By Carl Jones and Anne Sommers, L.M.
An innovative and controversial alternative, water birth was first popularized in the 1960’s in the then Soviet Union by Russian researcher and trainer Igor Tjarkovsky. He believed that being born in water enhances an infant’s physical strength and psychic abilities.
Another pioneer in the field of water birth, Dr. Michel Odent, focused on the benefits of water for the laboring mother.(At Pithiviers France, Dr. Odent oversaw a small maternity clinic run by midwives. Trained as a surgeon, he admittedly knew little about obstetrics but opened his mind and heart to what the midwives and mothers showed him about birth.) He found that when women got into the tubs during the first stage of labor, dilation accelerated and pain was reduced. Feeling more relaxed and comfortable in the tubs, many times the mothers attended by midwives were reluctant to leave, and ended up giving birth in the water.
Because of Odent’s revolutionary ideas, his encouragement of women to be free and act instinctually, expectant mothers came from all over the world to have their babies at Pithiviers. His clinic, the first underwater birthing facility in the west, became a model for the rest off the world.
Safety of Waterbirth
One of the problems parents and professionals are most concerned about is the mother developing an infection because of the water. Many childbirth professionals advise expectant mothers to avoid tub baths once membranes have ruptured.They believe that when the amniotic sac has broken there is a risk that bacteria may enter the uterus and cause infection. However, avoiding immersion in water is not necessary once the mother is in active labor, since there is no time for an infection to develop. Furthermore, obstetrician, Dr. Michael Rosenthal, claims that water, if anything, serves to keep things clean.
Dr. Odent says there have been no infections or complications associated with underwater birth at Pithiviers.
Both doctors agree that tap water with no chemicals added is perfectly fine for labor and delivery.Some midwives add salt to make a normal saline solution at the rate of 8 pounds per 100 gallons. This is enough to kill any bacteria. Chemicals and disinfectants such as Betadine (iodine) are toxic and should never be used. The can permeate delicate tissues such as the eyes or could be ingested by the newborn.
Another concern is the infant inhaling water with a possible risk of pneumonia or drowning.When babies are born their lungs are filled with fluid.It is their first breath that causes the air sacs to fill with air/oxygen and the fluid to deplete. Only after the lungs have been expanded with air could a baby drown from water inhalation, and lack of oxygen. Furthermore, as long as the placenta is attached, the infant continues to obtain oxygen through the umbilical cord.
Leaving the baby submerged after birth is the most controversial aspect of water birth. Most water birth advocates agree that the safest approach is to bring the baby to the surface within a minute or two after birth. Keeping the baby submerged for longer is not advised. Even though the risk of drowning is slight, the baby can develop hypoxia (a condition of inadequate oxygen).
As Dr. Rosenthal points out, “Within seconds after the birth, the uterine wall surface has been enormously reduced and the placenta (which provides oxygen fro the blood vessels in the uterus) is not elastic enough to remain attached.”
Many water birth practitioners advise the mother to leave the tank before delivering the placenta, to avoid the (hypothetical) risk of water embolism. Embolism, either with air or water is a rare complication and would usually accompanies a severe hemorrhage.The water or air molecule finds its way up the vagina and enters an open blood vessel in the uterus, where it travels to the heart, causing death. Water embolism from water birth has never been recorded.
According to the late Dr. Howard Marchbanks, who has delivered over 16,000 babies in his 45 years of practice, “Embolism has never been a problem, in my experience of 15 years of putting mother and baby in the water after birth.” He believes that there is more of a chance that air would enter the uterus than water.
Usually if the mother chooses to give birth in water, she remains in the tub throughout the birth process and sometimes for a short while afterward.
Experienced waterbirth midwife Susanna Napierala monitors the fetal heart beat with a doptone, a portable stethoscope which emits ultrasound or high frequency sound waves that are reflected off the fetal heart, and produce echoes, which are then transmitted to the audible sound of the fetal heart beat. In order to do this she asks the mother to raise her hips out of the water while she places the doptone on the abdomen. Other midwives use a plastic sheath and monitor the baby’s heartbeat underwater or use a special underwater Doppler.
Most mothers deliver in a sit-squat position or on hands and knees. Providing the tank is large enough, the mother is readily able to adopt the position of her choice.
The birth attendant usually remains outside the tub, where she can assist if necessary. However, some practitioners prefer to be right in the tub with the mother. If the tub is sufficiently large, the mother’s mate and perhaps others can join her.
Immediately after birth, the baby is lifted slowly and gently to the surface. Jeannine Parvati, well known childbirth educator and author of Prenatal Yoga chose a waterbirth for the delivery of her daughter, Halley.After Halley was born in a homemade redwood tub, Jeannine recalls, “When she emerged, it was with open and exploring eyes.”
The parents can begin the process of parental-infant bonding in the tub. The mother can hold her child to her breast and begin breastfeeding, or just explore her child with her eyes and fingertips. The father, too, can hold the baby skin-to-skin and enjoy eye contact with her in the tub.
Some midwives ask the mother to leave the tank for the delivery of the placenta because it is difficult for them to monitor the volume of blood loss in the water. When the mother leaves the tub, the baby can still remain in the water with the father, giving the father time to get to know his child.Some mothers return to the tub after the placenta is delivered.
Many women find that water birth creates an easier, less painful and shorter second stage labor.After her water birth, one mother recalls, “I think the delivery was significantly less painful and exhausting than it might have been ‘on land.’ I was able to spread out my energy consumption more easily. I didn’t tire myself out.”According to Tjarkovsky, the effects of gravity are lessened and our oxygen consumption is reduced while in the water, thus making it easier to labor.
The warm water helps the mother relax during first stage labor that in turn, may facilitate the birth process.Many midwives notice rapid dilation when mothers get into the water. One midwife recalls, “I had one client who, after laboring all night was fully effaced without dilation when I got to her home at 7:30 am after I convinced her to get into the tub she proceeded quickly to 2 cm. Within an hour and a quarter, still in the tub, she advanced to 8 cm. Soon she was pushing. The baby was born an hour later. This was a primip (a first time mother).”
In addition, Dr. Odent points out, “Immersion in water seems to help women lose their inhibitions.”This can help the mother surrender to labor and thereby give birth more efficiently.
The buoyant weightlessness of floating in the water seems to lighten the heavy ‘bearing down’ feeling of contractions,” recalls midwife Anne Rivers. She says, “The warm water helps the tissues to stretch.” Though her water born daughter, Naelani, was larger than her previous three babies, she was able to give birth without an episiotomy for the first time. “I could sit down and move around with no pain.What a difference! Recovery was a grand time resting with the baby!”
The books by well known childbirth author, Carl Jones, include the international best seller Mind Over Labor, and Alternative Birth, have helped innumerable women and babies enjoy safer more fulfilling births.