Underwater Birthing
Underwater delivery is a subject of continuing interest and controversy. Birthing pools are found in increasing numbers in North America, Western Europe, Australia, and South Africa. Indeed, according to newspaper reports, there were 20,000 underwater deliveries in Great Britain alone. The protocols for underwater deliveries vary among birthing centers, but the Waterbirth International Society has put together general guidelines. First, a thorough explanation of the waterbirth process should be provided for the interested couples. Mothers should be advised that contraindications to underwater birthing include high-risk pregnancies (eg. maternal cardiac/renal disease, hypertension), meconium in amniotic fluid, fetal distress, need for induction, multiple pregnancies, breech presentation, and genital or skin infection.
The water temperature can vary between 90 o F and 10l o F depending on the mother’s comfort, but should not exceed 101 o F. Any debris that accumulates must be strained out as quickly as possible. The mother can be immersed in warm water at any point in labor. She can adopt whatever labor posture she chooses. Although underwater birthing is far from being pain free 80% of the underwater participants reported a soothing of pain.
Most health care providers do not advocate episiotomy in patients who opt for underwater birthing. In one study, no episiotomies were performed in the group of 100 patients who delivered underwater, resulting in a 29% incidence of vaginal tearing.
Fetal/Neonatal Effects
Numerous claims have been made regarding the potential benefit and/or harm of underwater delivery for the developing neonate. Charkovsky (noted proponent of water birth) believes that birth into water minimizes the effect of gravity on the brain at the moment of birth, decreasing the initial oxygen requirement and thus promoting optimal brain function: however, this conclusion is based neither on existing data nor on our current scientific understanding of brain development. Little is known about the effect of underwater birth on the developing baby and further research is needed.
Patient Counseling
Midwives and Physicians should be prepared to provide accurate information for patients who express an interest in underwater delivery. While there is currently no mechanism in place to assess the quality of birthing centers that offer underwater delivery, women can obtain formation from the Global Maternal-Child Health Association (GMCHA) based in West Linn, Oregon. This group offers books, articles, studies, stories, and photos related to waterbirth and maintains a list of practitioners, hospitals, and birthing centers that incorporate the use of water during labor and delivery.