Water immersion during labour and birth has become an increasingly popular option for pain relief for women around the world.
Many maternity wards have been redesigned to include private birth baths, so women who want to labour in warm water can do so at their discretion.
Is Water Birth Dangerous? 3 Things You Should Know
Staff in many hospitals are being trained to support and help women to give birth in water.
In many places, however, there are still restrictions placed on water birth, and it pays to understand the evidence (or lack of) related to these policies and the arguments that are raised.
#1: Your Baby Might Drown
Babies have an inbuilt mechanism which prevents them from drawing breath until it is safe to do so.
A baby who is born into water might have her head underwater for some moments. During this time, she is supplied with oxygen from the placenta, via the umbilical cord.
Being born isn’t the trigger for a baby to start breathing. The change in temperature from a steady 37C (98.6F) in utero to the outside air temperature is the first trigger to establish respiration.
If the water temperature is kept at a steady 35-37C (95-98.6F) this ensures your baby isn’t triggered to breathe and inhale water.
Babies are also born with a dive reflex, which means they will swallow rather than inhale water if they open their mouths.
Once the baby’s body is born, she is lifted to the surface of the water and is then able to take her first breath.
Found out more in How Does A Baby Breathe During Water Birth?
#2: Your Baby Could Inhale Meconium
Although very rare, meconium aspiration does occur in some babies. Meconium being passed while baby is still in utero is considered a sign of distress, but it’s not always the case.
The biggest concern with meconium aspiration is that if a baby inhales this substance, it can cause serious complications. Babies who pass their first poo in utero will not automatically inhale it, however.
Babies who do inhale in utero are severely distressed; this is something your care provider should be aware of long before meconium aspiration is a concern.
Women who have meconium stained waters cannot usually get into a birthing pool – for two reasons. One reason is the potential risk of infection (due to the amniotic sac being ruptured). The other reason is that the care provider will prefer to clear the baby’s airways via suction.
For babies with meconium present, routine suction before the shoulders and body are born is no longer recommended.
Read more about this in Meconium In Amniotic Fluid – Is It Dangerous?
#3: Your Baby Could Get An Infection
There have been several cases reported of babies who have contracted Legionnaire’s Disease due to water births.
A report on two babies in Arizona, who died of Legionnaire’s disease, has raised concerns about the likelihood of babies contracting infections during water births.
The researchers looking into these cases found there were numerous gaps in infection control for water births. These included the use of a jetted Jacuzzi instead of a disposable birthing pool; water was also allowed to remain at 98.F (36.7C) for a week
Legionella bacteria commonly grow in water systems – such as air conditioners, plumbing systems, hot tubs or spas baths. The optimum temperature for the growth of Legionella bacteria is 77.0°F–108.0°F (25.0°C–42.2°C).
While investigating these deaths, the researchers found a report of another infant death from Legionella disease, in Texas. The department of health from that state developed new guidelines for midwives who conducted water births; this has prompted the Arizona Department of Health Services to develop similar resources.
While the risk of Legionella infection can’t be completely eliminated, because of the use of warm tap water in birthing pools, it can be significantly reduced by running hot water through the hose for at least three minutes before filling the pool. This clears the hose and pipes of stagnant water.
All facilities offering water birth should also have rigorous maintenance and cleaning protocols for pools and tubs. Women birthing at home in a birthing pool should ensure there is a brand new liner provided.
There is a common perception that a baby born into water will be exposed to all sorts of infectious pathogens.
A baby’s first exposure to bacteria should be from her own mother. A baby born vaginally is colonised with bacteria from the mother’s vagina and rectum, and this bacteria will also be in the water of the birthing pool.
Studies repeatedly show there is little to no difference in infection rates between babies born on land and those born in water.
In this study, researchers examined bacteria in the water at two time points during 250 water births: the first after the tub was initially filled, and the second after the birth had occurred.
The culture studies found higher levels of bacteria contamination after the tub was filled. The hospital installed water filters, reducing contamination with Legionella in the samples taken immediately after filling the tub.
The study also looked at the number of newborn infections following birth. The higher contamination rates didn’t increase newborn infections. Of the babies born in water, only 1.22% had clinical signs of infection, compared with almost 2.65% of babies born out of water.
A study looking at outcomes in women using birthing pools found, of almost 9000 women who laboured or birthed in water, less than 1% of their babies had any suspected infection. The newborns had lab tests performed, and they showed no signs of infection.
Of just over 1500 women who had water births in this study, three babies were admitted to NICU for fever or suspected infection. None of the newborns needed any respiratory assistance, and none were diagnosed with an infection.
If you’re thinking about having a water birth, the following articles will help you to understand the benefits and risks: