What’s the difference between waterbirth and toilet birth?

Toilet paper on a toilet, close-up

The practice of waterbirth, widely beloved of natural childbirth and homebirth advocates, is nothing more than giving birth in a gigantic fecally contaminated toilet.

There is no difference at all.

Wait! Scratch that; there is one difference. Toilet bowl water is room temperature, leading to slower growth of microorganisms. Birth pools are heated to body temperature, the favorite temperature of harmful bacteria and the one that allows the bacteria to multiply to pathogenic levels.

The American Academy of Pediatrics’ Committee on Fetus and Newborn in conjunction with the American College of Obstetricians and Gynecologists has just updated its position on waterbirth. Nothing has changed since the previous edition published in 2005, except in the intervening years, more cases of perinatal death and injury have been reported.

The scientific evidence for giving birth in water has failed to demonstrate any benefit, but case reports have demonstrated a wide variety of risks:

Some of the reported concerns include higher risk of maternal and neonatal infections, particularly with ruptured membranes; difficulties in neonatal thermoregulation; umbilical cord avulsion and umbilical cord rupture while the newborn infant is lifted or maneuvered through and from the underwater pool at delivery, which leads to serious hemorrhage and shock; respiratory distress and hyponatremia that results from tub-water aspiration (drowning or near drowning); and seizures and perinatal asphyxia. (my emphasis)

But wait! Barbara Harper, the nurse who is the doyenne of American waterbirth claims that infants can’t breathe in the contaminated bathwater because the “diving reflex” prevents them from gasping.

Not so, according to the AAP and ACOG:

Although it has been claimed that neonates delivered into the water do not breathe, gasp, or swallow water because of the protective “diving reflex,” studies in experimental animals and a vast body of literature from meconium aspiration syndrome demonstrate that, in compromised fetuses and neonates, the diving reflex is overridden, whichleads potentially to gasping and aspiration of the surrounding fluid.

We know that fetal breathing movements (aspirating amniotic fluid into the lungs and out again) is a part of normal lung development. If there is not enough amniotic fluid, the baby’s lungs will be fatally underdeveloped (Potter’s Syndrome). And the presence of fetal breathing movements in utero is a sign of fetal well being when seen on ultrasound. So we know that babies breathe in and out in the uterus, even when they are well oxygenated, and we know that babies who are oxygen deprived breathe meconium into their lungs. It is the height of foolishness to claim that they won’t breathe fecally contaminated birth pool water into their lungs as well.

Most mainstream media outlets have covered this story by providing the facts. Unfortunately, the health column for WBUR, the Boston affiliate of NPR, is written by a doula, Rachel Zimmerman, among others. Zimmerman revealed her bias by “balancing” the scientific evidence from the AAP and ACOG with the blithering of Barbara Harper, as if a layperson who just makes stuff up is the equivalent of balance.

There’s currently a vigorous debate going on in the comments section, and I predict it is only a matter of time before Zimmerman starts deleting comments.

The bottom line is that waterbirth is no different from delivering in a giant toilet warmed to the preferred temperature of fecal bacteria. It is unnatural (no primates give birth in water); it is dangerous; and it is ludicrous to claim otherwise.

I have a simple question for waterbirth advocates:

Would you completely immerse your head (eyes open, of course) in the fecally contaminated bloody water of a birth pool in the aftermath of a birth?

I have a second question:

If you wouldn’t for a moment contemplate immersing your head in a pool of water with feces floating in it, why do you think it is a good idea to force your baby to do so?

239 Responses to “What’s the difference between waterbirth and toilet birth?”

  1. Carrie Looney
    April 9, 2014 at 2:44 pm #

    So, this is the post that brought me to this blog – as a childless and intend-to-stay-that-way person, I really haven’t had much call to learn all that much about pregnancy and childbirth, other than very specific ways it’s come into my profession – and that’s always been in a hospital/managed care setting. I had never heard of giving birth in water until a friend of mine started going on about how that was what she had been planning for her first child and would surely do for her second. I thought that was the craziest idea, but admitted my lack of knowledge and went looking for more information.

    Now I am in the uncomfortable position of whether to stay a friend and shut my mouth about all of the Evil Doctors With Their C-Sections And Epidurals And Hospital Infections That Kill All Of The Babies Kool-Aid that this discussion brought out, or not stay friends, and both of those are ugly and saddening choices for me.

