Immersion birth is increasing in popularity in the US. Celebrities such as Ricki Lake, Gisele Bundchen, and Pamela Anderson famously gave birth to their children in water, popularizing the trend.
In theory, it seems like a warm, relaxing way to give birth. The warmth and buoyancy sound like welcome relief. However, there is a bit of a risk in having a baby in a birthing tub. Risks that the American Academy of Pediatrics (AAP) haven't been able to overlook.
The AAP put out a statement in 2016 stating that they can't recommend immersion birth. The research around its safety and efficacy is lacking and the noted risks can't be ignored. Although the AAP's 2016 statement was a little more accepting of the practice, especially during the beginning stages of labor, than the 2014 version, it still considers the practice experimental with too many unknowns.
The AAP does say it's okay for moms to soak in a tub during the beginning stages of labor as it relaxes her and makes her buoyant. However, beyond the first stage, it isn't recommended. Or rather, there are no established benefits of immersion birth past the first stage.
Because the AAP considers immersion birth experimental, they recommend properly informing a mom-to-be of the risks, getting her informed consent, and following a strict protocol. They also urge clinics to only offer immersion birth on a clinical trial basis.
The AAP's position basically means that there is no convincing evidence that immersion birth has any positive effects on mom or baby and that instead there are some serious risk factors associated with it. Because they just can't find any true hard data on the benefits of immersion birth, the AAP can't give its blessing on immersion birth.
Some of the risks associated with immersion birth, that the AAP warn against, include:
13 Devistatingly, The Baby Could Drown
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The Journal of Pediatrics published a study in 2004 in which they list drowning as a potential risk factor for immersion birth. In extreme cases, a baby may drown or dry drown if they are born in the water. Any time water is present, there's a chance of drowning. Meanwhile, an open-air birth does not carry this same risk.
Midwives performing water births are trained to lift a baby's head above the water as soon as possible to prevent any water from entering the baby's lungs. However, it's still possible for the baby's body to suck in water before he comes up for air. It's difficult to find actual cases where a baby drowned during water birth, so proponents of water birth will argue fervently against the idea.
However, the AAP still lists drowning as a potential risk since it could hypothetically happen and the best prevention would be to keep babies out of the water.
12 The Umbilical Cord Could Snap Or Rupture
Because a baby must be pulled out of the water, the length of umbilical cord available to reach the water surface could be problematic. If a baby is attached to a short umbilical cord, the cord could potentially hold the baby under the water or snap when the baby is pulled to the surface.
Typically, a snapped umbilical cord can be clamped with no additional consequences. However, a torn cord can cause the baby to lose blood, which can lead to anemia or worse. This distance from the birth canal to the air is one of those problematic factors that the AAP had to take into consideration when making their statement. Although a super short umbilical cord like that and an umbilical cord avulsion in water are rare, they're still noted risk factors for immersion birth.
11 Infections Could Lead To Additional Complications
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Probably one of the more common, and relatively preventable, complications from water birth is infection. Although a baby can get an infection from a birth on land too, a water birth presents a different set of infection risks. First, birthing tubs are shown to carry more bacteria than birthing beds.
Second, your own body, and anyone else's that joins you, is in the water. Any bacteria on the body is going to be in the water as soon as your feet and bum enter it. Third, if you have a bowel movement during labor or you bleed into the water, it's going to introduce more bacteria to the water. Fourth, the source of the water used could be troublesome. If sterile water isn't used, then the water itself could contain bacteria.
The good new is that the risk for infection is pretty much limited to baby breathing in the water, which is rare. Birthing in a bed eliminates many of these extra contaminants, but taking proper preventative measures, like using only sterile equipment and preventing the baby from breathing too soon, can make an immersion birth a little less risky.
10 The Water Could Cause Maternal Infection
Any substance that enters the birth canal after a pregnant woman's water has broken could leave a mom susceptible to an infection herself. That's why doctors recommend moms don't bathe after their water has broken. Like with a bath, the water in which a mom birthed and secreted bodily fluids could potentially enter into the uterus and cause an infection.
And a mother doesn't need to battle an infection as she's trying to heal from childbirth.
Maternal infections from immersion birth are another reason the AAP can't recommend the practice. The evidence for maternal infection is limited though. One study showed that maternal infection rates for immersion birth weren't all that different from a standard bed birth. So, just the potential alone for mom to get an infection in the water is enough to be hesitant and fully aware of the risks.
9 Water Aspiration Leaves A Baby Susceptible To Problems
One of the concerns about birthing in water is the risk of water aspiration. Typically, a baby's innate diving reflex will keep it from inhaling underwater. After all, the diving reflex has kept the baby safe and sound inside the womb this whole time.
However, there are certain instances when a baby's gasp reflex overrides its diving reflex, which can result a medical emergency. Researchers and doctors know this happens from the instances of meconium aspiration they see.
Several factors can lead a baby to inhale water before reaching the air: if they're startled, if their head is brought to the surface before their body, or if the oxygen in the placenta is disrupted. One of the reasons the AAP is cautious about immersion birth is because of an unnecessary risk like this.
8 Sodium Levels Could Be Disrupted By Water Aspiration
Hyponatremia is a deficiency of sodium in the blood that is the result of water aspiration. Also known as water intoxication, hyponatremia can result in serious morbidity. When a baby ingests water inside the birthing tub, their electrolytes can become so diluted that their condition becomes a medical emergency.
The delicacy of a baby's electrolyte equilibrium makes a baby vulnerable to disruption in the first place. This is one risk that doesn't happen when a baby is delivered in the open air.
