Waterbirth - Myths and Realities
Source : Pubdate : 2011/10/12 8:22:00 Author :
A true story...
A pregnant woman who attended a major hospital for antenatal care and a booking-in visit was told by a senior consultant obstetrician that she must abandon her plan to birth in water because her baby would drown. Although the woman knew the obstetrician's advice was nonsensical, she found his assertion confronting and confusing and discussed the comment with her midwife caregiver the next day.
The woman was reassured that labor and birth in water is perfectly safe, and provides many benefits for herself and her baby when conducted by attendants skilled in supporting normal labor and birth in water. Whether the obstetrician was ignorant of the truth or deliberately misinforming the woman is unsure, but in giving this 'advice' he perpetuated the most common myth associated with birth in water.
No, babies do not drown if they are born underwater. They live in a watery environment until labor heralds their transition from the uterus to the air-filled world outside. The stimulus to breath at birth occurs when the baby is exposed to air, plus the dramatic change of temperature, noise and light.
During a water birth this occurs when the baby is lifted up out of the water. His umbilical cord, his lifeline, continues to provide oxygenated blood while he responds to the new stimuli and fills his lungs with air for the first time. Simultaneously his heart function converts to include the oxygenated blood provided by his lungs, no longer solely relying on the placenta. Delaying clamping and cutting of the umbilical cord is very beneficial to baby's transition to life outside the uterus. If allowed the umbilical cord may continue to pulsate for some time, providing baby with his full quota of blood volume via the placenta, maximizing perfusion of his newly functioning lung tissues and supporting his transition, unhurried, into his new world.
How does water help the woman during labor?
The benefit of using water to reduce the pain of childbirth is well established and accepted, and the use of a shower or hot wet towels for pain relief is common practice in most care settings. When immersed in deep warm water the buoyancy enables a woman to move more easily than on land, allowing freedom to maneuver and work with her contractions assisting the descent of the baby. Immersion reduces opposition to gravity, providing ease of movement and conservation of energy.
The comforting water environment promotes deeper relaxation allowing the woman's hormones to respond appropriately, facilitating endorphin release and efficient progress of labor, including relaxation of the pelvic floor. This alleviates pain and optimizes the progress of her labour.¹
Women who wish to labor and/or birth while immersed in deep warm water know it is a simple way of assisting them to cope without the use of strong drugs. A reduction in the use of pain relieving drugs not only benefits the mother who is more alert and responsive after the birth, but the baby will also benefit considerably.
Women also know that labor in water increases their chances of giving birth naturally and normally with a minimum of interference or medical intervention. A prospective observational study in Switzerland in 1999 found waterbirths had the lowest rate of analgesia use, the lowest episiotomy rate and lowest incidence of 3rd and 4th degree tears, as well as the lowest maternal blood loss.² The birthing pool provides an environment which enhances a woman's sense of privacy - a zone which is her own - permeated only by those entrusted and permitted by the laboring woman. This may be particularly important to women who have been subjected to sexual abuse in the past.
What about the baby's wellbeing?
Immersion in water during labor reduces pressure on the woman's abdomen, and buoyancy promotes more efficient uterine contractions and better blood circulation. This results in better blood circulation and oxygenation of the uterine muscles, and more oxygen for the baby during labor. The Swiss study also found babies born in the water had the lowest rate of neonatal infection, and the average Apgar score at 5 minutes was significantly higher after waterbirths.
Other waterbirth studies failed to detect differences in the incidence of neonatal morbidity or mortality between water and land birth and found fewer babies adopted deflexed positions during the first stage of labor when their mother's used water immersion for pain relief.³ Water born babies are typically relaxed and alert at birth as their mothers have not required drugs during labor. One study has demonstrated that babies whose mothers had epidural anesthesia were still showing adverse effects of the drug up to six weeks later.4
What about after the birth?
Water offers a laboring woman an environment where she can behave instinctively and feel in control. When a woman feels in control during childbirth, she experiences a higher degree of emotional well-being postnatally.5 many studies have confirmed that women who give birth in the water have a most satisfying birth experience.6
Common misconceptions about labor in water