Is water birth safe

Water Birth Risks and Safety Concerns | Center for Women's Health

Your care team will work with you to safeguard the health of you and your baby during waterbirth. Being well informed is essential and will help you avoid frustrations and complications.

Safety for the baby

Water temperature

If the temperature of the water is either too hot or too cool it can cause undue stress for your baby. The temperature is maintained close to 98 degrees and laboring women are encouraged to stay hydrated and comfortable. Your baby’s heart rate may go up if overheated. A rapid heart rate could also indicate infection or distress, so it must be evaluated carefully.

Breathing

Another concern for your baby is what happens if your baby is born underwater and then tries to take a breath. We know that a healthy baby who is not in distress will begin to breathe only when he or she feels cool air on its mouth and nose. Thus, if you are giving birth in a tub, you must have your bottom and hips completely under water to prevent your baby from taking a breath. If your pelvis is partly in and partly out of the water during actual birth, air could touch your baby’s mouth and he or she could inhale before the whole birth is completed. Once born, your baby is raised gently to the surface and cradled in your arms with his or her face out of the water. Then your baby will start breathing safely.

Body heat

Babies can lose heat very rapidly. It is important to make sure the water in which your baby is born is at least body temperature. That way, the baby will not get chilled. A cold baby uses more oxygen and can be slow to breathe and nurse.

Infection

Infection can occur from two sources. One source is germs that you might carry in or on your body and the other source is germs that might be present in the pool or water. Because the birth always involves the release of body fluids, researchers have looked at the potential for infection. During birth, you will lose fluid from the bag of waters, pass urine, blood and sometimes stool. Fluid from the bag of waters and urine is usually sterile. There are normally no germs in those body fluids. Blood can carry both bacteria and viruses. Stool usually carries bacteria and other types of organisms. Current research indicates that most germs cannot live very long in warm, chlorinated water. City water has chlorine in it to kill germs, and city water is what goes into our tubs so the chance of infection due to water contamination is remote. Also, if there are bacteria or viruses in body products or fluids, the amounts are thinned out with exposure to a large tub of water. That makes germs less able to cause infection.

A new tub liner and hose is used with each patient. The tubs go through a thorough cleaning process with special cleaning products that kill germs after each use. To prevent cross-infection between you and healthcare providers, healthcare personnel wear special gloves and gowns during examinations and the birth.

Fetal distress

Labor is stressful for both you and your baby. Nature has equipped healthy babies and mothers to handle that stress. Fetal distress occurs when your baby’s ability to cope with labor is compromised in some way. A problem can show up in labor and be recognized by changes in the baby’s heartbeat, or a problem might show up shortly after birth. Sometimes a stressed baby will have a bowel movement in the amniotic fluid before it is born. Checking on how babies are handling labor is managed the same way for all babies whether or not you labor or give birth in water. Typically babies are monitored electronically for 20 minutes or so when you first arrive in the hospital. In active labor the heartbeat of every baby is monitored with a waterproof Doppler (special stethoscope) every 15 minutes. If there are indications that your baby is experiencing a problem, you may be asked to leave the tub and the electronic heart rate monitor will be used.

Umbilical cord

Umbilical cords vary in length. As the baby is brought up to the surface of the water, it is important that the umbilical cord is not pulled. Tugging hard on the umbilical cord could tear it, which might cause the baby to lose blood through the cord. This is a rare event. The midwife will assist you with bringing the baby to the surface gently so that the cord is not pulled.

During birth, it is common to find the umbilical cord wrapped around the baby's neck. When the birth happens underwater, we may have to unwrap the cord or move the baby through the cord just as we do when the birth occurs out of the tub. Sometimes, the midwife may ask the woman to change positions or stand up in order to unwrap the cord.

Safety for the laboring woman

Infection

The same principles about infection described above apply to the laboring woman. Research shows that water does not enter the birth canal and travel upward during labor and there is not increased incidence of infections of the birth canal or uterus because of a waterbirth.