    But I really appreciate that there is a blog where I can get good information about these issues.

    • Young CC Prof
      April 9, 2014 at 3:38 pm #

      It is unfortunate that some people have been “educated” by the natural childbirth movement so thoroughly that they are immune to reason.

      Where is this friend planning to deliver?

      • Carrie Looney
        April 10, 2014 at 7:08 am #

        I don’t want to say much more out of respect for her privacy. But the thing that surprises me is she says water birth is sanctioned by the NHS and offered in the UK? I don’t have the knowledge to know if this is true or not (I’m not in the UK).

        • Dr Kitty
          April 10, 2014 at 7:24 am #

          It is indeed offered in the UK for low risk women.

          NICE intrapartum guidelines state

          “Water birth
          Women should be informed that there is insufficient high-quality evidence to either support or discourage giving birth in water.”

          The data from the UK where 0.5% of all deliveries are in water suggests it may be safe, and there are clear best practice guidelines.


          • Carrie Looney
            April 10, 2014 at 11:09 am #

            Interesting – so with the same dataset, the US specialists say “Not recommended outside of an RCT,” and the UK specialists say, “Go ahead, the water’s fine?”

          • Jade
            April 27, 2015 at 3:36 am #

            It’s different in different countries because midwives trained in the US have not had the same training as midwives from other countries. In Canada waterbirth is deemed as safe by our government. Our government actually pays for midwives to attend home water births because the birth stats are the same or better than hospital birth stats.

            I support birth wherever anyone wants to birth as long as they have a highly trained professional caring for them. Midwives in Canada are highly trained (they have had 4 years of schooling to learn how to deliver babies… this is much more education than family doctors that are delivery babies.) Of course OB’s have had many more years beyond that, yet they have never seen a waterbirth or seen a home birth and have probably never sat with a labouring woman from the start of labour to the end of labour (like midwives do) which is why I actually value midwifery care over OB care (for normal low-risk women)

        • Young CC Prof
          April 10, 2014 at 11:07 am #

          If she’s doing it in a hospital, or in a birthing center physically attached to a hospital, they should be able to fix the baby if anything goes wrong as a result of the water birth. If she’s doing it in a freestanding birthing center or at home, the risk to the baby is far higher.

          As with any kind of birth.

  2. MJA87
    March 24, 2014 at 1:34 pm #

    Could you be anymore ignorant Dr. Amy? So I suppose people who take baths instead of showers are just “bathing in toilet water”? You do realize all the same bacteria are in just plain old bath water that supposedly make a birth tub a “toilet bowl”. I would far rather give birth in that then the “sterile” hospital environment where you can be exposed to fabulous infections like MRSA and C. diff. Not everyone eliminates during labor either, sooo it’s basically the same as a bath tub. My baby has never been sick or had any sort of infection, she is 7.5 months old. My cousins baby born 1 month after mine has had at least 5 colds/viruses/infections, born by c-section. Anecdotal? Yes. But I will take my choices Anyday.
    I work in healthcare and feel blessed to rarely run into doctors as bitter, ignorant and ill informed as you.

    • Amy Tuteur, MD
      March 24, 2014 at 1:45 pm #

      You’re joking, right?

      Please let me know where you work in healthcare so I can run in the other direction.

      • MJA87
        March 24, 2014 at 1:49 pm #


        • birthbuddy
          March 26, 2014 at 2:07 am #

          So, you came along and thought you could give Dr Amy a stern talking to, you based it on your health credentials, you got called out and now you are squirming like a worm. Is that about it?

      • MJA87
        March 24, 2014 at 1:53 pm #


    • Trixie
      March 24, 2014 at 1:57 pm #

      I feel like “working in health care” could mean you’re on the custodial staff, back in the payroll office, a transcriptionist, a food service employee…all of which are respectable and hardworking positions, but none of which qualify you to give medical advice. If you have credentials, state them.

      • MJA87
        March 24, 2014 at 2:11 pm #

        I hate to break it to you… But my services are billable. This website isn’t about my credibility.

        • Trixie
          March 24, 2014 at 2:18 pm #

          Billable…great. So what are your credentials?

          • Amy Tuteur, MD
            March 24, 2014 at 2:31 pm #

            Sh’e a dietician, apparently.

          • MJA87
            March 24, 2014 at 2:47 pm #

            Wow, thanks for sharing my personal information.

