Biology 103
2002 First Paper
On Serendip

Over the past few years, there has been a resurgence in interest in homebirths and other "alternative" ways of giving birth. There has been a rise in if not the actual incidences of births involving a midwife instead of an obstetrician, at least in the coverage in the news and in parenting magazines of midwives and their art. The debate has gone back and forth over whether midwives are reliable sources of support when having a baby. This debate has become so common that it is becoming part of our collective culture, most recently in the Oprah Book Club book Midwives: A Novel by Chris Bohjalian (1). One of the reasons their credibility has been questioned is that midwives are more likely to participate in an alternative birthing style, such as water births. The debate around water births has been almost as lively as that around midwives themselves. Both the supporters and opponents of the practice are passionate about their arguments, both of which can be very convincing.

The number of hospitals that offer water births has risen in the last decade, but most are still performed by midwives in birthing centers or in the home. Even with the growing number of hospitals offering this service, "the American College of Obstetricians and Gynecologists has not endorsed the technique. It says there is not enough data to prove safety" (2). Most of the studies on water births have been conducted in the United Kingdom, where the practice is offered in most hospitals. While water births are not still the norm, having the mother rest in a tub of warm water during labor is very common there.

Spending part of the labor process in water has proved to be beneficial even if the mother leaves the tub before actually giving birth. "Warm water helps a laboring woman's muscles relax-which often speeds labor. When a woman is more relaxed and comfortable, the uterus functions optimally, reducing stress to both mother and baby. Water appears to lower a woman's stress and anxiety level, thereby lowering stress-related hormones which cross the placenta. Many women repeatedly report the wonderful pain relieving properties of water" (3).

The benefits of a water birth for a mother go beyond the simple relaxing qualities of water. The tissues of the vagina become much more elastic in water, making the actual birth easier for the mother. "A 1989 nationwide survey published in The Journal of Nurse Midwifery on the use of water for labor and birth reported less incidents of perineal tearing with less severity" (4). This reduced stress on the vaginal tissues and birth canal converts into less stress during birth for the child. Combined with the relaxed uterine muscles, water births are considerably less physically stressful for both the mother and the baby.

Even with all of these benefits, many hospitals in the United States still do not endorse, let alone offer, water births in their maternity wards. Attached to these benefits are some very serious risks. The same warm waters that help to relax muscles during labor can be incredibly harmful to the mother after she has given birth. The warm water can keep the muscles relaxed after the deliver of the placenta and prevent blood clotting. While immersed in water, it is also harder to tell how much blood is being lost as it is diluted in the bath water. "Also, if the placenta is delivered under water the combination of vasodilatation and increased hydrostatic pressure could theoretically increase the risk of water embolism" (5). These risks are all still in the theoretical stage, but they are risks nonetheless.

There are also risks for the baby in water births. While the British Medical Journal reports that there is a 95% confidence in live water births, they do concede that there is a risk of water aspiration (6). Instinctively, babies should not breathe in until they are confronted with air. They should continue to receive oxygen through the umbilical cord until they start to breathe on their own or the cord is cut. Studies have shown, however, that "babies who do not get enough oxygen during childbirth [due to stress in the birth canal or placement of the umbilical cord] may gasp for air, risking water to enter their lungs" (2). A more preventable, but still serious, problem is the increased chance of snapping the umbilical cord during a water birth. There have been no studies on why the risk of snapping the umbilical cord is higher among water births, but it is speculated that the increased movement involved in bringing the child to the surface of the water after the birth is to blame (6).

The debate concerning the safety of water births will continue as the practice becomes increasingly popular in the United Kingdom and elsewhere. There are no studies that directly link water births to the risks I have outlined; they are deemed theoretical or consequential. One must decide to weigh the benefits with the possible risks before choosing to undergo a water birth. As the practice becomes more accepted and studied, more conclusive studies will be carried out, making the decision easier for expectant mothers.

References

1)Bohjalin, Chris A. Midwives: A Novel. Vintage Books, 1998.

2)"Water birth drowning risk." BBC, August 5, 2002.

3)Birth and Women's Center - Water Births.

4)"Why Water." Global Maternal/Child Health Association and Waterbirth International.

5)LMM Duley MRCOG, Oxford. "Birth in Water: RCOG Statement No 1." Royal College of Obstetricians and Gynaecologists. January 2001.

6)"Perinatal mortality and morbidity among babies delivered in water: surveillance study and postal survey." British Medical Journal. August 21, 1999.


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