health 2

Water Birthing

7

Running Head: Mind/Body, Water Birthing

Mind/Body: Water Birthing

Western Oregon University

Summer 2008

HE 413

Mind/Body: Water Birthing

In a society where birthing babies while hooked up to intravenous fluids, receiving epidurals, lying on a stiff hospital bed, only to end up sharing a room with someone else while recovering is the cultural norm, it is difficult for many people to understand the concept of underwater birthing or why anyone would even want to explore it as an option. Science and health are constantly discovering new ways to do things, and all of them deserve to be looked at especially when they may improve the birthing process and provide babies with a less stressful welcoming into this world. Women who choose to go an alternative route such as underwater birthing the scenario typically goes much differently than the conventional hospital visit depicted above. Women who choose to water birth usually begin labor out of water until they have moved farther along in labor. When it is decided it is time, the women gets into a tub of warm water to deliver her baby, although some women choose to labor in the tub and get out before the delivery. This water is kept and regulated at 98.6 degrees Fahrenheit, as this is the temperature of the human body at homeostasis and it is important that the baby is kept at this temperature (Water birth, 2008). The tub is sanitized thoroughly after every use and tested from any bacterium as this could increase the risk of infection to the mother and the baby. Usually there is only a mid-wife and the father present during the birth as many feel a doctor is not necessary. When the baby is born it is released from the mother into the pool of water that should feel to them a lot like the amniotic sac in which they have been living in for the past nine months, where it then can be handled by the father, mother, or the midwife. The baby should not be left in the water for a great period of time while being touched as the baby could be stimulated into breathing underwater and that may potentially be harmful (APA, 2008). The baby will take its first breath once it has been emerged from the water and felt air touch its mouth and nose. Then the mother can hold the baby in the water and relax. Because it is difficult to access blood loss while the mother is still in the tub, many women will get out of the tub to birth the placenta.

Although many people question the safety of this method for the mother as well as the baby, it is still growing in popularity. More and more hospitals across the United States are beginning to adopt this alternative and provide the services to expectant mothers who wish to birth in water. Oregon Health Sciences University in Portland Oregon is one of the first to provide a midwifery and water birth clinic. The demand for water birthing in the United States and other countries has been growing over the last thirty years however there has been little sufficient research done on the risks involved or research to prove the claims in which advocated for water birthing make. Some good research does exist but much more is needed.

The process of underwater birthing claims that overall the stress level and pain discomfort of the women and baby will be decreased and the baby will be born into a relaxing, calm environment more like the one in which it is coming from. There are also claims that the warm water increases the women’s energy level, the buoyancy of the water lessens her body weight and allows free movement, promotes better uterine contractions which increases the flow of oxygen lessening cramps, lowers blood pressure caused by anxiety, allows the perineum to become more elastic which decreases the amount of tearing or need for an episiotomy and stitches, relaxes the mother physically so she can mentally focus on delivery, and the water provides a sense of privacy and lessens fears (APA, 2008). The two claims that the majority of the women are finding most appealing about water birthing is that it is less stressful for the baby to be born into an environment that is more like the amniotic sac than born straight to dry air, and that the women will be more relaxed which lessens pain and their need for drugs. Although many research differs in findings, some of the proposed risks of giving birth in water are possible water embolism in which water enters the mothers bloodstream, water inhalation by the baby in rare situations, infection due to bacterium in the tub or water, and some suspect a lack in ways to deal with various complications that may arise (Karatzas, I 2007). Many people fear the baby drowning because they do not understand that babies get air and breathe through the umbilical cord attached to the mother and will only breather on their own when stimulated to do so by contact with the air, the cord is cut, or rare complications in which being handled stimulates them to breath, or if there are complications with the umbilical cord. Some advocates of water birthing claim that in many of these situations they are aware that this will occur and the women can simply lift her pelvis out of the water to deliver the baby, in order to avoid the baby from inhaling any of the tub water.

As mentioned earlier one of the claims of water birthing is that it decreases the risk of needing an episiotomy, and lessens vaginal and perennial tearing. An episiotomy is a surgical procedure for widening the outlet of the birth canal so the baby can be birthed avoiding a jagged rip of the perineum (the area between the anus and the vulva) which is harder to heal. During an episiotomy, an incision is made between the vagina and the rectum (MedicineNet, 2008). The usual cut goes straight down and does not involve the muscles around the rectum or the rectum itself. However, episiotomy is also associated with a higher incidence of extensions or tears into the muscle of the rectum or even the rectum itself which is more difficult to repair and more painful for the mother (MedicineNet, 2008). It would be understandable that any women would like to decrease their chances of experiencing this during any kind of birth.