          • Amy Tuteur, MD
            March 24, 2014 at 2:55 pm #

            Right. How dare I check to see if you are a healthcare provider when you were having so much fun pretending that you were?

          • The Bofa on the Sofa
            March 24, 2014 at 2:56 pm #

            Where did you find her “personal” information?

          • LovleAnjel
            March 24, 2014 at 4:55 pm #

            Probably when she signed into Disqus/Google/whatever with her email address. Like we all do.

          • MJA87
            March 24, 2014 at 3:22 pm #

            I do work in healthcare, just like I said. Maybe you should put a warning where we enter in our email that Dr. Amy will use it to find and publish our personal information.

          • MJA87
            March 24, 2014 at 3:31 pm #

            I’m going to go ahead and contact “Disqus” because I wasn’t aware that “Dr Amy” could find and use our personal information. I would think a Dr. would have a better grasp on privacy.

          • LovleAnjel
            March 24, 2014 at 4:57 pm #

            Did you use it to sign in to an account (Disqus, FB, Twitter, Google)? You checked the terms and conditions box when you signed up? I believe their right to distribute your information would be detailed there.

          • MJA
            March 24, 2014 at 5:04 pm #

            I didn’t use Facebook/Google/Twitter. Just the regular sign in where you pick a name , enter email and check guest sign in. I don’t see why my email would be given to Dr. Amy as it specifically says it will not be shared with anyone. At any rate, it’s a violation of privacy.

          • Florence
            March 24, 2014 at 7:48 pm #

            You are really making a big deal out of nothing…. Are you offended you got caught in a “white lie”, is that why you are all up in arm? it isn’t like she shared your address tel#, SSN…I mean come on now!!! all she said is that you are a dietican!

          • MJA87
            March 24, 2014 at 7:57 pm #

            Understand this, I do not want someone like Dr. Amy to have access to my personal information, that’s what I’m upset about.

          • Anj Fabian
            March 24, 2014 at 7:59 pm #

            I’m sure there’s an “Internet Privacy For Beginners” somewhere.

            Please go read it.

            Here’s a book:

          • Florence
            March 24, 2014 at 9:49 pm #

            oh don’t get me wrong I understand, we had a lunatic UCer following us and listing all of our full names places we go to ect on her crazy blog…so I get it!!! but DrA will never mess with you in real life, I can tell you that much!

          • anion
            March 25, 2014 at 9:03 am #

            Then don’t enter it on her website, idiot.

          • LovleAnjel
            March 24, 2014 at 8:35 pm #

            Not really, since you used it to sign into *her* blog. She has your IP address too, you know.

          • birthbuddy
            March 26, 2014 at 2:04 am #

            Yippee, another court case. How did the last one end….?

          • anion
            March 25, 2014 at 9:01 am #

            Do you honestly know nothing about how the internet–and commenting on websites–works? Why do you think it asks for your email to begin with? ANY website where you enter your email to comment will make that email visible to the site’s admin. I have the emails and IPs of everyone who has ever commented on my website, too. I have even occasionally used them to privately answer a question or share a comment I don’t want online or whatever else.

            You don’t want the site’s admin to see your email address and potentially find you from it? Use an anonymous email address. It isn’t hard. I comment here with a hotmail account for anion. My personal info isn’t attached to it (although I have emailed Dr. Amy in the past giving her my actual name and identifying myself as Anion). That’s basic internet security, FFS. Thirteen-year-olds know to do that if they don’t want the site’s admin to have their “real” email address.

            And seriously, identifying you as a dietitian is not releasing your personal information. Two seconds on Google shows there are at least 67,000 dietitians in the US–do you think my stating that fact is also somehow “outing” you?

          • birthbuddy
            March 26, 2014 at 2:01 am #

            Don’t get all huffy, stay around and play.

          • Amy Tuteur, MD
            March 24, 2014 at 3:49 pm #

            Maybe you shouldn’t pretend to be something that you are not.

          • Florence
            March 24, 2014 at 7:45 pm #

            Your personal info are safe, there are thousands of dietician in the US. Nothing to worry about!

          • Rochester mama
            March 24, 2014 at 5:18 pm #

            Dietitians are healthcare providers and I’m officially done with this blog. I used to like it. Right now you look like the typical MD bully who has to be the smartest rightist person in the room and treats allied health staff like servants.

