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Friday, September 5, 2014

Water Immersion for Labor, Not Birthing Endorsed

Water births are not being endorsed but sitting in the tub, or as gynos put it “water immersion,” during labor can be done safely  in maternal centers, birthing suites and other certified birthing centers. The American Congress of Obstetricians and Gynecologists and the American Academy of Pediatrics are not as sure. Newest guidelines call for allowing labor, although no maternal or fetal benefit has ever been shown, but not actually birthing in the tubs. The tubs used do have planned ways of making sure that between patients the tub is clean and safe for the next maternal-baby unit, so we don't have concerns regarding infections. All water immersion programs have specific criteria that a woman must meet when she presents in labor, she and her fetus must continue to meet these criteria as her labor progresses , and there are  emergency strategies as to when to move out of the tub to a bed for when there are signs of maternal or fetal stress. If these policies for water immersion labor and delivery are followed carefully, then safety is enhanced. If policies are not followed, or the mom or baby evaluation is interfered with because of being in the tub, then the pregnancy is actually at more risk. When planning one’s birth, no matter if you plan to use the tub or not, it’s important to get consultation from your birth attendant, but here are few considerations. For the mom infections inside the uterus during labor (chorioamnionitis) or infections of the uterine lining after labor (endometritis) are possible after labor, but don’t seem to have a greater risk of developing whether or not the mother labors in a tub than birthing in a bed. The mom’s blood pressure will be lower in the tub than when laboring in a bed, but in most cases this won’t translate into an abnormal heart rate for the baby. Births can occur in a quick or precipitous manner and thus anyone laboring in a tub theoretically might still deliver in that tub. The plan for the position and the place for the actual birth has to take into consideration ‘birth trauma’ meaning injury to the baby. This can happen with any birth, but fortunately very rarely does a birth injury occur in a natural birth with no risk factors. If one has risk factors then a plan for how to avoid these has to be in place. Risk factors for having a traumatic birth are not limited to but include the baby being large, the mom being obese, the baby having known birth defects (an extreme example would be a baby without full closure of the abdominal wall), and the baby not coming down in the perfect head down (vertex) position. Babies at high risk for birth trauma are not ideal candidates for water immersion. There are situations when the birth attendant needs to assist the baby’s passage. Water births that occur in specially designed tubs do allow for some birth attendant assistance, but there is not as much flexibility to assist as there would be in a specially designed birthing bed. Birthing in the water, rather than a bed, exposes the infant to a very different set of stimuli: different temperature, different smells, different ability to get air with first gasp (would likely get water instead of air), different physiologic pressure on lung cage, different bacterial counts, and increased exposure to particles (for example if there is blood or stool in the water), than the baby would have if birthed in a bed or squatting. No studies have quite quantified what the consequences of these differences would mean for a healthy baby, or a baby who has challenges we have not yet discovered. Complications to the baby from birthing in a tub have included cord rupture and infections and high red cell blood count (polycythemia). Water birth complications to babies that are unique to this type of birth include the baby being born with abnormally low blood salt (sodium) levels, the baby drowning. So this has led many obstetricians to tell patients we have to talk about the known science and some of the unknowns. Given that, yes, many women have safely delivered in the tubs, but many birthing units have now prohibited these in an effort to enhance safety, including those in our local community Presence and Carle..But enjoying splashing in a pool some day with your healthy child, now that's an endorsement we can all go with!


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