"There are women who have successful, uncomplicated water births every day in this world. However, even with the perfect set-up, a woman still needs to understand the risks of infection transmitted to the fetus through the birthing water and the possibility for drowning," says Marra Francis, M.D., a gynecologist practicing in San Antonio. The largest and most recent study, published in 1999 in the British Medical Journal, cites a 95 percent confidence in the safety of water births, but the practice poses an increased risk because the majority of water births take place at home, where there is no immediate medical help. In 2011, The American College of Obstetricians and Gynecologists stated 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." Water births themselves are not significantly more dangerous than birth out of water, but when they take place at home -- and most of them do -- there is an increased risk.
The Committee on Obstetric Practice "believes that hospitals and birthing centers are the safest setting for birth, [but] it respects the right of a woman to make a medically informed decision about delivery." Part of that medically informed decision means understanding the benefits and risks. "Anyone thinking about delivering at home needs to think through the worst-case scenario for the ultimate safety of their baby and themselves," says Sharon Mikol, M.D., an ob-gyn practicing in Cleveland. Most practitioners agree that the risks of water birth are minimal when mothers are screened appropriately during pregnancy and before labor, but a woman still has to be the right candidate for a water birth to reduce the risks. An uncomplicated pregnancy (low blood pressure, over 37 weeks of gestation, baby with a head down, etc.) is required for a water birth. Before choosing water birth, consider the risks.
Water birth means sitting, pushing, and delivering in a tub -- which often includes feces in the tub. A baby born in that environment could possibly swallow the contaminated water, increasing his risk of infection. Depending on whom you ask, the likelihood of an infection differs because data is limited. Although it is proven that more bacteria are found in birthing tubs than in birthing beds, a 2005 study published in the Journal of Maternal-Fetal and Neonatal Medicine found that out of 1,600 water births, there wasn't an increase in the risk of neonatal infection. This was conditional upon women being selected appropriately for water births and the proper sterilization of the tub and other equipment. But even if you fill the tub with sterile water, it becomes contaminated with vaginal and rectal flora the minute a mom sits in the tub. "There is no way to make the water contaminant free," Dr. Francis says. A baby that swallows some of the tub water is at a risk for infection. "Babies are genetically and physiologically programmed to take their first breaths of air, not water, within seconds of their head being delivered." Babies do have a "dive reflex" that instinctively closes their airway and prevents them from breathing in water, but a few scenarios may still cause them to inhale water:
- They are startled during birth
- The head is brought to the surface before the rest of the body; this overrides the dive reflex
- Their oxygen supply from the placenta is affected in some way
It is important to know, however, that even as infectious bacteria is expelled outward during birth, nothing is moving up and inward. Therefore, the risk of infection occurs only if the baby breathes too soon (midwives and OBs are trained to minimize that risk) or if the equipment (tubs, filters, pumps) is not sterilized properly.
This medical term means a baby has had its first bowel movement before birth and inhales the contaminated amniotic fluid, which causes respiratory problems. Doctors and midwives are able to tell if this has happened when the water breaks because meconium is typically green, sticky, chunky, and thick. Extra precautions have to be taken when the first bowel movement occurs prior to delivery. A doctor or midwife needs immediate access to the baby to be able to clear his airways. Christy Dorff, a mother of two from Mesa, Arizona, describes how she had to forgo a water birth when she found out her baby was at risk of meconium aspiration. "I had to labor on my back, so that my midwife would have immediate ability to suction the baby's nose, mouth, and throat." The severity of meconium aspiration depends on how much meconium your baby inhales. Generally, the more contaminated fluid is inhaled, the more serious the condition.
Although significant studies have yet to show the exact percentage of pneumonia cases in water birth, it is one of the risks. To prevent pneumonia, the water must remain between 95 and100° F and the baby must be brought to the surface immediately upon delivery. Pneumonia usually develops within the first 24 to 48 hours after birth, and it is caused by meconium aspiration, fecal contamination, and bacteria from tub water. "There are also case reports of babies dying of pneumonia post-water birth that was a direct result of ingesting water with fecal contamination water. As most water births are done at home or in a freestanding birth center, there is little 'research' done as a collective group," Dr. Francis says.
Where there is water, there is a risk of drowning. A 2004 study from the Journal of Pediatrics lists "drowning and near-drowning, asphyxiation...as fetal risks of water birth. Owing to complications, the baby could possibly stay underwater too long and his lungs can fill up with water. Medical professionals do everything to prevent this by placing the baby with his head above water so he can get enough oxygen to breathe as soon as he is born.
Tearing of the Umbilical Cord
Patrick Weix, M.D., Ph.D. an ob-gyn practicing in Irving, Texas, and a contributor to the medical website healthtap.com, reveals that "short umbilical cords can tether the fetus underwater or tear, leading to fetal blood loss. Maternal tears can be difficult to assess [underwater], and patients may bleed excessively." The good news is that a cord short enough to cause such an incident is rare. During a water birth, a baby is usually brought quickly to the surface, head first. This swift movement will enable her to start breathing as soon as possible, but there's a risk that the umbilical cord may snap. "A snapped umbilical cord can be life-threatening, as the fetus can bleed freely until it is stopped. It is usually easily managed by clamping the cord. It leads more often to neonatal anemia than anything else," Dr. Weix explains. Of course there are risks involved, but many women still feel water birth is the right choice for their family. Keep in mind, though, that if you do choose a water birth, the safest place to have one is in a hospital or a birthing center adjoined to a hospital, with the support of a licensed certified midwife. Make sure to assess all of the risks with your medical professional and plan what the team will do should any of these scenarios occur.
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