March 24, 2014 | 46 Comments

One good argument against waterbirth

Thinking about waterbirth small

You wouldn’t let your baby play in the toilet; why give birth to him there?

Author:Amy Tuteur, MD

View all posts by Amy Tuteur, MD →
  • Tara
  • nunya

    No thanks, I don’t need nor will I drink the kool-aid offered here on ‘Dr. Amy’s’ site.

    http://medicalmalpractice.levinperconti.com/hospitalborne_infectiondisease/

    http://www.babycentre.co.uk/a542003/the-history-of-water-birth

    • Elizabeth A

      Neither of your links appears to have much relevance for women considering home birth in the US. And both of them could use some better citations.

      • nunya

        Umm, Elizabeth, I believe this posting was about water birth and hospitals in the US approve of water birth. So maybe you all should let the hospitals know that they are allowing babies to be born in toilet water since they seem to be uninformed according to you all! Do you really think hospitals would allow water birth if it were unsafe???

        • Elizabeth A

          Do I really think hospitals would allow waterbirth if it were unsafe?

          Well, for starters, not all hospitals in the US allow, or even offer, waterbirth. Many lack the facilities and equipment, and some allow patients tp labor in water, but require them to get out for the birth itself.

          There are other posts on this site which detail the current opinion of medical associations regarding water birth. They aren’t fans. Nonetheless, women request this option, and some (absolutely not all) hospitals offer it. Some doctors with experience with water birth in a hospital setting have raised some serious concerns. And there is no denying that the water gets filthy.

          I am not required to assume that any particular hospital practice is necessarily good just because it happens to be in use, and this one is pretty controversial.

  • nunya
    • Elizabeth A

      So, we’re stupid because professional photos exist, and therefore waterbirth is awesome?

      I am so glad that things turned out well for that family, but they’ve made a number of choices I wouldn’t. I would absolutely NOT, for example, do a cord burning ceremony that involved a toddler, a candle, and the bed I was lying on.

      That lady has lovely hair, and I’m impressed by how dry and neatly brushed it stays while she delivers the baby. Her bikini top is cute too. But the gorgeousness mostly strikes me as a pain in the ass I am glad not to have worried about when it was my turn.

      • MLE

        Would you invite assorted children to your birth?

        • Elizabeth A

          Personally? Hell no.

          One of the things that bugs me about birth photography is how peaceful and gracious and obliging the moms always seem to be. I’m sure this is partly selection bias – if you’re screaming and throwing up and crapping yourself, you are unlikely to tell the photographer she can post those photos – but it introduces this unpleasant pressure. It’s not enough to give birth to a baby, you have to look great and be the perfect hostess while you’re at it. (I also get annoyed at suggestions about treats for the nurses at the hospital, and what to feed the midwives. When people are at my house for extended periods, or crises, I generally tell them to make free with what’s in the fridge, but I don’t believe a laboring woman should be required to think about buffet service.)

          • MLE

            Exactly, it’s wonderful that she apparently had very little pain and the baby just slid out. Pinterest birth is not everyone’s experience, and an ocean of warm relaxing water isn’t going to change that.

        • Box of Salt

          MLE, no, nor would I invite a professional photographer to document the process and post my photos on the internet.

          But, hey, that’s just me.

  • ngozi

    This is just crude, I know, but I keep thinking that during labors and deliveries a woman can poop, pee, or vomit at any time. I think the people who insist on delivering in water, or those who want crowds of people present during the labor and delivery tend to forget that.

  • Delawaremamma

    This is OT but pertains to a past subject. Does anyone still peek at Ruth Iorio’s Instagram? I admit I go check her crazy about once a week and noticed that she attended a “Birth class reunion”. They took a class photo and it looks like one of the families experienced a loss. They couple standing directly behind Ruth only have a photo. Do we know anything more about Ruth’s midwife? Other than the fact that Ruth nearly bled to death. It would appear that the same midwife lost a baby around the same time. But homebirth is COMPLETELY safe. Right?!

  • birthbuddy

    Controversy alert! – saddle up the high horses.
    Taking Dr Amy’s point a step further; would it be acceptable to deliberately bath your newborn (or any child) in the toilet or similar environment?
    I believe this would be deemed child neglect, abuse or at the very least, negligent.
    From a rights perspective, the mother’s right to performance art (autonomy) terminates at the exact point when the child is expelled alive from her body (in fact, earlier in some states).
    The child immediately, at that point, becomes a legal entity, entitled to it’s own rights and protections. For instance, not to be subjected to unnecessary risk or harm and being captive in a contaminated pool of faeces, blood and urine.
    The child (or someone on their behalf) is entitled to sue the mother (or accessory) for this breach and any harm suffered.
    Waterbirth may in fact be tortuous or illegal ?

  • oldmdgirl

    Well, in all fairness, I have let my baby play in the toilet, but that’s way different than letting her inhale blood, poo, and urine.

  • Zornorph

    Well, my cat has been known to drink from the toilet, but I suspect he’d turn up his nose at a birthing pool. Unless they left the placenta floating in it; he’d probably fish that out and eat it. He really likes raw flesh – I feed him chicken livers because he kills things if I don’t. Serves me right for naming him Dexter.

