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

[ToothFairy]

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!

Dilly was born in the pool, he likes to tell people he was born in a paddling pool You would not have got me out of that pool if you'd paid me! I did have to get out once to use the toilet, and I vowed to myself then that I wasn't getting out again. I hope you get your waterbirth this time Kate, mine was lovely and I'd recommend it to anyone.

[robyn]

I just read the scaremongering article, and there was one thing in it that def made sense to me - baby's practise breathing in the womb and inhale amniotic fluid, why would they not then do the same in the water, stimulated or not?
Just pondering, I'll never have a water birth. I'm a tens machine girl, and the idea of taking it off to get in water would terrify me!

[blackberrycrumble]

I'm up far too late reading the stories on another site linked to the one Eleanor posted the link to (and run by the same crazy ob), called 'hurtbyhomebirth' which is basically lots of tragic stories. Putting the questionable use of these stories to one side it seems very clear that the problem isn't home birth, it is the lack of training of the people calling themselves 'midwives' in the US. It seems pretty much anyone can register as a midwife in many states. Inevitably, they have no idea what to do when things go wrong. Very, very sad.

[ToothFairy]

But why is it safe for them to inhale amniotic fluid in utero, but not water once they're born? When does it become not OK to inhale fluid?

With Dilly's birth there came a point when the TENS wasn't enough any more. Getting in the pool was a massive relief.

[robyn]

I don't know, that's what I wondered. they worry about the amniotic fluid being inhaled if it has poo in it, and I guess the water may well have all sorts in it?

it was the only thing she wrote that seemed to make any sense so I thought someone here would rubbish it for me

I love the idea of a waterbirth but it's not for me, the tens machine stopped really doing anything pain relief wise quite early on, but it was like my magic totem, there was no way I was taking it off!

[Riotproof]

OT, but my impression is that in the uk, home birth is considered a "normal" option and supported by the national healthcare scheme. Am I right? Cause that is way cool. Here, home birth is well beyond crunchy and must be done privately by independent midwives, who have to pay insurance making it prohibitively expensive.

[monster]

OT, but my impression is that in the uk, home birth is considered a "normal" option and supported by the national healthcare scheme.

Not sure about the UK, but that's the way it is here in NZ.

I laboured in the pool, but DS was born beside it, for various reasons (including my impatience). I was given the option to have him in there. DD was born in a pool in the dining room.

[ches]

Nobody ever looked at me like I had four heads when I wanted to go natural, not even as a VBAC patient. The hospital wouldn't let me near water, though, because I was "high risk." I ended up with a uterine infection and me & T having tachycardia and being on post-partum antibiotics for a week each regardless.

What saddens me most about the state of labour & delivery in the US is the dearth of baby-friendly hospitals. There is scant bf support. It was better this time around, but still only one lactation consultant on the ward and not full-time.

[TPM]

Found this about breathing in the water;

The American Academy of Pediatrics 2005 statement on water birth concluded: "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 after informed parental consent." This statement is refuted by midwife Annie Sprague, who suggests this is one of the most contentious and possibly influential myths surrounding water birth and this fear is not supported by current research, which has shown to the contrary that babies do not breathe underwater (Johnson,P., Birth under water- to breathe or not to breathe. British Journal of Obstetrics & Gynaecology, 1996. 103(March 1996): p. pp 202–208, Otigbah, CM., et al., A retrospective comparison of water births and conventional vaginal deliveries. European Journal of Obstetrics, Gynaecology & Reproductive Biology, 2000. 91. p. 15-20. To summarise, in utero, a term baby breathes approximately 40% of the time and this is not merely a practice for extra uterine life. Forty-eight hours or so before the onset of labour, fetal breathing stops, probably due in part to a secondary rise in the levels of prostaglandin E2, and is thought to prevent a baby inhaling water. The larynx acts as a valve during fetal breathing movements (aided by inspiratory muscles) preventing little intake of amniotic fluid. If any fluid makes contact with the larynx, the fetal dive reflex is triggered and any fluid is then swallowed. The large number of chemoreceptors found in the larynx further supports this process and these receptors help the baby determine which fluids to inhale and which to swallow. In other words, the baby can recognise that water should be swallowed and not inhaled

[TinLIN]

To summarise, in utero, a term baby breathes approximately 40% of the time and this is not merely a practice for extra uterine life. Forty-eight hours or so before the onset of labour, fetal breathing stops, probably due in part to a secondary rise in the levels of prostaglandin E2, and is thought to prevent a baby inhaling water. The larynx acts as a valve during fetal breathing movements (aided by inspiratory muscles) preventing little intake of amniotic fluid. If any fluid makes contact with the larynx, the fetal dive reflex is triggered and any fluid is then swallowed. The large number of chemoreceptors found in the larynx further supports this process and these receptors help the baby determine which fluids to inhale and which to swallow. In other words, the baby can recognise that water should be swallowed and not inhaled

Can I just say: WOW! Humans are amazing things, aren't we?!

