Waterbirths "not recommended" in USA - Why???

[Juddystarlet]

I stumbled across as US video of a waterbirth on the baby center webiste. The narrator states that giving birth in water is "still unconventional and considered risky and not recommended by the American College of Obstetrics and Gyneacologists".

There is no date on the video but it appears recent and the only comments have been left in the last few weeks.

I wondered if any of our friends from the USA can shed any light on this as there are no such risks given here in the UK.

I've also noticed on OBEM USA that the "normal" way to give birth in on your back with your feet in stirrups - something we have very little of in the UK for normal births. As I understand it, stirrups are generally only used for assisted deliveries.

[fourweewonders]

Only seen one or two episodes of obem america but declining an epidural is (saddly) seen as weird and crusty on there. not saying that anyone who choose one is bad but a woman who chooses not to have one deserves equal respect in her choices

[Rosie_t_Riveter]

I haven't seen OBEM but everything I have read from the US indicates that birth is much more medicalised than in the UK. Epidural/C-Section rates are much higher over there and it seems like a natural birth is seen as something to be treated rather than aspired to. I didn't read any websites from the US on birth for this reason. I did read Ina May Gaskin's Guide to Childbirth and the information on interventions to avoid was a bit scary!

[Kate]

do you have to pay for epidurals there? Is that why they're encouraged?

[Louisianablue2000]

I only saw one US OBEM but found it so distressing I couldn't watch anymore. I saw one where the woman's epidural failed (this was her third baby and each time the epidural had failed). Everyone was shouting and it was horrible, I bet in the UK she would have been told not to bother with the epidural and she would have been properly assisted in a natural birth by a midwife instead of having a lot of clueless nurses who thought not having an epidural was a disaster.

I wonder if they show the British OBEM in America, it would be a bit of a shock to most people I think!

Waterbirths are considered pretty normal and desirable here but I have heard questions like 'won't the baby drown' by older people so maybe there is just so little knowledge in the States that those kind of views are more widespread. And why would the doctors in the States recommend a procedure for which there is lots of evidence from the UK showing that it reduces the need for other (more expensive) pain relief?

Actually, what are the rates of waterbirth like in other countries? We are quite unusual on our reliance on gas and air (I think the Scandinavians like it as well but that's about it) so presumably there are a few other differences across the world. I wonder which western country has the biggest 'natural childbirth' culture?

[ches]

In the US, most women choose an obstetrician for their prenatal care and a gynacologist for annual well-woman care. I buck the trend, choosing midwife-led care for both and trying (and failing) to have natural childbirth (twice).

Many obstetricians refuse to preside over water births, but hospitals are increasingly installing tubs as they are growing in popularity. That being said, a woman who was told she couldn't L&D in water and wanted to could readily change providers to one who would accommodate her. However, the culture is strongly towards wanting oxytocin to "get it over with" and epidurals "in the parking lot" because why should you feel pain if you don't have to.

There is some conspiracy theory stuff about insurance companies dictating policy based on pressure from drug companies. The reality is that doctors get paid for intervention so offer an a la carte service and health insurance is structured to give the perception that these interventions are free. This leads to unconstrained demand and increasing cost.

[Eleanor]

Waterbirths are considered pretty normal and desirable here but I have heard questions like 'won't the baby drown' by older people so maybe there is just so little knowledge in the States that those kind of views are more widespread. And why would the doctors in the States recommend a procedure for which there is lots of evidence from the UK showing that it reduces the need for other (more expensive) pain relief?

Rates of medical-negligence litigation in the US possibly have an influence - would lead to the position that as long as there's any evidence of increased risk (or even lack of evidence of no increase in risk) it's not worth doctors getting involved.

Here's an American obstetrician who is fiercely against water birth on grounds of increased risk to the baby (warning, her opinions are very forcefully expressed and she discusses some really sad cases, so don't go there unless you don't mind possibly being upset...) http://skepticalob.blogspot.co.uk/2010/ ... ities.html

[Kate]

I completely failed to have a waterbirth last time (no pools available, risk of infection due to waters breaking early etc...) but do most people actually deliver in the water? I get the impression a lot of women labour in the water, then climb out for the very last bit. Sorry if that's a stupid question!

