A gentler way to give birth?
Sunday, August 01, 2004
Waterbirth grows in popularity, but questions about safety remain By Jennifer MesichPhoto courtesy of West Suburban Midwife Associates Annie Breitenstein glows after the birth of her son Simon on Aug. 9, 2001. Her daughter, Ruthie, was also born in water.
Elmwood Park mom Mary Kate Dempsey always wanted to give birth at home, but ended up having Caesarean sections with her first two children. The third time, however, she was determined to have a calmer, more natural birth. After a lot of research, she decided on waterbirth.
"I spent a lot of time in the library reading medical journals and reading studies online," says Dempsey. "I heard a lot about the pain reduction and was interested in trying water. I got a big inflatable pool, but didn't think that I wanted to actually give birth in the water."
Waterbirth-giving birth while submerged up your chest in a pool or tub filled with warm water-is growing in popularity in many areas of the country. Midwives at West Suburban Midwife Associates, an Oak Park women's health practice that offers alternative birth methods, reports 84 percent of their clients requested waterbirths over the past year, up from 21 percent in 1998.
While some consider it a great alternative to a traditional natural delivery, waterbirth remains controversial. A number of doctors have spoken up against the method calling it an experimental fad, questionable at best and potentially dangerous to children.
But the fans of waterbirth, people such as Dempsey, say it works well for them.
During labor, Dempsey got in and out of the pool several times. When she started pushing, she decided to get back in the water. "By the time it was time to push I didn't want to move and gave birth after 40 minutes of pushing. After that I was definitely a believer," she says.
Is it safe for babies? The main concern is the baby's safety: Will the baby drown?
"Temperature change and exposure to air cause the baby to breathe, so the baby would not take a breath in the water," says Jacque Shannon-McNulty, a volunteer for Waterbirth International, a nonprofit organization founded in 1988 that pushes for waterbirth as an "available option" for all women.
The water used in a waterbirth is usually between 95 and 100 degrees Fahrenheit-close enough to the mother's body temperature that the baby doesn't detect any change of environment, advocates say.
Annie Breitenstein never gave the problems a second thought. "I wanted to do a relaxing and less invasive birth," the Oak Park mom says about her two waterbirths. "I was able to go in and out of the water [during labor] and it made me more comfortable. It was also a more comforting way for my baby to come into the world."
Barbara Harper, a registered nurse and founder and director of Waterbirth International, says newborns also have a dive reflex, which prevents them from inhaling water.
Another concern is whether health care professionals can adequately monitor the baby while the mother is in water. West Suburban Midwife Associates uses waterproof monitoring equipment that gives the same information as traditional monitoring devices.
It's experimental A number of doctors and pediatricians do not recommend waterbirths for their patients because they believe it could prove harmful to mother or child.
The American College of Obstetrics and Gynecologists, a nonprofit membership organization based in Washington, D.C., does not have an opinion on waterbirth. The group's Committee on Obstetric Practice "felt that 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."
Surprisingly, the American Academy of Pediatrics has not taken a formal stance on the procedure.
But many doctors hold strong opinions on the subject. "It's an experimental process that hasn't been proven to be safe or effective for newborns," says Dr. Daniel Batton, director of newborn medicine at William Beaumont Hospital in Royal Oak, Mich., and a member of the academy's Committee on Fetus and Newborn. "There are clear risks and there have been a number of case reports of complications. We talk about risks and benefits and there are no known benefits for the baby."
The August 2001 edition of Pediatrics, the journal of the Elk Grove Village-based academy, includes four case reports of newborns at a New Zealand hospital who experienced complications due to waterbirth. The article reports all four infants breathed in some water and had symptoms of "fresh-water near drowning." None of the case reports say how long the infants were underwater. The infants improved and were eventually released without long-term problems, the article reports.
The editor of the journal, Jerold F. Lucey, also wrote: "I've always considered underwater birth to be a bad joke, useless and a fad which was so idiotic it would go away. It hasn't! It should!"
Most recently, Newsweek magazine reports in its May 10 issue: "Even doctors open to alternative treatments draw the line at underwater birth."
Finding the facts Waterbirth advocate Harper, however, says people who fear waterbirths simply suffer from a lack of information.
"People talking this way have never witnessed it or spent anytime researching it, they just have opinions," says Harper, who had two of her own children in water. "It's all good publicity since it gets people to think and look up real statistics."