But I must admit, instinctively it makes me feel a bit at the thought of my babies not breathing for 48 hours before birth!!!!

I didn't get near the pool with Squeak (she was in too much of a hurry to get out!), but at the time, I was only planning to labour in the water. I just wasn't grabbed by the idea of actually giving birth in it, although I was more than prepared to love it once I was in there and refuse to get out . But my 'plan' was to give birth out of the water.

[jvnt]

I suspect it's like the system here where whilst everything may be considerably more medicalised because the medicine is a financial transaction you have a lot more choice than you would have under the nhs, therefore you can seek out a sympathetic doctor/birthing centre/midwife if you are inclined.

Here you need to plan a long way ahead and chose your doctor, doula and hospital carefully but once you've done your planning you may be more likely to get the birth you want than the 'lottery' system in the UK, I certainly got more or less what I wanted both times even though we're renowned for having the highest c-section rate in the world (I think) although I would have loved a water birth. Water births are similarly not recommended here but I think we're starting to get a couple of birthing centres where you can have one... too late for my two but a step in the right direction.

[Eleanor]

But why is it safe for them to inhale amniotic fluid in utero, but not water once they're born? When does it become not OK to inhale fluid?

Before they're born they're getting their oxygen into their blood from the placenta; obviously after they're born they need to take in oxygen themselves. I'm not sure what the exact point of changeover is though (presumably it's more a process than a single moment) but oxygen deprivation at birth can cause brain damage. There's also the problem of getting bacteria etc in the lungs that shouldn't be there.

I reckon Bananacustard has a very good point indeed about the problems coming from lack of care, attention & training rather than from a particular method.

[monkeydo]

I laboured and gave birth in the pool, the midwife's main concern was that the water had to be the correct temperature when J emerged, she said it had to be the same as blood temp which I guess may be to prevent him taking a breath in the water? Either way it was lovely, you wouldn't have got me out for all the money in the world!

[Rosie_t_Riveter]

I laboured and gave birth in the pool, the midwife's main concern was that the water had to be the correct temperature when J emerged, she said it had to be the same as blood temp which I guess may be to prevent him taking a breath in the water? Either way it was lovely, you wouldn't have got me out for all the money in the world!

This. And Robyn, I used a TENS machine for TheWriggler's birth and loved it. I used it for TheBean up to the point that I could get in the pool and the effect of the water beats the TENS machine hands down.

[Juddystarlet]

But why is it safe for them to inhale amniotic fluid in utero, but not water once they're born? When does it become not OK to inhale fluid?

Before they're born they're getting their oxygen into their blood from the placenta; obviously after they're born they need to take in oxygen themselves. I'm not sure what the exact point of changeover is though (presumably it's more a process than a single moment) but oxygen deprivation at birth can cause brain damage. There's also the problem of getting bacteria etc in the lungs that shouldn't be there.

It takes several minutes for the umbilical cord to stop pulsating so they are still getting blood and oxygen from the mother for a while after birth (if you have a natural third stage) so I don't think there is any danger of a lack of oxygen.

I laboured and gave birth in the pool, the midwife's main concern was that the water had to be the correct temperature when J emerged, she said it had to be the same as blood temp which I guess may be to prevent him taking a breath in the water? Either way it was lovely, you wouldn't have got me out for all the money in the world!

Mine was the same. She didn't mention any issues with the baby taking a breath underwater, but that babies can't maintain their body tempreture and so mustn't be in a cooler environment.

I'd read the information on babies taking a breath under water and to me, it makes no sense. They have the dive reflex, which prevents them from breathing in water, which is why they can "swim" underwater at such a young age. During the birth process, they are moving from one body of water to another and therefore surely wouldn't breath until bought to the surface. It's the air on the cheeks that then triggers a breath - the same way as if you blow on a new borns face - they instinctively breath in.

Interesting views from all over the world, though.

The article made for interesting reading - strong words indeed. But I choose to ignore and will continue with my plan for a waterbirth at home!!