What expectant mothers should know about water births_lowres

Moms and midwives say laboring in water makes the process gentler and less painful.

When Annie Zeller had her first baby a few years ago, she really wanted a water birth. But she was at a local hospital, and the doctors wouldn't let her do it.

  "I knew if could just get in the water, then the baby would come," she said of her first labor and delivery, which she said was prolonged and not the best possible experience.

  So Zeller, 31, decided to do things differently when it was time to have baby number two. Two and a half months ago, she gave birth to a girl, Lia, in a birthing tub at home, under the care of a licensed midwife.

  "The water helped me so much to relax. I was even able to doze off a little bit," Zeller says. "It was 1,000 times better than my first. I was so much more comfortable, physically and emotionally."

  Other New Orleans moms like Zeller have requested water births in recent years, according to Zeller's midwife, Emmy Trammell — so much so that major New Orleans hospitals have catered to their demands by offering water deliveries in addition to the more traditional bed deliveries.

  The new Perkin Alternative Birthing Center, which opened in Ochsner Baptist Women's Pavilion in January, is one of those facilities offering water births for laboring mothers.

  With its staff of certified nurse midwives, a home-like environment and personalized options that include water births, the Perkin staff says that because of the new center, New Orleanians now have more options when it comes to birthing choices.

  "The hospitals are finally coming around to listening to public demand," Trammell says about Ochsner and other regional hospitals that offer water birth as an option.

  However, a new opinion from the American Academy of Pediatrics says that while immersion in the first stages of labor may "be associated with decreased pain or use of anesthesia and decreased duration of labor," immersion during the second stage of labor is more questionable as a practice.

  "The safety and efficacy of immersion in water during the second stage of labor have not been established, and immersion in water during the second stage of labor has not been associated with maternal or fetal benefit," reads the opinion, written by the academy's Committee on Obstetric Practice for an April 2014 journal article.

  "Given these facts and case reports of rare but serious adverse effects in the newborn, the practice of immersion in the second stage of labor (underwater delivery) should be considered an experimental procedure that only should be performed within the context of an appropriately designed clinical trial with informed consent."

  Proposed benefits during underwater immersion, according to the study, include decreased maternal stress and stress-associated hormone levels, and a "gentler" transition from the in utero to ex utero environment. But the opinion says those don't necessarily offset some reported complications, which include higher risk of infections, umbilical cord rupture, respiratory distress or drowning.

  In conclusion, the opinion essentially says that immersion should only be used during light labor — and even then, doctors advise the procedure should be closely monitored.

  "Although not the focus of specific trials, facilities that plan to offer immersion in the first stage of labor need to establish rigorous protocols for candidate selection, maintenance and cleaning of tubs and immersion pools, infection control procedures, monitoring of mothers and fetuses at appropriate intervals while immersed, and protocols for moving women from tubs if urgent maternal or fetal concerns develop," the opinion concludes.

  Mary Alice DeCoursey, a licensed midwife who works in the West Jefferson Medical Center, is one of several local midwives who disagree with the overall conclusion of the American Academy of Pediatrics opinion.

  DeCoursey says that, at this point, water birth has been established as an acceptable way to deliver for any healthy mother. Moreover, she says, any labor or delivery can present complications, and several hospital practices which are done in absence of clinical trial study aren't labeled "experimental."

  "The bottom line is, there are a number of practices in obstetrics, such as continuous electronic fetal monitoring for low-risk women in labor that have not been rigorously studied in clinical trials, yet continue to be used," DeCoursey said.   

  "It's distressing to have a practice, such as hydrotherapy, singled out and labeled as experimental when there is a large and growing body of research that supports hydrotherapy as a reasonable choice for healthy women expected to have a normal labor and birth."

  DeCoursey and two other New Orleans midwives cite a website called Waterbirth International (www.waterbirth.org), a resource and referral service founded and directed by award-winning author, midwife and childbirth educator Barbara Harper.

  In an article called "Waterbirth Basics," which was published in Midwifery Today Magazine in summer 2000, Harper addresses questions about water births, including the risk of drowning, infection and when an expectant mother should enter the water.

  According to Harper, a newborn will not take a breath before exiting the water because the environment is so similar to the one in utero. Inhibitory factors and fluid already present in the infant's lungs upon birth contribute to this phenomenon. Bringing the baby out of the water shortly after it's born, she added, prevents asphyxiation.

  Infection is another oft-cited concern, but Harper and local midwives say the chances aren't any higher than with any "normal" hospital-setting birth.

  According to Harper's research, of 150,000 water births given worldwide from 1985 to 1999, there were no reports of infant deaths due to water inhalation. And a 2012 Cochrane study found no harm to babies when studying labor or birth involving 3,243 women.

  Trammell, who holds degrees as both a licensed midwife and a certified professional midwife, says she's never had a mother regret giving a water birth. Trammell handles an average of 30 births a year. So far this year, she's assisted in nearly 10 births, and about half of those have been water births. And they've all been healthy experiences, she says.

  "I've never experienced any of my mothers getting an infection," Trammell said. "You have a clean tub with a clean source of water and sterile gloves."

  Trammell also suggests that moms get in the tub only for active labor, so the water helps advance the process, rather than slow it down.

  Midwives in the city implement a number of practices to ensure healthy delivery, according to Catherine Badeaux, a licensed midwife who works in the Perkin facility and who recently attended her own daughter's water birth.

  "We have specific guidelines," Badeaux says, which include making sure that only women with low-risk pregnancies do water births, and that neither mom nor baby has diseases or infections.

  Midwives keep the temperature of the water at 95-100 degrees, and the tubs are sanitized between each patient, Badeaux and other midwives say.

  "In my career, I've never had a problem," Badeaux says, adding that water births don't always result in a crying baby being born "because a water birth is a gentle birth."

  DeCoursey reiterated that all of this water birth popularity was driven by patients' requests.

  "What's much more telling is [the] consumer side of it — that's what driving this," DeCoursey said. "If they didn't want it, it wouldn't be out there. They started doing this at home because it wasn't available at hospitals and so hospitals started offering [water births]."