Water birth

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A mother participating in a water birth. Merlin Lotus Birth 2006.jpg
A mother participating in a water birth.
Water birth

Water birth is labor and sometimes delivery that occurs in water, usually a birthing pool. The American College of Obstetricians and Gynecologists does not recommend birthing in water as the safety has not been determined. [1] Proponents believe childbirth in water results in a more relaxed, less painful experience that promotes a midwife-led model of care. [2] Critics argue that the safety of waterbirth has not been scientifically proven and that a wide range of adverse neonatal outcomes have been documented, [3] including increased mother or child infections and the possibility of infant drowning. A 2018 Cochrane Review of water immersion in the first stages of labor found evidence of fewer epidurals and few adverse effects but insufficient information regarding giving birth in water. [4]

Contents

Benefits

A moderate to weak level of evidence indicates that water immersion during the first stage of childbirth reduces the pain of labor. [4] A 2018 Cochrane Review found that immersion at this stage reduces the use of epidural analgesia; however, there is no clear evidence on the benefits of immersion for the second stage of labor, namely delivery (sometimes called full water birth). [4] There is no evidence of increased adverse effects for immersion during the first or second stages of labor. [4]

There is not strong evidence that a water birth reduces tearing or perineal trauma. [4] Water birth may offer perineal support for the mother, and some theorize that this may decrease the risk of tearing and reduce the use of episiotomy. [5]

A 2014 review reported that water immersion during the first stage of labor can reduce the length of that stage, labor pain, and the use of epidural or spinal analgesia. It is also associated with a lower rate of cesarean delivery and stress urinary incontinence symptoms 42 days after delivery. The review reported that immersion during labor did not appear to increase the rate of infections for the mother or the baby, and APGAR scores for the newborn infant were similar to those of conventional births. [6]

Risks and concerns

The British Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives issued a joint statement in 2006 supporting water birth for healthy women with uncomplicated pregnancies but does not recommend it in cases of complications. [7]

In a 2005 commentary, the Committee on Fetus and Newborn of the American Academy of Pediatrics (AAP) released an analysis of the scientific literature regarding underwater births. The Committee noted several positive studies for underwater birth but went on to criticize them for lacking proper scientific controls, a significant number of infant deaths and diseases, and the general lack of information to support the use of water births. The paper concluded: [8]

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 RCT [randomized controlled trial] after informed parental consent.

The AAP received numerous letters in response to the statement, many claiming passionately that water birth had strong benefits and minimal risks for both parents and children and criticizing the AAP for failing to publish positive studies about the practice. In response, an author of the statement noted that the claims made were unsubstantiated and based purely on anecdotal evidence, with no randomized controlled trials (RCTs) that would allow an evidence-based assessment of the safety and benefits of water births. The author concluded by urging for proponents to support such a trial so that the question could be answered. The editor of the journal Pediatrics , where the commentary was published, noted that no such trials had ever been submitted to the journal, which had a policy against publishing articles that are not based on scientific evidence. The reply concluded that "I have not received any science-based commentaries from the groups that you cite in your letter. We cannot publish every letter, based on opinions only, that we receive." [9]

Water births

Most hospitals do not accommodate water births because of the added risks involved. Although there is moderate to weak evidence that water births lessen pain without the need for an epidural, [4] there are no medical proven reasons why an expecting mother would need a water birth. Furthermore, there is an added liability of hospital water birth because of the inability to see what complications could potentially be happening from underwater. [10] Therefore, the majority of water births are done at home. However, there are some hospitals that do still offer alternative birthing suites for families that want to do a water birth.[ citation needed ]

Birth pool

A birth pool is a specially designed vessel containing water for women to immerse themselves in for pain relief during labor. Birth pools work on the same principle as a bathtub, but are distinct from them [11] due to buoyancy and freedom of movement, factors deemed to be important in labor. [12] A birth pool can either be permanently installed or portable. Getting into a pool of water for labor is often called water birth because some women choose to remain in the water for birth as well.

Health policy in England stipulates women should be given the opportunity to labor in water through the publication of Intrapartum care guidelines issued in 2007 by the National Institute for Health and Care Excellence (NICE). The Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives have jointly supported labor and birthing in water, and encourage hospitals to ensure birth pools are available to all women. [7]

Characteristics

Before birth pools became readily available there were many stories of women laboring and birthing in re-purposed tub-like products including animal watering troughs. [13]

Ordinary bathtubs found in American and British homes do not provide enough room for women to comfortably move and try different positions in labour, such as squatting or kneeling, and are not deep enough to create buoyancy. In order to create the feeling of weightlessness through buoyancy, it is necessary for the water to almost cover the women's breasts while she is sitting and should cover her belly while she is squatting, leaning over the side of the pool or kneeling upright in the pool sitting back on her heels.

