The practice of waterbirth is somewhat contentious in the United States, despite it’s use in other developed nations. As the name suggests, waterbirth is when a mother labors and gives birth in water. The baby is born submerged and promptly brought to the surface. Advocates note anthropological evidence of cultures that gave birth in the water.
Laboring in water often relaxes the mother. Buoyancy offers relief from pain and reduced stress on tissues. The baby is born into warm liquid, similar to the amniotic fluid. Small studies have shown no ill effects from immersion on mother or baby. However the Committee on Obstetric Practice and the American Academy of Pediatrics consider underwater delivery to be an experimental practice in need of more research.
Enter: More Research!
A cohort study published in the Journal of Midwifery & Women’s Health (January 2016) looks at the health outcomes of waterbirth. This is the largest study to look specifically at waterbirth in the US population.
Researchers looked at data from the Midwives Alliance of North America Statistic Project (MANA Stats). MANA Stats is an online data collection effort that gathers complete courses of care of women who have had midwife-led pregnancies and births. This study analyzed over 18,000 mid-wife attended births occurring both at home and in birth centers in the United States from 2004-2009. About 35% of these births were underwater.
The researchers compared 5-minute Apgar scores across the cohort. The Apgar score quickly evaluates a newborn’s physical condition on a scale of 0 – 10, the higher the better. By comparing the waterbirths to non-waterbirths, they found that babies born underwater were less likely to have a low 5-minute Apgar score, and were less likely to be hospitalized. Mothers having waterbirth had a decreased the risk of hospitalization in the first 6 weeks postpartum. However, the women did have an increase risk of genital tract trauma. But there were no increased risks of infection for the mother.
The researchers note that the better outcomes are not straight forward. Mid-wives would likely ask women experiencing complications to get out of the tub for closer monitoring. Thus, the data might be skewed, with only low-complication births being completed under water. While there is no conclusive evidence of an added benefit from immersion during birth, the study concludes that waterbirth in the US is being done safely. “Based on our results, waterbirth certainly is not harmful to the neonate. Our findings also suggest that US midwives attending home and birth center births on the whole are appropriately managing women as they labor and birth in water.”
The mothers who gave birth while immersed in water had no increased risk of adverse outcomes except for an 11% increase in odds of genital tract trauma. Researchers couldn’t find any pattern as to trauma location and severity. Thus, they think the “finding of increased risk of maternal genital tract trauma requires further investigation.” Midwives and doctors should talk about the possible risk of genital tract trauma with women who are making an informed decision about waterbirth.
In conclusion, giving birth underwater is not dangerous for the baby. The study concludes that “waterbirth is a reasonably safe option for use in low-risk, low-intervention births-especially when the risks associated with other forms of pharmacologic pain management are considered.”
Sources:
http://onlinelibrary.wiley.com/doi/10.1111/jmwh.12394/full
http://www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Obstetric_Practice/Immersion_in_Water_During_Labor_and_Delivery
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