  • LMS1953

    Question: as regards laboring in the first stage in a birthing tub (which many women state they enjoyed and which the ACOG/AAP Bulletin considered appropriate in qualified case – are there waterproof wireless transducers? If not, what is considered an appropriate protocol for intrapartum monitor? Can a woman labor in a tub if an intrauterine catheter and fetal scalp monitor lead are in place?

    • Jessica

      There is waterproof wireless telemetry monitoring. I was on CEFM while being induced and was able to labor in the tub with that belt. (When I was not in the tub I had more traditional monitoring.) I was not permitted in the tub once my water had broken, so I would imagine that an intrauterine catheter or fetal scalp monitor would also preclude water laboring.

      • LMS1953

        Thanks! AROM is a good way to induce labor without pitocin and a good way to augment labor with lower doses of pitocin: they often go hand-in-hand – start pit, establish a good pattern, then do AROM. That would not seem to give much time to enjoy the tub.

        • Trixie

          I don’t think many hospitals have the waterproof wireless ones though. And I was not allowed in the tub with broken water either. I think that’s pretty standard.

      • toni

        How would you know that your water has broken if it happens in the tub?

        • Jessica

          I have no idea – I didn’t think much about it since I was only 3cm and my OB ended up doing AROM after I got out of the tub and requested an epidural.

        • Medwife

          I felt mine go “pop”. A slow leak person wouldn’t know.

    • moto_librarian

      Back before I left the FB group for my CNM practice’s patients in disgust, there was frequent bitching about not having enough access to the tubs. They were portable, and only two were available at any given time. You could not use the tub if your water had broken, and VBACs were ineligible because of the requirement for CEFM (not waterproof monitors in my hospital). I got to the point where I simply could not take the ignorance being posted there by idiot doulas and other patients. The consensus seemed to be that the CNMs were “medwives,” like that was a bad thing!

      • Jessica

        The L&D suites at my hospital each have deep tubs with whirlpool jets and showers, and as I recall my SIL was able to shower even though her water had broken.

    • MaineJen

      I was able to labor in the tub with water broken (but no sauna jets! Darn); I was on pitocin drip so they used wireless CEFM in the water. Pretty nifty.

  • anion

    Forgive the crudeness (and mild hyperbole), but I keep thinking of waterbirth as akin to welcoming a baby to the world with a dirty swirly.

  • It’s easy to forget that birthing pool/tub water is not only fecally contaminated. There will be amniotic fluid and blood in it by the time the baby is born, as wll as zillions of maternal skin (and the “invisible” dirt on that skin) cells and bacteria that have been luxuriating in tepid water for hours. Water in regular pools is chlorinated not just because of possible urinary contamination. birthing pool water is a veritable soup of contaminants, none of which are good to swallow or inhale.

    • Siri

      Ah, but if the water LOOKS clean, that means it IS clean! Stick that in your pipe and smoke it, you … erm … midwife with 30 years of experience. .. 😉

      • anion

        Yep. Everyone knows that germs are visible to the naked eye. That’s why it’s safe to injest water draining from a swimming pool, or in a river or lake, or from any well anywhere, or in which raw chicken has been rinsed. If the water’s clear, it’s clean.

        • Siri

          It’s a little-known fact that rinsing raw chicken in water improves its purity significantly. Scandinavians have been performing chicken-rinsing ceremonies for centuries. The very word for midwife, ‘jordmor’, means ‘chicken-rinser-high-priestess’.

          P.s. The chickens are all volunteers.

          • anion

            Silly me! Thank you for educating me on that bit of historical truth hidden by the evil chicken-hating patriarchy. Shame on them for stealing our raw-chicken-water birthright!

            I would like to hold my own chicken-rinsing ceremony at home. Do you know any high priestesses that would be willing to come to my house and rinse my chicken? It’s okay if they have a prison record or pending charges–I Trust Chicken.

          • Siri

            I’m available Mon – Fri from dawn till dusk, have a cleanish record, and can bring my own sacred chickens. All for the bargain price of $100/hour plus taxes. Don’t you want your babies to have the very best?

    • LMS1953

      Midwives of all stripes are ever on the alert to warn that vaginal exams should not be done too frequently so as to avoid causing infection: (I think they also do it to prevent tracking the course of labor on a Friedman curve). Yet they poo-poo (pun intended) the risk of infection with waterbirth.

    • Young CC Prof

      Definitely! Even if there’s no poop, no GBS, we are talking about a newborn baby’s lungs. Ordinary skin and surface bacteria can cause plenty of havoc if they wind up getting drawn inside.

      My mother, who’s about a 7 or 8 out of 10 on the crunchy scale and delivered my brother in a birthing center, thinks delivery in water is patently absurd and getting into a tub anytime after rupture of membranes carries a significant risk of infection to both parties. (And her labors started with spontaneous rupture of membranes, so no tubs for her.)

      I mean, you aren’t supposed to immerse babies under 6 months. In a swimming pool, lake, bath, ocean, anywhere. And the immune system of a minutes-old baby is far less effective than that of even a one-month-old.