The original circular birth pool used by Michel Odent, the originator of the concept of birthing pools, at Pithiviers hospital in France in the early 1980s was 2 metres (6 ft 7 in) in diameter and 60 centimetres (24 in) deep, large enough to accommodate two people and make it difficult for interference during the birthing process. [14] Modern birth pools are somewhat smaller, with a diameter between 110–150 cm (43–59 in) and at least 50 cm (20 in), preferably 56 cm (22 in), of water. [15]

Related Research Articles

<span class="mw-page-title-main">Midwifery</span> Pregnancy and childbirth-related profession

Midwifery is the health science and health profession that deals with pregnancy, childbirth, and the postpartum period, in addition to the sexual and reproductive health of women throughout their lives. In many countries, midwifery is a medical profession. A professional in midwifery is known as a midwife.

<span class="mw-page-title-main">Caesarean section</span> Surgical procedure in which a baby is delivered through an incision in the mothers abdomen

Caesarean section, also known as C-section or caesarean delivery, is the surgical procedure by which one or more babies are delivered through an incision in the mother's abdomen, often performed because vaginal delivery would put the baby or mother at risk. Reasons for the operation include obstructed labor, twin pregnancy, high blood pressure in the mother, breech birth, shoulder presentation, and problems with the placenta or umbilical cord. A caesarean delivery may be performed based upon the shape of the mother's pelvis or history of a previous C-section. A trial of vaginal birth after C-section may be possible. The World Health Organization recommends that caesarean section be performed only when medically necessary.

<span class="mw-page-title-main">Childbirth</span> Expulsion of a fetus from the pregnant mothers uterus

Childbirth, also known as labour, parturition and delivery, is the completion of pregnancy where one or more babies exits the internal environment of the mother via vaginal delivery or caesarean section. In 2019, there were about 140.11 million human births globally. In the developed countries, most deliveries occur in hospitals, while in the developing countries most are home births.

<span class="mw-page-title-main">Umbilical cord</span> Conduit between embryo/fetus and the placenta

In placental mammals, the umbilical cord is a conduit between the developing embryo or fetus and the placenta. During prenatal development, the umbilical cord is physiologically and genetically part of the fetus and normally contains two arteries and one vein, buried within Wharton's jelly. The umbilical vein supplies the fetus with oxygenated, nutrient-rich blood from the placenta. Conversely, the fetal heart pumps low-oxygen, nutrient-depleted blood through the umbilical arteries back to the placenta.

A birthing center is a healthcare facility, staffed by nurse midwives, midwives and/or obstetricians, for mothers in labor, who may be assisted by doulas and coaches. The midwives monitor the labor, and well-being of the mother and the baby during birth. Doulas can assist the midwives and make the birth easier. Should additional medical assistance be required, the mother can be transferred to a hospital. This transfer is more likely if an epidural is needed, there is meconium staining, it is a prolonged labor, or the newborn needs intensive care. Some hospitals have birth centers as an alternative to the usual high tech maternity wards.

<span class="mw-page-title-main">Episiotomy</span> Surgical incision of the perineum and the posterior vaginal wall

Episiotomy, also known as perineotomy, is a surgical incision of the perineum and the posterior vaginal wall generally done by a midwife or obstetrician. This is usually performed during second stage of labor to quickly enlarge the aperture allowing the baby to pass through. The incision, which can be done from the posterior midline of the vulva straight toward the anus or at an angle to the right or left, is performed under local anesthetic, and is sutured after delivery.

<span class="mw-page-title-main">Apgar score</span> Scale for newborn viability

The Apgar score is a quick way for health professionals to evaluate the health of all newborns at 1 and 5 minutes after birth and in response to resuscitation. It was originally developed in 1952 by an anesthesiologist at Columbia University, Virginia Apgar, to address the need for a standardized way to evaluate infants shortly after birth.