          • S
            March 24, 2014 at 7:35 pm #

            Sure she was being purposely vague and evasive, and she deserved to be called out on it (and people were calling her out) — but what is the rationale for sharing this detail? Certainly no one here thought there was any chance she was a physician. Honestly i’m a little freaked out by this.

          • birthbuddy
            March 26, 2014 at 1:59 am #

            I think the point is that you get away with BS on this site. You need to know your stuff and you will be called on lies. You also won’t be blocked for disagreeing, which is a bonus.

          • The Bofa on the Sofa
            March 24, 2014 at 3:03 pm #

            You are the one who introduced them as relevant to the discussion. You can’t cry when someone calls your bluff.

          • Guest
            March 24, 2014 at 3:52 pm #

            Honestly, I think it is pretty un called for and unethical to publish the profession of someone who want to remain anonymous. I support what you do, but this, not so much.

          • Karen in SC
            March 24, 2014 at 3:54 pm #

            With nothing else to go on, I think anonymity is preserved.

          • Guest
            March 24, 2014 at 3:58 pm #

            It’s just way too close to invasion of privacy IMO. It may not be illegal, but it just smacks of intimidation.

          • Guest
            March 24, 2014 at 8:00 pm #

            Sure, but digging for and sharing this type of information, when the only purpose is spite and/ or intimidate someone, that is crossing a line IMO. A dietitian *is* a health professional and they do work in hospitals. The OP did not claim to be involved in obstetrics or claim to be a physician.

            Do you think it is a *good* idea to post person information about people here without their permission? Do you think it is ethical? If so, why?

          • fiftyfifty1
            March 24, 2014 at 8:08 pm #

            In your case, I think it’s a good idea. You tried to bolster your argument by claiming you worked in health care. But then you refused to say how. There was no privacy reason for you to hide your profession, as other details about you are not available. We still have no idea about any of your *personal* information.

          • Guest
            March 24, 2014 at 8:32 pm #

            I am not the original poster, just someone that doesn’t agree with what happened with her information.

          • fiftyfifty1
            March 24, 2014 at 9:10 pm #

            Sorry Guest, my bad!

          • birthbuddy
            March 26, 2014 at 1:56 am #

            The point was well made and still stands.

          • Florence
            March 24, 2014 at 7:44 pm #

            amnonimity is absolutely preserved!

          • MJA87
            March 24, 2014 at 4:53 pm #

            Apparently, Dr. Amy was given my email and used it to find my name and profession. I did not agree anywhere to have that information shared with Dr. Amy. It has been reported. I forgot that no one works in healthcare except for MD’s…. I must remember to write to the University I attended to make sure they stop calling their Allied Health graduates healthcare professionals.

          • Florence
            March 24, 2014 at 6:43 pm #

            Are you ashamed of being a dietitian ?

          • MJA87
            March 24, 2014 at 8:02 pm #

            Absolutely not. But it’s completely irrelevant to the convo. And most people have no clue what a clinical dietitian does anyway.

          • MJA87
            March 24, 2014 at 2:32 pm #

            What relevance does it have??? I work in a clinic, even if I were a regular patient I would still be grateful to not run into doctors like Dr. Amy. There are occasional bad eggs but no one so immature or spiteful as the one who writes this drivel.
            I would like to see Dr. Amy do a little home study. She should swab her toilet, her bath tub and a local birth tub at a hospital and show us the culture results.

          • Tim
            March 24, 2014 at 2:39 pm #

            What is this study supposed to reveal? Most hospitals don’t let you actually give birth in their tubs, just labor in them. Wouldn’t we have to include the fold up birthing tub that a CPM keeps in her car trunk in the swab test?

          • Tim
            March 24, 2014 at 2:42 pm #

            And of course, we’ll have to see which is dirtier – a tub kept in the rusted out trunk of a car subjected to northern winters and road salt, or one in a very intact trunk but that bakes at 200 degrees in the hot southern sun all day.

          • MJA87
            March 24, 2014 at 2:49 pm #

            Yikes, I don’t think we should go there. I’m only talking about the large, jacuzzi type tubs they use in hospitals and birth centers.

          • The Bofa on the Sofa
            March 24, 2014 at 2:50 pm #

            Yikes, I don’t think we should go there. I’m only talking about the large, jacuzzi type tubs they use in hospitals and birth centers.