  • Mary W

    Ok internets I have an unrelated question and I don’t want to call up my OB and hassle him.

    My last daughter was born at 35 weeks and change. She was very blue and floppy when she came out despite the EFM being fine. Pushing was less than a minute and amounted to one gentle push so her head came out, then her many times wrapped around her neck cord was cut and the doctor just gently slid the rest of her out. At points during labor she would decelerate and the nurse would drop the pit, then turn it back up, then back down. Apparently my OB was pissed off that she didn’t call him because he would have done something involving inflation?…I can’t remember if it was an amniotic substitute tubed in or if it was some other procedure (epidural didn’t work at all, so memory is mildly hazy). When they were finally going to do that I was ready to push all of a sudden so they didn’t.

    She spent a bit over a week in NICU due to fluid in the lungs and needing antibiotic treatment, and associated breathing difficulty.

    Anyway, coming out the shade of a blueberry, shouldn’t there have been some issues on the monitor in the hour leading up to her actual birth? Is it possible the strip was crap and they just weren’t saying anything so I wouldn’t flip out? If they were going to do the procedure that I can’t quite remember what it was, is that indicative that the strip was iffy and they were trying to stabilize it?

    Thanks in advance for you collective wisdom.

    • Sullivan ThePoop

      I am not sure. I do know that my nephew that was a second twin was born blue from a scheduled C-section and the doctor said that happens with twins and it was nothing to worry about. Both of the twins spent 3 days in the NICU for poor temperature regulation.

      My son was born at 35 weeks 5 days and he wasn’t breathing when he was born, but only his hands were blue. Nothing was wrong before.

      Edited to add, maybe his feet too I just couldn’t see that area.

      • Young CC Prof

        As I understand it, almost all vaginally-born babies have blue hands and feet. A certain amount of oxygen deprivation is an unavoidable part of the process, and the fetus is built to deal with it. It even helps the heart, lungs and circulation prepare to switch over from fetus mode to baby mode.

        • Sullivan ThePoop

          Neither of my daughters did, but that doesn’t mean anything. I just think with my son it was something that happened right at the end because they had to resuscitate him, but it took no time and he only spent a little over an hour in the NICU and never had to go back.

    • Captain Obvious

      Probably an amnioinfusion. Which replaces some sterile saline back in the uterus to resuspend the umbilical cord within fluid to help decrease how much cord compression is occurring. Preterm babies do end up with TTN and respiratory problems. Thus the 39 week rule. Preterm and FHR issues certainly may all contribute to what you describe. Without seeing the tracing, it’s all speculation. But then again, the tracing doesn’t always predict outcomes perfectly.

    • MJ

      My son was born at 37w exactly after an induction for SROM in the absence of labour. We had continuous monitoring which never showed any signs of concern. My midwife had to loosen a cord loop around his neck and deliver him through it. He was born blue all over but crying, breathing, and vigorous. He took a long time to pink up, but the midwives kept an eye on him and he didn’t need any special care at all. I’ve wondered whether it was a combination of being early and the cord loop? But certainly he was the only one of my three who didn’t come out pink.

    • Jen

      I’m not sure about what your Ob might have done, but my second son was born vaginally at 38w after a spontaneous labour. Less than 15 minutes of pushing and he came out purple/blue. He was moving and breathing immediately after birth but took a while to cry out. I have a photo of him taken about four hours after the birth and he is still a shade of purple. I asked my Ob about it later (I wondered if his cord was wrapped around his neck but she didn’t say), she said it may have been because the birth was so quick.

  • Rochester mama

    I bet my toilet is cleaner than the water at the public beach we go to in the summer time on the Mississippi, or the mud from the sprinkler in the back yard he plays in thanks to birds and rabbits.

    • guestzilla

      But do you let him play in it? Yes or no?

      • Alexicographer

        I’m entirely sure my toilet water is cleaner — after the toilet has been flushed but before it has been used again — than the lake that DS and I swim in during the summer (or any number of other places we play/splash/swim in), but I think part of Dr. T’s point here is that the sort of water birth she’s expressing concern about involves the newborn baby swimming in the “toilet” *after* it has been used but before it has been flushed, as it were. The lake we swim in isn’t dirtier than the toilet right after it’s been used and before it’s been flushed!

        And my son (we’ve been swimming together in the lake in question since he was 4) is a capable swimmer who pretty much understands that he shouldn’t drink the lake water. It’s no guarantee he won’t get some in his mouth and swallow it, just as I could — and certainly some parents would ban swiming there on those grounds. Heck, as far as that goes we did have a cryptosporidium outbreak in our local public pool system this winter, so there can, indeed, be risks, including in “clean” water. Still, a very different sort of risk — and of course a 4+ year old has got a much more developed (and vaccinated!) immune system than does a newborn. I’d never have dreamed of dunking him in either the lake OR the pool as a newborn!

    • PJ

      So what’s your point? You’d happily wallow in your toilet? If I knew water was dirtier than my toilet there’s no way I’d be letting my son in there.