Severe cases of hyponatremia can lead to seizures, respiratory failure, and coma. Hyponatremia can also impair a baby's growth. A salty saline infusion is typically used as part of the treatment as well as careful monitoring of electrolyte levels. This is why the AAP finds it so important to ensure that babies don't breathe water.
7 Bacteria In The Lungs Could Lead To Pneumonia
If a baby ingests water during delivery, the bacteria in the lungs can cause an infection such as pneumonia. The data about how much higher the risk is for pneumonia in immersion birth isn't clear, but it is definitely a risk factor that increases in the water, because fecal matter and other bacteria could potentially be present.
After all, you are exposing the water to your body and bowel movements are common during delivery. Pneumonia can also develop as a result of meconium aspiration, which happens during land births too.
Because of the risk of pneumonia, moms are instructed to keep the water between 95-100 degrees, or approximately a normal body temperature range. Proper sanitation measures must be taken to keep bacteria to a minimum. The baby must also be brought to the surface immediately after it's born. These preventative measures may help lessen the risk of pneumonia during immersion birth.
6 Pneumonia Could Progress Into Sepsis
When contaminated water gets into a baby's lungs and causes pneumonia, it can further develop into sepsis. One study points to a case of a baby who died from severe sepsis following water birth. Sepsis occurs when a baby's underdeveloped immune system goes into overdrive as it tries to fight a bacterial infection.
One of the reasons why your doctor tells you that a newborn temperature over 100.4 is a medical emergency is because it can be an early sign of sepsis.
Some signs of sepsis include a high temperature, breathing problems, low blood sugar, lethargy, changes in heart rate, swollen belly, vomiting and jaundice. Your doctor might perform blood tests, a spinal tap, a chest X-ray and other tests to determine the cause of infection. Then, the baby will be given antibiotics through an IV.
Most babies recover fully from sepsis, however it's important to be aware that sepsis is one of the main causes of infant death.
5 Temperature Changes Could Result In Hypothermia
A baby's thermoregulation system is brand new and ultra sensitive upon their arrival. Therefore, they can be susceptible to overheating and hypothermia, especially if they are born with a low birth weight. The nature of a water birth exposes a baby to variable temperatures that their body might not be able to regulate well.
The temperature of the water, the temperature of the room, the exposure of wet skin to air, and mom's own body temperature all affect a baby's body temperature. It's imperative to try to control all these factors during immersion birth.
To help prevent hypothermia, most babies are placed directly on mom's chest for skin-to-skin care. Mom's body temperature will help her baby's body regulate its own temperature. Also the water and the room must be kept at a reasonable temperature to help the baby make a smooth transition.
4 An Umbilical Cord Hemorrhage Could Be Life-Threatening
If an umbilical cord ruptures during the baby's travel from birth canal to the water surface, there is a risk of hemorrhage. The umbilical cord is obviously a baby's lifeline. It passes oxygen and nutrients to the baby until it is properly clamped and secured.
If left untreated, a ruptured umbilical cord that hemorrhages could be fatal, although this is pretty rare. Hemorrhaging could also go undetected in murky water. Mom's own blood loss could certainly camouflage an umbilical hemorrhage when every second would count. The treatment would be immediate clamping, which is usually sufficient.
However, if a severe hemorrhage turned into an emergency during a water birth at home, the travel to the hospital could be problematic. Severe hemorrhaging can also lead to anemia and shock, which we'll talk about next.
3 Hemorrhaging Could Lead To Shock, Or Worse...
If the umbilical cord snaps and hemorrhages, baby could be at risk for shock. And it happens really fast as blood pours out of the umbilical cord very quickly. When a baby goes into shock, proper oxygen and nutrients aren't delivered to the baby's tissues. Metabolic waste products can't be processed either, an emergency that could eventually lead to cell death.
Shock can lead to organ damage, GI bleeding, intestinal damage, and brain damage. Blood transfusions and NICU stays would likely become necessary at that point. Because of this catastrophic domino effect from umbilical cord rupture to hemorrhage to shock, it's understandable why the AAP might be hesitant to promote immersion birth.
2 Out-Of-Whack Sodium Levels Can Cause Seizures
Acute hyponatremia, or sodium imbalance in a baby's body, can result in seizures if severe. When blood sodium levels are low, the body moves water into the cells. As water enters the brain's neurons, the brain suffers cerebral edema (swelling). The symptoms of brain swelling from hyponatremia include headache, lethargy and nausea, none of which a baby can obviously communicate to you. In the severest of cases, the brain swelling and sodium deficiency can cause seizures, something a mother never wants to witness.
Hypertonic saline solution is given in very careful concentrations to help the seizures subside. Sodium levels are monitored closely to help bring the body back to equilibrium. In the worst cases, if left unchecked or too far progressed, hyponatremia can lead to coma and death.
1 The End Result Could Be Disastrous
Several of the complications listed in this article can and have resulted in a baby's death. As stated earlier, there was a baby that died from sepsis. Drowning, hyponatremia, hemorrhage and infection can all have fatal effects if they're not stabilized or if they're left untreated.
Obviously, death is the most heartbreaking result of immersion birth that the AAP wants to try to prevent. If immersion birth shows little evidence of being helpful for birth and more evidence for risk, it's no wonder the AAP hasn't been able to recommend it. Watching a baby go through any of the heartbreaking symptoms above might be enough to deter any mom from attempting immersion birth.
But the preventable risk for death makes immersion birth seem a little more reckless after taking a closer look.
Sources: Parents, AAP, PubMed, Medline Plus