Hoping some of the resident Dr.s will chime in w/references.
friend’s DIL wants a water birth. No philosphical problem with the concept, however, would like to have some idea of what pre existing conditions would be considered ‘contra-indications’ for a water birth.
For example - history of prolonged labor?
leaking from amneotic sac?
etc.
thanks much.
Lack of gills in infant.
(yes, this is somewhat tongue in cheek, but it’s still a damned good contra-indication as far as I’m concerned)
QtM, MD
(who gave up OB in 1990 after delivering about 800 kids. Never delivered one in the water, never dropped one either)
My guess would be any typical high risk indicators - pre-eclampsia, meconium in the water, premature labor. Also, I don’t know if there are any monitors you can use while laboring in water. One hospital I’m familiar with allows laboring in water, but wants the mom to come out for monitoring at intervals. I assume if the monitoring indicated a problem they would insist on having the mom on dry land.
If the delivery is done at a birthing center and NOT in a hospital, and the newborn has difficulty breathing, by the time the baby is rushed to the hospital, the time lapse may result in a very deleterious effect on the baby. If one could predict accurately that there would NOT be a problem or apgars below normal, I have not seen any problem with a water delivery…but one cannot predict with accuracy and thats where the problem lies.
If the delivery is done at a birthing center and NOT in a hospital, and the newborn has difficulty breathing, by the time the baby is rushed to the hospital, the time lapse may result in a very deleterious effect on the baby. If one could predict accurately that there would NOT be a problem or apgars below normal, I have not seen any problem with a water delivery…but one cannot predict with accuracy and thats where the problem lies.
If the delivery is done at a birthing center and NOT in a hospital, and the newborn has difficulty breathing, by the time the baby is rushed to the hospital, the time lapse may result in a very deleterious effect on the baby. If one could predict accurately that there would NOT be a problem or apgars below normal, I have not seen any problem with a water delivery…but one cannot predict with accuracy and thats where the problem lies.
Mad Sam, that’s exactly the line of reasoning you could use with regards to any birth outside a hospital and it’s not valid. You can’t go treating every birth as an emergency. If a baby is brought to the surface of the birthing pool immediately which is good practice then you don’t lose any time at all – well say approximately 5 seconds.
wring, if you google water birth there’s a fair amount of info on it. Monitoring isn’t an issue – the birth attendants just put the doppler inside a bag to keep it dry. I’m coming up blank on what the precise contraindications were. IIRC prolonged rupture of membranes, meconium were definite contraindications. The baby must be brought to the surface of the water immediately. There’s a horrific video from the 1980’s where a baby is born in a spa and quietly drowns on the floor while everybody celebrates. Idiots. Waterbirth is happening in quite a few hospitals so it isn’t the fringe practice it once was. Sheila Kitzinger has an excellent book as does Barbara Harper.
And just what are the advantages of water birth?
The Cochrane Medical Abstracts (evidence-based medicine) last update on the subject shows no difference in medical outcomes from water immersion (including birth in water), positive or negative. So that leaves it up to the individual mother to decide if she prefers it or not. The often-cited benefits are mostly qualitative, in that pain managment is easier (floating in warmth helps), and positioning for pushing is easier (resulting in less perineal trauma). The rates of maternal infection and breathing difficulties are (despite the expectations to the contrary) the same for water birth as other births.
Qualitative differences are not measured by most studies. A woman may choose not to use pain meds but do so easily, or conversely, she may choose to forgo pain meds with a great deal of effort and difficulty. The women I know who labored in water, and the few who also birthed there, said it was much more comfortable than a natural/non-medicated birth out of water… though they could have managed without the water, they preferred the comfort of the water.
The Cochrane Abstract Conclusions:
Note, however, that the Cochrane review was last substantively updated in 1997. More has come out since then, but is is mostly more of the same - it supports water birth as safe (comparable to other approaches) when applied to low-risk births. Anything that makes for high-risk would be contraindicated, I’d think - interventions to help with high risk situations are often not easily performed in water births. Occasionally a child is admitted for water aspiration, but even that isn’t common.
Try searching Medline for studies. There are some that show dramatic reductions in request for/use of pain meds, and show a shortening of the first stage of labor, not to mention a decrease in the use of episiotomy (partly because of lack of access, I’d guess). Many of these studies are from Europe, where water birth is more common in a hospital setting.
I guess I wasn’t clear. Situation = friend’s dil has decided on an at home water birth.
We’ve assumed that in a ‘low risk pregnancy’, this isn’t necessarily a problem. We also understand that in any birth, immediate dangers can present at time of delivery which may be critical.
What she’s looking for are specific pre-birth conditions which would make the preganacy a high risk and therefore the decision to do an at home water birth should be reconsidered.
Does elevated blood pressure do it? what about spotting? etc.
thanks.
I think she’ll have to talk to a midwife or Ob about those specifics. I’d think that again, it would be anything that qualified her THEN as high risk. Sudden spike in BP? Increased risk, therefore a decision must be made about the situation, but depending on the severity of the change, it may or may not be significant. But that would be managed at the time by the health provider (unless she’s going unassisted, in which case, I hope she has more info than I do!). Any of her vitals being out of normal range would be questionable, I’d think (temp, BP, heart rate, respiration rate).
Ruptured membranes - happens all the time in water birth, and they don’t take you out. However, they may ask that you not get IN until labor is definitely underway if they’ve already ruptured. A long soak can reduce oxytocin production, so that will then slow the labor. Don’t want to jump in immediately and slow things down more if you are technically ‘on the clock’ with ruptured membranes and no active labor.
Bleeding - bloody show is again, normal. Any big gush of blood would need to be checked out, as would symptoms of placental abruption without bleeding. But normal bloody show isn’t an issue at all.
According to my handy “The Birth Partner” laboring in water is great, but should be limited to 1.5-2 hour stints, since hydrostatic pressure can affect the production of oxytocin, and slow labor. But there are no listed contraindications. So a slow labor is a contraindication for getting in just yet, and in general, waiting until 5 cm dilation is best…
Really, anything else that would qualify as an emergency/risk would probably disqualify her for water birth… but all those are the same things she should already know from her care provider. Things like prolapsed cord, excessive bleeding, maternal fever, being infected with dangerous bloodborn pathogens (positive for HIV, say), footling or transverse breech presentation (or any breech presentation, depending on the provider), fetal distress, substantial meconium staining in the fluid (might only necessitate increased monitoring and getting out of the water so that baby’s nose/mouth can be suctioned before full delivery), and so forth. Try here or here for more.
Question - does the DIL not have someone guiding her on this info? Or is she just not sharing the info with MIL?
and why did this thread still show 9 posts with wrings as the last one, even though my view is refreshed (heck, my view is utterly new, changed order and everything!)
weird.