With the recent release of an opinion statement on immersion in water during labor and delivery (water birth) by the American Congress of Obstetricians and Gynecologist (ACOG) and the closure of water birth programs at several Twin Cities hospitals, we wanted to explore this issue in greater detail.
The use of water during labor and birth, known as hydrotherapy, has been growing ever more popular in the United States both inside and outside of the hospital setting. We offer the option of water birth at Health Foundations Birth Center because the best available evidence demonstrates that hydrotherapy offers physiological and psychological benefits in labor and birth.
What the experts say
According to The American College of Nurse Midwives, “labor and birth in water can be safely offered to women with uncomplicated pregnancies and should be made available by qualified maternity care providers. Labor and birth in water may be particularly useful for women who prefer physiological childbirth and wish to avoid use of pharmacological pain relief methods.”
They further state: “Warm water immersion hydrotherapy during labor provides comfort, supports relaxation, and is a safe and effective non-pharmacologic pain relief strategy that promotes physiologic childbirth.”
The American Association of Birth Centers posits that, “water birth, with careful selection criteria and experienced providers, does not negatively affect mothers or newborns.”
Prevalence of Water Birth
Overall, approximately 6% of women in the United States experience the pain relieving benefit of hydrotherapy during labor and/or birth. This rate is higher among midwifery and midwife-led collaborative practices. Among midwives, water birth rates are between 15 and 64% during labor and 9 to 31% during birth.
Evidence on hydrotherapy during the first stage of labor
The first stage of labor includes early labor, active labor, and the transition into pushing and involves the thinning and full dilation of the cervix, among other things.
Evidence for the safety and effectiveness of laboring in water during this first phase are well established.
Pain relief is the most clearly established benefit of laboring in water. Evidence also suggests the possibility that first stage hydrotherapy can also:
- Hasten the process of cervical dilation/shorten the duration of this stage of labor
- Resolve labor dystocia (difficult labor or abnormally slow labor progress)
- Increase postpartum maternal satisfaction with childbirth
There is no evidence of a positive or negative correlation between hydrotherapy during this stage and any of the following:
- maternal infection during or after labor and delivery
- the length of second or third stage labor
- type of delivery
- perineal laceration (incidence or severity)
- postpartum blood loss
- rate of hemorrhage
- postpartum depression
- abnormal fetal heart rate patterns
- meconium stained amniotic fluid
- umbilical cord blood pH values
- newborn Apgar scores
- admissions to special care nurseries
- or rate of breastfeeding at 6 weeks postpartum
Evidence on hydrotherapy during the second & third stages of labor
The second stage of labor involves pushing and delivery of the baby. The third stage involves the delivery of the placenta.
At present, evidence is not as conclusive as experts would like with regards to hydrotherapy during the second stage of labor. Additional research is needed.
It can be hard to weave through the language of medical research. Most professionals agree that Randomized Control Trials (RCTs) will produce the most reliable evidence. However, to date, most evidence about birth in water has been gathered from clinical audits and observational studies rather than these randomized controlled trials. Some case studies are also being examined but they produce a very limited picture of water birth and should not be used as the basis for recommendations or practice decisions, cautions the American College of Nurse-Midwives.
Observational studies are considered more reliable and offer some of the best evidence about water birth at the present time. This evidence suggests that women who experience uncomplicated pregnancies and labors with limited risk factors and evidence-based management have comparable outcomes whether they choose to birth in water or not.
When it comes to the best available evidence, data generated by midwifery care provides the most accurate view of the safety of water birth because midwives practicing in birth centers are trained water birth providers.
The American Association of Birth Centers has gathered data on over 15,500 births among low-risk women birthing at a birth center from 2007 to 2010. Of these births, nearly 4,000 were water births in birth tubs (57.6%), Jacuzzis (34.6%), and standard bathtubs (7.8%).
This data revealed the following:
- Rates of postpartum and neonatal transfer from the birth center, and neonatal procedures were low in general, and were slightly lower for births in water when compared to non-water births. This has been reported elsewhere.
- If labor was not progressing smoothly, women were unlikely to give birth in water
- Rates of newborn transfer to a hospital were lower after water birth (1.5%) than non-water birth (2.8%)
- Rates of adverse newborn outcomes were below 1.0% in the water birth population. The total rate of any respiratory issues was 1.6% in the babies born in water and 2.0% in those not born in water.
- There were no cases of pneumonia, sepsis or other respiratory infection following water birth and there were no reports of ruptured umbilical cords or newborns breathing water into their lungs associated with birth underwater.
Safe Water Birth at Health Foundations Birth Center
At Health Foundations Birth Center, we follow the best evidence available in every aspect of care we offer to our families, including water birth. Each of our midwives is highly trained and experienced in offering water birth safely and when appropriate to low risk mothers.
Along with the American College of Nurse-Midwives and the American Association of Birth Centers, we believe women should be given the opportunity to remain immersed during labor and birth if they wish to do so within the context of a shared decision-making process with their care providers. We also believe women have the right to make informed choices regarding water birth and are happy to discuss the best evidence available regarding hydrotherapy in childbirth with all interested clients.
We strictly follow the best practice guidelines we’ve learned in our rigorous educations, and as set forth by The American Association of Birth Centers and The American College of Nurse Midwives. All of our midwives are qualified to provide education, risk assessment, and care to women who desire water immersion for labor or birth.
If you are a current client and have questions about water birth, please do not hesitate to call us or speak with us during an upcoming visit. We want you to feel empowered to make informed decisions about all aspects of your care.