[FlossiesMum]

I completely failed to have a waterbirth last time (no pools available, risk of infection due to waters breaking early etc...) but do most people actually deliver in the water? I get the impression a lot of women labour in the water, then climb out for the very last bit. Sorry if that's a stupid question!

I think it depends on hospital policy. Some areas seem to recommend getting out to give birth, some that you stay in the water if you're happy. I think they'd struggle to forcibly move someone who was determined not to get out though! My midwives never even suggested I get out - they seemed to assume from the start I'd want to give birth in the water (which I did, both times)

[VanillaPickle]

I delivered in water twice (induction with the first so not allowed near the pool) and on both occasions at some time early on I was asked if I wanted to deliver in the water, and did I want 3rd stage in the water. On both occasions when it came very close to the time I was asked gently if I wanted to stay put, which I did. I don't remember first time round but second time round they did say that they recommended I got out to deliver the placenta which I did quite happily (perhaps because I had the injection??).

Honestly you would not have been able to get me out of the water to deliver, it was sooooo lovely in there and quite lovely having the first cuddles in the water.

I think some midwives are not confident in water birth techniques hence encouraging women to just labour in the water. Luckily on both occasions I had midwives who were very confident, armed with waterproof equipment, lights dimmed, calm voices and torches!!!

[cvious]

Okay, so I have no idea what OBEM is, but I am American. Water births tend to not be done at hospitals here because there is some worry about infection risks, whether real or perceived. I was told Icould labor in a jetted tub on our birthing suite until my water broke. I wanted out before then anyway, but I've heard they are pretty lenient on that policy. Water births are encouraged for home births and birth center births. My OB said at home there is not the same infection risk as using a hospital's tub. I guess they aren't confident about their cleaning staff!

I went to a giant US hospital using an obgyn and had no issues having an unmedicated birth in whatever position I wanted not connected to anything. In the jetted tub until transition. I wasn't comfortable being in water after puking in it.

[blackberrycrumble]

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Here's an American obstetrician who is fiercely against water birth on grounds of increased risk to the baby (warning, her opinions are very forcefully expressed and she discusses some really sad cases, so don't go there unless you don't mind possibly being upset...) http://skepticalob.blogspot.co.uk/2010/ ... ities.html

Crikey, just had a read of that. No way would I let her anywhere near me, in labour or otherwise! She sounds really....nasty.

[sparkling]

I completely failed to have a waterbirth last time (no pools available, risk of infection due to waters breaking early etc...) but do most people actually deliver in the water? I get the impression a lot of women labour in the water, then climb out for the very last bit. Sorry if that's a stupid question!

At our hospital the MWs said that overall the pool is 'underused', and that most women who labour in the pool get out before they deliver. For that reason they asked if I minded a student being present for my nice calm waterbirth, as they are fairly unusual. (She certainly saw an interesting birth as once Jiglet's head was out she got stuck and I had to get out to deliver the body )

My OB said at home there is not the same infection risk as using a hospital's tub. I guess they aren't confident about their cleaning staff!

I was not allowed in the pool until they had run the taps for half an hour, cleaned it and filled it - felt like the longest hour of the whole process, I had been in the bath at home and loved the pool. I think the tap running thing had to happen every morning.

[TPM]

I have also delivered in the water twice but was never asked if I wanted to get out. Some mws are a bit concerned about delivery in the water. Even my midwife who actively encourages water birth is very paranoid about touching the baby whilst it's under water. The theory is they don't take a breath till they're stimulated so you shouldn't touch their head when it's born but as they've come from water into water plus their chest is being compressed by your pelvis birth canal, it sea they can't and don't. Then as theyre lifted Into tge cold air it makes them gasp. If you think about it they dont worry that clipping a monitor to the baby's head might make it breath in amniotic fluid inside you so a hand on its head in the birth pool is unlikely to stimulate a gasp. Especially given how calm water births usually are. If the mothers relaxed the baby tends to be born fairly chilled out too. There's some good factual stuff on water birth on the homebirth.org website.
I'm fairly sure the chap (presumably an obstetrician) that decided it was a good idea and really ran with it, researched it, initially promoted it etc was French. Not sure how many water births they have there?

[Kate]

Thanks - just asking after reading the scaremongering article (foolishly!!). Hopefully there'll be time for the pool this time, probably not if it's as quick as Roo's though....