<span class="mw-page-title-main">Preterm birth</span> Birth at less than a specified gestational age

Preterm birth, also known as premature birth, is the birth of a baby at fewer than 37 weeks gestational age, as opposed to full-term delivery at approximately 40 weeks. Extreme preterm is less than 28 weeks, very early preterm birth is between 28 and 32 weeks, early preterm birth occurs between 32 and 34 weeks, late preterm birth is between 34 and 36 weeks' gestation. These babies are also known as premature babies or colloquially preemies or premmies. Symptoms of preterm labor include uterine contractions which occur more often than every ten minutes and/or the leaking of fluid from the vagina before 37 weeks. Premature infants are at greater risk for cerebral palsy, delays in development, hearing problems and problems with their vision. The earlier a baby is born, the greater these risks will be.

<span class="mw-page-title-main">Home birth</span> An attended or an unattended childbirth in a non-clinical setting

A home birth is a birth that takes place in a residence rather than in a hospital or a birthing center. They may be attended by a midwife, or lay attendant with experience in managing home births. Home birth was, until the advent of modern medicine, the de facto method of delivery. The term was coined in the middle of the 19th century as births began to take place in hospitals.

Natural childbirth is childbirth without routine medical interventions, particularly anesthesia. Natural childbirth arose in opposition to the techno-medical model of childbirth that has recently gained popularity in industrialized societies. Natural childbirth attempts to minimize medical intervention, particularly the use of anesthetic medications and surgical interventions such as episiotomies, forceps and ventouse deliveries and caesarean sections. Natural childbirth may occur during a physician or midwife attended hospital birth, a midwife attended homebirth, or an unassisted birth. The term "natural childbirth" was coined by obstetrician Grantly Dick-Read upon publication of his book Natural Childbirth in the 1930s, which was followed by the 1942 Childbirth Without Fear.

<span class="mw-page-title-main">Breech birth</span> Birth of a baby bottom first

A breech birth is when a baby is born bottom first instead of head first, as is normal. Around 3–5% of pregnant women at term have a breech baby. Due to their higher than average rate of possible complications for the baby, breech births are generally considered higher risk. Breech births also occur in many other mammals such as dogs and horses, see veterinary obstetrics.

Labor induction is the process or treatment that stimulates childbirth and delivery. Inducing (starting) labor can be accomplished with pharmaceutical or non-pharmaceutical methods. In Western countries, it is estimated that one-quarter of pregnant women have their labor medically induced with drug treatment. Inductions are most often performed either with prostaglandin drug treatment alone, or with a combination of prostaglandin and intravenous oxytocin treatment.

<span class="mw-page-title-main">Lotus birth</span> Birth method

Lotus birth is the practice of leaving the umbilical cord uncut after childbirth so that the baby is left attached to the placenta until the cord naturally separates at the umbilicus. This usually occurs within 3–10 days after birth. The practice is performed mainly for spiritual purposes, including for the perceived spiritual connection between the placenta and the newborn.

<span class="mw-page-title-main">Shoulder dystocia</span> Birthing obstruction complication

Shoulder dystocia is when, after vaginal delivery of the head, the baby's anterior shoulder gets caught above the mother's pubic bone. Signs include retraction of the baby's head back into the vagina, known as "turtle sign". Complications for the baby may include brachial plexus injury, or clavicle fracture. Complications for the mother may include vaginal or perineal tears, postpartum bleeding, or uterine rupture.

<span class="mw-page-title-main">Unassisted childbirth</span>

Unassisted childbirth (UC) refers to the process of intentionally giving birth without the assistance of a medical birth attendant. It may also be known as freebirth, DIY (do-it-yourself) birth, unhindered birth, and unassisted home birth. Unassisted childbirth is by definition a planned process, and is thus distinct from unassisted birth due to reasons of emergency, lack of access to a skilled birth attendant, or other. It is also different from homebirth, although most UCs also happen within the home.

<span class="mw-page-title-main">Frédérick Leboyer</span>

Frédérick Leboyer was a French obstetrician and author. He is best known for his 1974 book, Birth Without Violence, which popularized gentle birthing techniques, in particular, the practice of immersing newborn infants in a small tub of warm water — known as a "Leboyer bath" — to help ease the transition from the womb to the outside world. He also advocated low lighting and quiet in a warm room to limit the supposed shock of birth,[Reynolds, Concise Encyclopedia of Special Education, 138] and that a newborn be laid on its mother's stomach and allowed to bond, instead of being taken away for tests.

The term childbirth positions refers to the physical postures the pregnant mother may assume during the process of childbirth. They may also be referred to as delivery positions or labor positions.

Trinidad and Tobago is the southernmost country of the West Indies; as of 2013, its adjusted maternal mortality rate is 84 deaths per 100 000 women; the rate is adjusted for underreporting and misclassification by the World Health Organization. The contraceptive rate, that is the percentage of women in union aged 15–49 years currently using contraception, is 42.5%. The fertility rate is 1.8 children per woman. Fourteen weeks of maternity leave with allowances is provided by the government; women typically choose to take this leave after the birth rather than before, to spend time with the newborn.

