Guest Writers, Home Birth Advocacy

Not Your Mother’s Labor: Water Birth Part I

2 Comments 07 September 2012

Among the gems of pregnancy “wisdom” passed from generation to generation and still hanging on today, one of the most stubborn is “Don’t get in the tub after your water breaks, you’ll get an infection!”

Is it true? Does dirty tub water get siphoned up the vagina, delivering a direct dose of microbes to the uterus? Or is it a misnomer that should go the way of “If you put your arms over your head the baby will strangle!”

Photo courtesy of birthersage via CC license

Since many home births, or at least labors, take place in a birthing pool, you’ve likely thought about this issue at some point in your research and/or birth planning.

Whether you’re just mildly curious about the level of risk or you have deep concerns about laboring or birthing in water, a look at some of the available data will bring into focus the scientific truth about this popular pregnancy tale.

I began writing this post with the notion that I’d fit everything I wanted to cover into one post. Well…that’s not going to happen because there is so much delicious info and I don’t want to skimp on sharing details, so it’s going to be a two part series. Besides, if I tried to cram it all into one blog post I wouldn’t have room to share part of my own water birth story. :)

So, here we go – let’s begin with the findings of ACOG in their Committee on Obstetric Practice opinion on warm-water immersion in birth:

The Committee feels there are “insufficient data, especially concerning rates of infection, to render an opinion on whether warm-water immersion is a safe and appropriate birthing alternative.”

While ACOG’s opinion usually needs to be taken with several grains of salt, it’s a useful jumping-off point – how much data is enough? There is actually a fairly significant body of evidence on outcomes, including infection, and water labor/birth.

Dr. Siegel’s Tampon Experiment

This body begins in 1960 with the work of Dr. Peter Siegel. Dr. Siegel posed the age-old question, “Does bath water enter the vagina?” In his experiment Dr. Siegel had women place tampons into their vaginas then sit in a potassium iodide bath for 15 minutes, then did an iodine reaction test on the tampons.

There was no sign of the tampons, therefore the vaginal vault, having exposure to the water at all. What’s more, five of the women were in the last two weeks of pregnancy and five were in the first three days postpartum. Only one of the women had had fewer than 4 children, and most were parity 6-10, making Dr. Siegel’s results that much more astounding.

Dr. Siegel’s conclusion read:

Thus, the fear that bath water may infect a pregnant or puerperal woman is not founded on fact, since normally no water enters the vagina. Therefore, restrictions on bathing during and after pregnancy are not warranted on this basis alone. Moreover, this teaching represents another classic example of error.

Not only does it represent an example of error, it also represents another in a long list of common sense findings that somehow escaped being adopted into standard of practice over the years, although the reasoning has changed, as evidenced by this telling statement on a nurses’ forum:

Unfortunately, with the lawsuit-happy public these days, it would take only one case of “tub acquired” infection to ruin an OB’s practice and put the tubs in mothballs.”

Sadly that’s the truth about most common obstetrical practices these days – it’s all about liability. Fortunately that’s not such an issue with home birth, however it’s still prudent to know what the research says so that we go into birth armed with information and ready to refute antiquated nonsense that may be slung our way.

In this first installment on water birth, I will cover a couple pieces of research that look at infection, one of which focuses specifically on GBS (Group B Strep). In part two, we’ll talk more about data on general outcomes of water labor and birth, encompassing other aspects of maternal/fetal well-being in addition to infection risk.

The Cochrane Review

Firstly let’s take a look at what is considered the largest overview of labor and/or birth in water, the Cochrane Review: Immersion in water in labour and birth, Cluett ER and Burns E., out of University of Southampton in the UK.

This is a review of a group of 12 “randomised controlled trials comparing immersion in any bath tub/pool with no immersion, or other non-pharmacological forms of pain management during labour and/or birth, in women during labour who were considered to be at low risk of complications, as defined by the researchers.”

There were a total of 3243 women included in the comparison, which found no statistically significant difference among the water birthers and land birthers with regard to:

  • neonatal infection
  • maternal infection
  • APGAR scores
  • neonatal unit admissions

There was, however, a significant reduction in epidural/spinal anesthesia in the waterbirthing group as well as one trial which revealed a birth satisfaction rate in the immersed moms of four times the rate in the control group.

The reviewers conclude that while more research is warranted:

There is no evidence of increased adverse effects to the fetus/neonate or woman from labouring in water or water birth.”

Judy Cohain’s Stunning GBS Findings

The second piece of evidence I’d like to look at is a paper by Judy Slome Cohain, CNM published in the Winter 2010-11 issue of Midwifery Today Int Midwife, “Water birth and Newborn GBS disease”. 

Cohain found one – yes one – case of early onset newborn GBS in 4432 hospital water births. To understand how astounding this number is, we’ve got to consider that the accepted rate of GBS among births on land, with antibiotic prophylaxis, is approx. one in 1450.

As Cohain points out, there are a number of possible explanations for this incredible reduction in risk – from the water washing the microbes off the baby, to the benefits of kangaroo care, to lower levels of intervention causing a decrease in transmission.

If I were the betting kind, my money would be on a combination of factors resulting in these amazing outcomes, but one thing is as clear as a freshly-filled birth pool – water birth, whether at home or in a facility, likely offers benefits beyond what we’ve even dreamed.

More to come in part two on water birth. Please share your thoughts and experiences with us in the comments…

 

Misha Safranski is mother to five beautiful children, birth mother to a sixth, VBAC mom, unschooling parent, intactivist, lactivist, and freelance writer. In addition to working full time for a major online media company, Ms. Safranski publishes an advocacy blog on birth and intuitive parenting issues called Creating Dissonance. She resides in Michigan with her children and furbabies.

Your Comments

2 Comments so far

  1. Courtney says:

    ive often wondered why people think this… considering you can take a bath or go in a pool with your period and not bleed into the water, stands to reason that no water is entering your vagina and that biatch is sealed like a vault :P

  2. bonyolult says:

    there is also an italian study specifically on infection in water births, with about 3000 births involved. no difference was found in antibiotics need in the babies born in water or dry, despite the fact, that, well, indeed in a few cases there were some nasty bacteria floating around in the water! so, yes, any sane person would suggest to pay attention to cleanliness, but good to know about this study whenever the infection dispute is coming up. don’t remember the researchers’ names, sorry…


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