be a good candidate for water birth. This is designed to prevent any life-threatening complications from occurring in the first place. "High-risk conditions or complications in labor often necessitate continuous fetal monitoring or immediate intervention, which is better accomplished outside of the water," Dr. Huang says. There are certain circumstances in which women should not choose water birth. Marra Francis, M.D., a gynecologist practicing in San Antonio, specifies that women with "Group B Strep positive cultures, gestational diabetes, preeclampsia, macrosomia, intrauterine growth restriction, prematurity, unproven pelvis" should opt out of water birth. Of course, always talk to your health-care provider to understand the full risks and reality of your choices. Water birth is a very personal decision, one that requires much thought and research -- because there's more to water birth than the tub.
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