Obstetric anesthesia or obstetric anesthesiology, also known as ob-gyn anesthesia or ob-gyn anesthesiology, is a sub-specialty of anesthesiology that provides peripartum pain relief (analgesia) for labor and anesthesia for cesarean deliveries ('C-sections').

<span class="mw-page-title-main">Pain management during childbirth</span>

Pain management during childbirth is the treatment or prevention of pain that a woman may experience during labor and delivery. The amount of pain a woman feels during labor depends partly on the size and position of her baby, the size of her pelvis, her emotions, the strength of the contractions, and her outlook. Tension increases pain during labor. Virtually all women worry about how they will cope with the pain of labor and delivery. Childbirth is different for each woman and predicting the amount of pain experienced during birth and delivery can not be certain.

References

  1. American College of Obstetricians and Gynecologists (November 2016). "Clinical Guideline: Immersion in Water During Labor and Delivery" . Retrieved 4 August 2020.
  2. Cluett, E. R.; Burns, E. (2009). Cluett, Elizabeth R (ed.). "Immersion in water in labour and birth". The Cochrane Database of Systematic Reviews (2): CD000111. doi:10.1002/14651858.CD000111.pub3. PMC   3982045 . PMID   19370552.
  3. Schroeter, K. (2004). "Water Births: A Naked Emperor". Pediatrics. 114 (3): 855–858. doi:10.1542/peds.2004-0145. PMID   15342864. S2CID   46409090.
  4. 1 2 3 4 5 6 Cluett, Elizabeth R.; Burns, Ethel; Cuthbert, Anna (16 May 2018). "Immersion in water during labour and birth". The Cochrane Database of Systematic Reviews. 5 (6): CD000111. doi:10.1002/14651858.CD000111.pub4. ISSN   1469-493X. PMC   6494420 . PMID   29768662.
  5. Garland, D (2000). Waterbirth: An Attitude to Care. Elsevier. ISBN   0750652020.
  6. Yinglin Liu; Yukun Liu; Xiuzhi Huang; Chuying Du; Jing Peng; Peixian Huang; Jianping Zhang (2014). "A comparison of maternal and neonatal outcomes between water immersion during labor and conventional labor and delivery". Research Article. BioMed Central. 14 (1): 160. doi: 10.1186/1471-2393-14-160 . PMC   4019783 . PMID   24886438.
  7. 1 2 "Immersion in water during labour and birth" (PDF). Royal College of Midwives/Royal College of Obstetricians and Gynaecologists. 2006. Archived from the original (PDF) on 13 April 2009. Retrieved 29 August 2012.
  8. Committee On Fetus Newborn; Blackmon, D. G.; Adamkin, L. R.; Bell, D. H.; Denson, E. F.; Engle, S. E.; Martin, W. A.; Stark, G. I.; Barrington, A. R.; Raju, K. J.; Riley, T. N.; Tomashek, L.; Wallman, K. M.; Couto, C.; Couto, J. (2005). "Underwater Births". Pediatrics. 115 (5): 1413–1414. doi:10.1542/peds.2004-1738. PMID   15867054. S2CID   31354079.
  9. Hess, S. (2005). "Strong Opinions Versus Science in Water-Birth Controversy". Pediatrics. 116 (2): 522–523, author 523 523. doi:10.1542/peds.2005-1334. PMID   16061620. S2CID   27629579.
  10. "Can I Have a Water Birth in a Hospital?". Parents. Retrieved 4 August 2020.
  11. Harper, R.N., Barbara (2005). Gentle Birth Choices. Inner Traditions. pp.  175. ISBN   1-59477-067-0.
  12. "Tips on encouraging a straightforward birth during labour". National Childbirth Trust. Archived from the original on 28 August 2017. Retrieved 27 August 2017.
  13. Bertram, Lakshmi (2000). Choosing Waterbirth. USA: Hampton Roads Publishing Company, Inc. pp.  31. ISBN   1-57174-152-6.
  14. Harper, Barbara (2005). Gentle Birth Choices. USA: Inner Traditions. pp.  175–176. ISBN   1-59477-067-0.
  15. Lichy, Dr. Roger; Herzberg, Eileen (1993). The Waterbirth Handbook. UK: Gateway Books. pp. 63, 132. ISBN   0-946551-70-7.