Bleeding

It is very hard to estimate the amount of blood a woman passes after she delivers the placenta (afterbirth). This is true whether the woman is delivering in a bed or a tub. There is some research that suggests a slightly greater amount of blood loss after a waterbirth. The nurse or midwife will check your uterus frequently to make sure there is no excessive bleeding. If there is a concern, you may be asked to exit the tub for an examination and/or treatment.

Hydration

The combination of hard, physical work (labor) and immersion in a warm tub of water can lead to loss of body fluids through sweating. Dehydration (not having enough liquid in the body) can cause an increase in your heart rate and a mild fever. You will be asked to drink at least 8 ounces of clear fluids every hour to prevent dehydration

Length of labor

Some researchers have noted that if a laboring woman gets into a warm bath too early in labor, it will slow down her labor and space out the contractions. Because of this, many experts recommend that a laboring woman wait until labor is well established and her cervix is at least four centimeters dilated before using the tub.

Others have noticed that labor goes faster if the woman is four centimeters or more dilated before she gets in the water. Labor may slow down if the woman stays in the tub continuously for more than one or two hours. There is no good research on this yet. If labor slows, the logical thing to do is to walk around for a half-hour or so and then get back in the tub.

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Benefits and Risks of Water Birth

Written by Shahreen Abedin

Reviewed by Nivin Todd, MD on September 11, 2022

The American College of Obstetricians and Gynecologists (ACOG), which sets guidelines for pregnancy and childbirth care in the U.S., says a water birth during the first stage of labor may have some benefits but delivering your baby underwater should be considered an experimental procedure with risks. The first stage is from when contractions start until your cervix is fully dilated.

Studies show water birth during stage one doesn’t improve your or your baby’s medical outcome.

A warm bath might help you relax and help you feel more in control. Floating in water helps you move around more easily than in bed, too.

Some science suggests that the water may lower chances of severe vaginal tearing. And it may improve blood flow to the uterus. But study results about these points aren’t clear.

Stage Two of Labor: Time to Exit the Tub

Things change during the second part of labor. That’s when your cervix is completely dilated and open and you start pushing until the baby is born.

Many doctors say there isn’t enough information to decide how safe or useful water birth is during this period.

Being out of the water for the second part of your labor makes it easier to move fast in case something goes wrong, ACOG spokesman Aaron Caughey, MD, says.

“If you have to do an emergency C-section, it would be foolhardy to risk an extra 4 or 5 minutes to move you out of the water,” says Caughey, chairman of the obstetrics and gynecology department at Oregon Health and Science University.

Water Birth Risks

Here are some of the rare problems that could happen while water birthing:

You or your baby could get an infection.
The umbilical cord could snap before your baby comes out of the water.
Your baby’s body temperature could be too high or too low.
Your baby could breathe in bath water.
Your baby could have seizures or not be able to breathe.

“It’s important to emphasize the ‘rare’ part. But these are the sorts of outcomes that are severe, like drowning,” says Jeffrey Ecker, MD, who co-wrote the ACOG committee's opinion on water births.

Are You a Good Water Birth Candidate?

Some factors may keep you out of the running for a water birth. You shouldn’t try it if:

You’re younger than 17 or older than 35.
You have complications like preeclampsia or diabetes.
You’re having twins or multiples.
The baby is in the breech position.
The baby is premature.
You’re having a really big baby.
You need to be constantly monitored and it can’t be done in the tub.
You have an infection.

Water Birth Precautions to Take

If you’re thinking about a water birth, talk to your health care professional early in your pregnancy to find out if it’s a service the hospital provides. If so, who will manage your labor and delivery? A midwife can assist, but they will need backup from a physician

If it’s not done in a hospital near you, you may have to go to a birthing center or do it at home.

Regardless of where you decide to deliver, having a water birth means you should ask questions about how the labor and delivery are done. Things to look for:

You have an experienced, licensed health care professional with doctor backup to help you through the labor and delivery.
High standards are kept to ensure the tub is clean and well-maintained.
Proper infection control measures are in place.
You and your baby are being properly monitored while in the tub as required.
There’s a plan to get you out of the tub as soon your doctor, nurse, or midwife says it’s time.
The water temperature is well-regulated, usually between 97 to 100 F.
You drink water during the birth to avoid dehydration.

