Guideline saying women should not birth in water sparks backlash
|By Michele Munz, St. Louis Post-Dispatch|
|McClatchy-Tribune Information Services|
After about 13 hours of contractions, she couldn't handle the pain. She wanted to give up on her natural birth plan, head to the hospital and get drugs. But the midwife told her the baby was coming too quickly for that. "If I am going to do this any more, it has to be in the tub," Haschke-Green said, sobbing.
After a few more contractions, Haschke-Green brought her baby out of the water and saw her take her first breath, thankful to have given birth without anesthesia or other medical interventions she had wanted to avoid.
Four months ago, the nation's associations of obstetricians and pediatricians issued an opinion denouncing water birth and sparking a backlash from water birth providers and mothers such as Haschke-Green.
The doctor groups wrote that giving birth in water "has not been associated with maternal or fetal benefit" and should be considered an experimental procedure. The opinion, which serves to guide the practices of hospitals and physicians and inform patients, said water birth should be provided to women only as part of a clinical study.
No hospitals in
Haschke-Green believes women should be able to choose a water birth.
"For someone going through the pain of childbirth, who is choosing not to have an epidural, to deny that option to a woman ... To me, that is just beyond cruel," said Haschke-Green, 34, who traveled to the
Birth centers are staffed by midwives and serve healthy women seeking a natural birth. At the
Midwives and birth centers are among the most vocal critics of the doctors' opinion.
The national associations of nurse midwives in
"Consequently, the document has the potential to introduce inappropriate fear about the safety of water birth" for those making decisions, the statement said.
The opinion prompted nurse researcher and founder of the popular Evidence Based Birth website,
"It's clear that research had nothing to do with this opinion statement that's affecting women all over the country," Dekker said.
The doctors groups' opinion states that while immersion in water during early stages of labor may help decrease pain or use of anesthesia, safety and benefits of immersion during pushing and birth have not been shown. The opinion refers to a dozen reports of rare but serious problems with babies, including infections from contaminated water, drownings and near drownings from inhaling water and umbilical cord rupture from lifting the newborn too quickly to the surface.
The opinion was written by Dr.
Macones said evidence shows that giving birth in water is no better than giving birth out of the water. "If it's not good for the baby and it has any perceivable risks, which there surely are, then you shouldn't be doing it outside of a study," he said.
Dekker found at least 19 studies on water birth done in the past 20 years, only six of which were mentioned in the opinion. The doctors' opinion relies heavily on the case reports, Dekker wrote, but the reports lacked crucial information, included possible intentional drownings and babies who fully recovered.
The birth center association said it studied more than 15,500 births reported by its member birth centers between 2007 and 2010, nearly 4,000 of them water births. Health outcomes were the same, the association found, with no reports of infection, ruptured umbilical cords or newborns breathing water.
"Women should be given the opportunity to remain immersed during labor and birth if they wish do so," no matter their geographic location, insurance status or birth setting, the nurse midwives opinion says.
An analysis published two months ago by the
While some look at the research and say there's no reason to conclude that water birth is dangerous, Macones says there's no reason to conclude it's safe.
"The bottom line is that these (studies) in no way can be considered reliable data ... I think it's absolutely misleading to present this sort of information to a layperson as 'science' that supports efficacy and safety," Macones wrote in an email.
Water immersion during labor gained popularity in the 1980s as women shared stories of pain relief, easier movement and holistic experiences. By 1994, doctors and midwives in the
The experiences of women who have given birth in water and water birth providers should be considered by policymakers, said
But in the water, she felt calm and relaxed. "It was the most important factor to a successful delivery," Revisky said. "I barely even felt the contractions."
The disagreements over the safety and benefits of water birth has one positive result -- support to conduct quality research, said Harper of
Harper has launched the first nationwide study where participants submit monthly data on their water births. It's open to any hospital in the U.S. that wants to participate.
The science will give more women such as Haschke-Green an informed choice as they face the pain of childbirth.
"If I decide to have a baby again, I would want water to be available, without a doubt," Haschke-Green said. "I would drive however far and stay in a hotel. I would not have my baby in a hospital that doesn't offer it, now that I have been through that."
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