Waterbirth veteran Dempsey did just that-and admits the negative information she found worried her at first.
"At the beginning, it definitely played into my fears," she says. "I had to take a step back and look at where they got their information. I found it was often based on their own misconceptions and fears."
Ultimately, she felt that the positives outweigh the negatives.
The biggest benefit, advocates say, is that water serves as a natural pain reducer. Dianne Garland, a registered midwife in Kent, England, has been collecting data on waterbirths since 1994. In her study, every mother who had a waterbirth was matched with a mother who had a traditional birth, with the mothers matched by the number of children they already had, age, ethnic background, and place and month of the birth.
"We found that waterbirth moms had shorter labors, less tearing, less high blood losses and babies in good health," says Garland.
Waterbirth International held its congress in Oak Brook in April, and Barbara Rudell, a certified nurse-midwife who practices in Paw Paw, Mich., told the story of one mother's first waterbirth: The mother had planned for an unmedicated waterbirth but begged for an epidural once labor started. The nurses persuaded her to get into the tub first to see if it would help.
"Thirty minutes later I came in to check on her and she was snoring," says Rudell. "She woke up for every contraction, saying, ‘This is great.'"
Another benefit is a greater range of movement in the water, which allows mothers to switch positions more easily. The water also helps produce more efficient contractions, helps lower blood pressure and aids in relaxing the mother. Mothers who want to give birth at home can buy or rent a portable birth pool.
Questions to ask Mothers who are not comfortable giving birth in water can labor in the water and then have a dry birth. When looking for a hospital or birthing center, though, mothers should ask questions about the facility's practices concerning waterbirth, says Gayle Riedmann, a certified nurse-midwife and co-owner of West Suburban Midwife Associates.
"You need to be careful about the difference between water labor and birth," she says. "You don't know until you get there what you want. Women often choose to stay in the water, but that option is often taken away" in hospitals that offer only water labor, not waterbirth.
Riedmann also recommends that Chicago-area mothers looking into waterbirth ask about a facility's epidural rates.
"They should inquire about the percentage of patients there that have waterbirths and the epidural rates. If the practice uses epidurals a lot, that says ... they don't really believe that a woman can get through it alone."
"It should be a natural option for every mother," Riedmann says. "Today, people say, ‘You're going to have an epidural, aren't you?' I hope someday it's, ‘You're going to have a waterbirth, aren't you?'" Waterbirth resources These hospitals, clinics and practitioners offer different water birthing services around the Chicago area.
University of Chicago Hospital 5841 S. Maryland Ave., Chicago (773) 702-1000 Obstetrics and gynecology (773) 702-6127 www.uchospitals.edu Water labor
West Suburban Hospital 3 Erie Court, Oak Park (708) 383-6200 Family Birth Center (708) 763-6622 www.westsub.com Waterbirth
Evanston Hospital 2650 Ridge Ave., Evanston (847) 570-2000 Labor and delivery (874) 570-2225 www.enh.org Water labor
George Elvove, MD 1029 West Park Ave., Libertyville (847) 362-1367 Home waterbirth
HomeFirst Health Service Mark Zumhagen, MD 2000 Golf Rd., Rolling Meadows (847) 981-1881 Home waterbirth
LifeSpiral Services Midwives Tracey Johnstone, DEM (773)-235-4815 Home waterbirth
Waterbirth International (800) 641-2229 www.waterbirth.org Waterbirth information and tub rental
Rush-Copley Medical Center 2000 Ogden Ave., Aurora (630) 978-6200 Women’s Health Center (630) 499-2485 www.rushcopley.com Waterbirth
Swedish Covenant 5145 North California Ave., Chicago (773) 878-2800 Appointments (773) 878-6888 www.schosp.org Water labor
HomeBirth and Women's Health, Inc. 400 East 22nd St., Suite F, Lombard (708) 445-8206 www.homebirthandwomenshealth.com Home waterbirth
West Suburban Midwife Associates 715 Lake St., Suite 273, Oak Park (708) 848-3800 www.westsubmidwives.com Waterbirth at West Suburban Medical Center
Weiss Memorial Hospital 4646 North Marine Drive, Chicago (773) 564-5242 Women’s Hospital (773) 564-5450 www.weisshospital.org Water labor
Jennifer Mesich is a journalism student at Northwestern University and a former Chicago Parent intern.