Getting into a warm bath too early might slow your labor.

Water Birth Costs

If your water birth is done in a hospital, it usually costs same as a vaginal birth if it’s covered by insurance. You may be required to rent the tub, which may be an extra $200 to $400.

If you buy your own tub or pool for a home birth, it can range between $65 to $500 depending on how fancy you go.

The fees for a midwife or nurse-midwife for a water birth at home will be the same as a normal birth, ranging from $2,000 to $6,000.

If you’re having your water birth at a hospital or birthing center, the midwife’s fee might be included in what you pay the facility, but usually only if they are employed by the hospital. Birthing centers charge between $3,00 and $4,000 per birth.

Water birth - advantages and disadvantages of the method in the maternity hospital, Moscow

Water birth is one of the alternative methods of childbirth, which is starting to gain popularity again. For the first time, this practice arose in the early 1980s, but then it began to decline. Now there is a lot of talk about natural childbirth in water with minimal medical intervention and that water helps. However, there is an opposite point of view: even mammals that live in water go to give birth on land.

Water birth and being in a bath in the first stage of labor to relieve contractions are two different things. In this article, we will touch on the topic of childbirth in water, when a child is born in a bath.

Water birth preparation

The first thing to do for a woman who decides to give birth in water is to consult a doctor. Childbirth in water is permissible only with an ideal pregnancy and the absolute health of the woman.

If there are no contraindications, it makes sense to attend childbirth preparation courses, where they will tell you in detail how to behave and what to expect from such childbirth. Especially if you're having your first water birth.

In addition, you need to choose a maternity hospital, where there are conditions for childbirth in the water. Water births in Moscow are available at the EMC maternity hospital on the street. Truth. We do not recommend giving birth in the bathroom at home. However, if you still decide to do this, consider the possibility of an ambulance on duty near the house. During childbirth, unforeseen situations may arise when the life and health of the mother and child may depend on the speed of providing qualified medical care. Take childbirth responsibly!

How is childbirth in water?

If a woman decides to give birth in water in a maternity hospital, then most often she spends all periods of childbirth in the bathroom. Water helps ease contractions. However, if desired, a woman can walk around the maternity ward, sit on a fitball, etc. If a woman is in the bath all the time, then the water is periodically changed so that it is clean. After the baby is born, it is laid out on the stomach, then pulled out of the water and the umbilical cord is cut after it stops pulsing. An experienced doctor or midwife clearly knows at what point you need to get the child out of the water so that water does not enter his lungs.

Benefits of water birth

Water makes it easier to endure pain, helps to relax the muscles of the whole body, and has a calming effect.
It is believed that the newborn experiences less stress at birth in the water.

Disadvantages of water birth

Childbirth is not the cleanest process. In the water in which the woman is located, amniotic fluid, blood discharge, and stool come out. And in the same water a child is born.
There is a risk of infection due to lack of sterility.
When a woman is in the water, there is no constant monitoring of the condition of the fetus (CTG), it can be difficult to quickly determine the onset of bleeding, as well as control the condition of the cervix.
There is a risk of aspiration (water entering the lungs) of the newborn. Some babies inhale immediately after birth, until the moment they are taken out of the water.

When is water birth impossible?

For any complications of pregnancy, such as preeclampsia, fetal hypoxia, breech presentation of the fetus, clinically narrow pelvis and large fetus, placenta previa, diseases of the cardiovascular system in the mother and other complications that the doctor will tell you about.

Water birth at EMC maternity hospital

The EMC maternity hospital has created conditions for any childbirth. The birthing ward has a comfortable bathtub for water births or relief of contractions in the first period.

Before giving birth, the doctor, together with the expectant mother, draws up a plan for childbirth, which takes into account all the wishes of the woman. If there are contraindications for a particular method of delivery, the doctor talks in detail about all the risks and ways to prevent them. If a woman is aware of all the shortcomings and risks, there are no medical contraindications, the doctor can take birth in the water. The price of the contract will not change from this. In the event of an unforeseen situation and danger to the mother and fetus, doctors can immediately change tactics, and even perform a caesarean section directly in the maternity ward - there is all the necessary equipment for this.

Should I decide to give birth in water

February 7 Likbez Health

This option has advantages, but is not for everyone.

Some doctors are against water births because they consider them dangerous and unnatural for humans and mammals in general.

Elena Berezovskaya

Obstetrician-gynecologist, researcher and author of books.

Water births carry many risks for both mother and baby. If we analyze the evolution of the animal world, then the history of aquatic births ended at the level of reptiles. Even crocodiles and turtles bury their eggs on land. Of all mammals, only whales and dolphins give birth in the water. But even those are on the surface, trying to push the baby into the air as quickly as possible.

But official recommendations, for example, from the American College of Obstetricians and Gynecologists, are as follows: healthy women with uncomplicated pregnancies between 37 and 41 weeks and 6 days can be offered to give birth in water.

The point is that such births do have some advantages over traditional ones. First of all - for the expectant mother. For a baby, there are no scientifically confirmed bonuses from such a birth.

Why give birth in water

The American Maternity Association explains the effect of soaking in a warm bath on a woman about to become a mother. Let's clarify right away: all scientifically proven benefits apply only to the first stage of childbirth - from the onset of regular contractions to attempts.

Warm water helps to calm down and relax.
In the water, a woman feels light, moves more freely and focuses on new sensations, and not on pain.
Water appears to reduce stress levels and cause the body to produce more endorphins, hormones that reduce pain. As a result, patients who decide to spend the first stage of labor in a warm bath are less likely to require anesthesia.
Water softens and relaxes tissues, making them more elastic. There is evidence that for this reason, in water birth, women are less likely to suffer from ruptures and other injuries of the perineum, and even lose less blood. But this information needs to be further verified.
In some cases, a warm bath can help shorten the first stage of labor by an average of 32 minutes compared to traditional bathing.

Why it's dangerous to give birth in water

A systematic review of 15 scientific papers conducted by experts from the international research organization Cochrane looks optimistic: it seems that water birth is as safe as traditional ones.

Nevertheless, doctors at the American College of Obstetricians and Gynecologists insist that it is better for babies to be born on land, not in water. This means that after the first stage of childbirth, the expectant mother should leave the warm bath. Such a recommendation is associated with small, but still existing risks to the health of a woman and her child. Here they are:

Infections. Water is not a sterile medium. In obstetric practice, there have been cases of infection of newborns with dangerous bacteria - Pseudomonas aeruginosa and Legionella pneumophila. In some cases, the infection has led to the death of infants.
Water embolism. This is the name given to the situation when water enters the mother's bloodstream.
Risk of suffocation. Usually newborns do not breathe until they are in the air: all this time they continue to receive oxygen through the umbilical cord that connects them to the mother. But if the tube gets twisted during childbirth, the baby will be forced to inhale. If at that moment he is in the water, the liquid can get into his lungs.
Broken umbilical cord. This can happen when a newborn is taken out of the water too abruptly. A severed umbilical cord is theoretically capable of leading to large-scale and deadly bleeding.

When it is better to refuse childbirth in water

There are direct contraindications for water birth. It's not worth the risk and it's better to forget about this venture if:

this is a premature birth, for a period of less than 37 weeks;
mother had a caesarean section in the past;
the woman has herpes or another skin infection;
the pregnant woman has a fever or doctors think there is an increased risk of uterine bleeding;
have difficulty monitoring the fetal heartbeat or need to monitor it constantly;
Doctors suggest shoulder dystocia, a life-threatening condition where an infant's shoulder rests on the mother's pubic bone and cannot pass through the birth canal;
Anesthesia is planned for delivery;
the fetus is in breech presentation;
mother is expecting the birth of two or more children.
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