As the result of there being so many variables to compare from land birth to water birth and there being insufficient research for some, we will look at the claim of water birth that it decreases the tearing of the perineum during childbirth and reduces the use of episiotomy’s and stitches. A study done by the Basel University Women’s Hospital in Switzerland conducted research on 513 patients of low risk pregnancies who requested a water birth from April 1998 through May 2002. They were looking to explore differences in the maternal and fetal outcomes when birth took place in or out of water, perineum tearing and episiotomy use being one of them. They found that of the women who birthed in the water 5.6% of them needed an episiotomy where as people who labored in the tub but got out for delivery had 48.9% need then, never got in the water and gave birth on land 37% needed them and women who gave birth on land and tools such as forceps where used during delivery 55.9% needed episiotomies (Zanetti-Dallenloach, Lapaire, Maertens, Holzgreve, Hosli, 2006). Although this study showed a reduced need for episiotomies by women who gave birth in water, there was a much higher percentage of perennial and vaginal tearing amongst the women who gave birth in water than the other three groups. This could be due to the water reducing the amount of visibility to the perineum and vaginal and leads one to think whether or not the need for episiotomy was much higher they were just unable to notice tearing.

Another study done over the period of eight years, studied the outcomes of episiotomy and perennial trauma of 737 deliveries in water compared to 407 in the bed. They found that for the births that took place in water there was a much lower episiotomy rate. Unlike the first survey the lack of episiotomies were not accompanied by vaginal or perennial tearing. 57% of the women who delivered in waters’ perineum remained intact, whereas only 36% of the women who birthed in a bed s’ did (Theoni, Zech, Moroder, Ploner, 2005). They also found the number of episiotomy’s used while birthing in the tub decrease over the eight years as well. Although the first studied mentioned also found a decrease in episiotomies they differ as far as perennial and vaginal tearing, so to conclude that episiotomy’s are reduced by water birthing from these two studies would be insufficient and unreliable. There needs to be more research to test this variable, most with similar outcomes in order to conclude water birthing actually has this benefit as well as others, and more research to prove or disprove there really are risks.

After reading many research journals, websites and books on water birthing and evaluation the finding of studies as far as risks and benefits of water birthing versus birthing out of water, I would be willing to try it for myself. I am not confident enough in the research to allow myself to be referring this modality to others. Although there have been some good studies that open the door to be furthered in research and approached, under water birthing lacks research which I believe is coming soon. I feel fairly confident that if I had a low risk pregnancy I would be successful and safe having a water birth, however I am not confident in water birthing when it comes to high risk pregnancies especially multiple births as the chances of these complications arising increases and not much research has been done on if these complications can be handled safely while in water. There are many claims to water birthing that I have found to hint towards being true through research; however there are many other benefits that as for now show no major difference in water birth and the benefits received during birth on a bed. Even in the cases explored in this paper and the claims of decreased episiotomy rates, it varies from case to case, and these are the only two studies that researched only that variable available through EBSCOhost while searching many databases and exploring the internet. This is a narrowed search only focusing on the outcome of one thing such as episiotomy but I feel all situations should be explored into such depth. I would like to see more research done, however I feel this modality is on to something and I am excited to see it grow as it is researched more.

References

Zanetti-Dallenloach, R., Lapaire, O., Maertens, A., Holzgreve, W., Hosli, I. (2006). Water Birth More Than a Trendy Alternative: A Prospective, Observational Study. Journal Achieves of Gynecology and Obstetrics. Volume 274, pages 355-365.

Karatzas, I. (2007). Preparing for Childbirth. Canadian Journal of Health and Nutrition. January 2007. Issue 291, pages 66-70.

Theoni, A., Zech, N., Moroder, L., Ploner, F. (2005). Review of 1600 Water Births. Does Water Birth Increase the Risk of Neonatal Infection? Journal of Maternal- Fetal and Neonatal Medicine. Volume 17, Issue 5, pages 357-361.

Episiotomy. (n.d.) Medicine Net. Retrieved July 20th, 2008 from http://www.medterms.com.

American Pregnancy Association (2008). Water Birth. Retrieved July 20th, 2008 from http://www.americanpregnacy.org/labornbirth/waterbirth.html

Waterbirth International (2007). All about Water Birth. Retrieved July 20th, 2008 from http://www.waterbirth.org/mc/page.do?sitePageId=38563&orgId=wi