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Monday, March 24, 2014

Pushing in The Pool? Experts Say 'OK' But Get Out Before the Baby Is Actually Birthed

Deciding how to labor and birth has a lot of factors. And one topic that comes up is use of a tub to labor or deliver in. Information from clinical studies has been trickling in, and the newest research tracked over 3000 women in order to make professional recommendations regarding the practice of pushing or birthing in water. Water can support weight and it's been thought that water birth could offer positioning advantages. Position in labor and pushing in the right position has been thought to be able to speed things up for mom, so lots of research and engineering design has been devoted to making this happen. In 2004 Gupta and Hofmer published a study looking at being sitting in the 30 degree position vs laying flat on your back to push the baby out, and yes, sitting was better: by 4 minutes...so baby's birth was sped up roughly the amount of time it takes for one extra contraction. Other gynos have looked at other factors such as mom's comfort, the health of the baby, the amount of bleeding after delivery, and again it's confusing. Squatting can bring the baby faster, but in some studies the mom's had more nerve injuries of their pelvic floor because of squatting as they pushed the baby out. So for less stress and strain, delivering in a tub may solve many of those issues. For the term pregnant mom water immersion for laboring and delivery can be done in a variety of positions and venues. In your lap pool when your contractions are just a hint of a cramp, in your tub at home when you are trying to decide if it's really labor, in a whirlpool in the labor suite, in a specially designed tub, in the shower in your labor suite, technically all these are water birthing options. In some studies those who labor immersed in the water have fewer epidurals for pain relief. And the newest data does suggest that the biggest benefit of a tub birth is comfort for mom.
However, actually accomplishing the birth with the birth canal completely submerged is more difficult for many reasons. In one set studies between 1997 and 2004 water birth complications included babies drowning, blood pressure problems, infections, and cord blood rupture. Water warmed to the body temperature is fairly perfect petri dish for the enteric (bowel) and local hospital bacterial species that could grow rapidly to levels that would be unsafe for a baby. Thus the American College of Obstetricians and Gynecologists (ACOG) has not yet issued a position statement, and the last actual statement by the American Academy of Pediatrics in 2005 actually had fairly ominous wording regarding the risks, and in their newest joint statement issued on March 20th. So even though you are ready to wade in, the professors of obstetrics aren't really ready to. So talk it over with your provider, there are benefits like less use of epidurals, and that might be reason enough to Wade Right In when the big day comes!

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