The Wooden Spoon Award for one of the most biased news reports of the year
This is one of the worst newspaper reports I’ve read all year. The use of deep water tubs during labor is a well-established method to help women cope with the pain of labor in ways that avoid the known side-effects and complications of narcotic drugs and epidural anesthesia.
And yes, some babies actually come out in the tub, although that is not the actual purpose of the deep-water tub for most families.
This article was obviously written by someone either who didn’t know what they were doing, or was looking for yet another opportunity to trash ‘alternative’ childbirth practices.
After admitting that:
- 29 previously published studies and found no significant differences between water births and other delivery methods in terms of complications, infant mortality or admissions to intensive care
- their review of the research did not show that delivering the baby under water was either safe or unsafe
- that one or more studies identified a possible advantage of underwater delivery – slightly higher newborn Apgar scores, which measure heart rate, breathing, muscle tone, reflexes and skin tone
The author noted that:
- the American College of Obstetricians and Gynaecologists and American Academy of Paediatrics recommend against underwater deliveries due to potential complications for babies such as infections, breathing difficulties and drowning
After quoting data from all these sources, their “advice” concluded by saying:
- “Most of these studies were small … and didn’t show any advantages of water births, either.”
- Because “most studies didn’t randomly assign some women to water births and others to more traditional deliveries, it’s impossible to conclude that water births cause higher Apgar scores.”
- quoted Dr. Amos Grunebaum, director of obstetrics at Cornell, saying:”There is no evidence that delivering underwater has any benefits and the authors of this study fail to acknowledge a benefit other than to mention that whales and dolphins give birth under water,”
“Just because something is popular does not mean it’s safe or has any benefits,”
“In fact, there is plenty of evidence to suggest harm like infections, seizures and pneumonia in the (infant).”(Dr. Grunebaum is the OB that published a paper claiming that midwife attended home births had a huge increase in zero Apgars at 5 minutes which just defies all reason, as it would mean that such babies were essentially dead at 5 minutes, which would result in an equal rise in severe morbity or mortality)
So let’s go over these again:
- 29 published studies found no significant differences between water births and other delivery methods in terms of complications, infant mortality or admissions to intensive care
- A few studies found pointed out one possible advantage of underwater delivery – slightly higher newborn Apgar scores as measured by heart rate, breathing, muscle tone, reflexes and skin tone.
In the first place, randomly assigning women to either of these two options simply would not work, not any more than the idea of a randomized trial between obstetrical management and OOH physiologically-based care. A woman who wants a hospital birth is never going to agree to OOH midwifery care instead and the same for families that want community-based midwifery care. after the obstetrical profession “randomly assigns” healthy women to physiologically-managed care as provided by midwives and family practice physicians, and a cohort of equally healthy women to the “more traditional” medicalized labors and obstetrically-managed deliveries
Secondly, the entire obstetrical profession (with a few notable and gratefully-acknowledged exceptions) has yet to admit that interventive obstetrics as the standard of care for healthy childbearing women was adopted in 1910 without ever conducting studies that compared the outcomes of physiologically-managed care for healthy women to as provided by midwives and family practice physicians, and a cohort of equally healthy women who had medicalized labors and obstetrically-managed deliveries.
As for water “birth”, I think it is regrettably misnamed; there is a demonstrable benefit when laboring women use immersion in a deep-water tub to deal more successfully with the pain of active 1st stage labor. Laboring women are not walking around the room and then getting into a deep water tub as a special place to give birth.
That said, about 40% of families that made arrangement for a deep-water tub, do eventually give birth while the mother is still in the water. I am glad for those 29 studies identified no increase in problematic outcomes for their babies. As a community midwife, I make sure that childbearing families know that it is theoretically possible for a depressed baby to reflexively ‘gasp’ while the head is being born. If that happens, the baby will have to spend considerable time in the NICU. While that is a very remote possibility, encourage them to avoid that unlikely problem by getting out of the tub to push their baby out.
But the best-laid plans of mice and men and midwives aside, the truth is that a significant number of laboring women who were not yet pushing have babies that suddenly ‘appear’ without warning and in spite of our plan to the contrary, they emerge into the water and are immediately brought to the surface.
It does seem that these babies are more likely to be pink, and the new mother less likely to have any perineal laceration. Nonetheless, I would never cite this possible association as a “recommendation” for having a baby be born in the water.
However, if Dr. Micheal O’Dont’s maternal-fetal ejection reflex takes over and we get a pink baby and intact perineum, I’m not going to complain about it.
http://www.channelnewsasia.com/news/world/is-water-birth-safe-for/2760580.html#.VzA3Pks7NBU.linkedin
LONDON: Giving birth in water is becoming more popular, particularly among women seeking an alternative to a medicated or hospital birth experience. But a new review finds little evidence on whether this option is good for babies.
Researchers analysed data from 29 previously published studies and found no significant differences between water births and other delivery methods in terms of complications, infant mortality or admissions to intensive care. Most of these studies were small, however, and didn’t show any advantages of water births, either.
“The notion that it is safe to have the baby under water has not been shown as safe or unsafe in our review,” said senior study author Dr Alastair Sutcliffe, a paediatrics researcher at University College of London Hospitals in the UK.
“Whilst it is a good plan to try labour in water, my advice is to wait until there is more convincing evidence of safety before having the actual delivery in water,” Sutcliffe added by email.
For mothers, labouring in a pool of warm water can help ease pain, lower the need for anaesthesia and potentially speed up the early stages of labour before the cervix is fully dilated and the baby is ready to emerge. Once it’s time to push, however, the benefits are unclear.
About nine per cent of babies in the UK were delivered under water last year, Sutcliffe and colleagues note in the Archives of Disease in Childhood – Foetal and Neonatal Edition.
In the US, however, the American College of Obstetricians and Gynaecologists and the American Academy of Paediatrics recommend against underwater deliveries due to potential complications for babies such as infections, breathing difficulties and drowning.
To assess the risks and benefits for babies, Sutcliffe and colleagues looked at data from studies that, combined, included about 39,000 births.
All of these studies were done in hospitals or birthing centres. Most were small observational studies with brief follow-up periods, and many were limited to women with uncomplicated, low-risk pregnancies.
The studies did point to one possible advantage of underwater delivery – slightly higher newborn Apgar scores, which measure heart rate, breathing, muscle tone, reflexes and skin tone.
But because most studies didn’t randomly assign some women to water births and others to more traditional deliveries, it’s impossible to conclude that water births cause higher Apgar scores.
“There is no evidence that delivering underwater has any benefits and the authors of this study fail to acknowledge a benefit other than to mention that whales and dolphins give birth under water,” said Dr Amos Grunebaum, director of obstetrics at New York Weill Cornell Medicine.
“Just because something is popular does not mean it’s safe or has any benefits,” Grunebaum, who wasn’t involved in the study, added by email. “In fact, there is plenty of evidence to suggest harm like infections, seizures and pneumonia in the (infant).”
– Reuters