            But why? Why are you not applying similar standards to midwives doing water births?

          • MJA87
            March 24, 2014 at 3:24 pm #

            Midwives(CNM’s) do use hospital grade birthing tubs. It isn’t just wackadoodle homebirth CPM’s with kiddie pools.

          • Bombshellrisa
            March 24, 2014 at 8:17 pm #

            If a woman wants a water birth at home with a CNM, they still rent the tubs.

          • Trixie
            March 24, 2014 at 2:39 pm #

            The relevant test would be to swab the mother’s own feces, not the tub.

          • Elizabeth A
            March 24, 2014 at 3:01 pm #

            If you want to lay claim to expertise, the basis of that claim is absolutely relevant.

            You work in a clinic. Awesomesauce, you have a job. There are two ways to be taken seriously here: Front your credentials openly, or hang around for a few weeks or months and let us judge you on your contributions to the discussion.

          • MJA87
            March 24, 2014 at 3:14 pm #

            My credentials don’t contribute to any expertise in child birth… They are totally irrelevant. My only point was that my coworkers and actually all of my closest friends are health care providers & doctors, I feel very lucky to be surrounded by caring/compassionate individuals.

          • Elizabeth A
            March 24, 2014 at 3:55 pm #

            You’re the one who brought your credentials up, when you came in with “I work in health care”, which might have passed, had you not doubled down with “my services are billable.”

            My mom’s a doctor. You’d probably hate her. She’s matured into a gruff old tiger, which is how she provides compassionate care. You don’t have to be sweet or nice to be right. When the chips have been down in my own case, I’ve been really well-served by doctors like my mom, who value good medicine more then affability. As a patient, I want my doctor to trample all opposition to help me. I want someone who can fight my insurance company, hospital administrators, and the forces of laziness on my behalf. I want to have the advantage of a strong person’s independent judgment, unmitigated by attempts to be nice to people who might well be wrong.

            Those doctors can be quite abrasive people. They aren’t universally abrasive – act intelligently, and they’re darlings. There really isn’t a reason why they should suffer fools more gladly.

          • The Bofa on the Sofa
            March 24, 2014 at 6:55 pm #

            Another victim of Pablo’s First Law of Internet Discussion

            For pete’s sake, do you not realize that half of the people responding to you are ACTUAL health care providers and doctors (not just friends of) and the other half do have friends that are?

            “I have friends who are health care providers and doctors” is pretty run of the mill here.

          • Dr Kitty
            March 24, 2014 at 4:06 pm #

            Oh I know, they’d all have E. Coli, Staph and various Coliforms! Do I win?

        • Elizabeth A
          March 24, 2014 at 2:35 pm #

          Ooh, can I play? My services are billable too! I hold a dual masters degree, and I am professionally licensed. I’ve done considerable recent work in health care administration. That means I’m special, and can breadcrumb about how special I am while refusing to give details.

          So, you’re what – coding and billing? Acupuncture?

    • moto_librarian
      March 24, 2014 at 2:30 pm #

      Um, you do know that L&D units have separate ventilation systems from the rest of the hospital, right? And that community-acquired MRSA is becoming more common?

      And let me guess: is your cousin’s baby in daycare?

      • MJA87
        March 24, 2014 at 6:17 pm #

        Nope, cousin’s baby is being taken care of at home by a parent. Who knows what I’ve exposed my own baby to given where I work. It doesn’t really matter, it’s just a personal observation and not truly “proof” of anything.

      • SuperGDZ
        March 25, 2014 at 8:29 am #

        the cousin’s baby is whatever she needs it to be to back up her argument

    • auntbea
      March 24, 2014 at 3:30 pm #

      If poop were coming out of my shower head, I would be on to a plumber ASAP.

      • fiftyfifty1
        March 27, 2014 at 1:39 pm #

        Unless it was 100% pure breastfed baby poop, in which case you should charge an admission fee. Breastfed baby poop spa treatments cure everything that ails you.

    • Captain Obvious
      March 24, 2014 at 8:46 pm #

      Late to discussion, I have read downstream. I don’t poop in my bath water yet none of my kids would get into my bath water when I’m done. Would you use used bath water from an unknown person? I almost feel like I need to shower to rinse off the soapy residue after my own bath. That’s probably why I mostly shower. Most women DO pass some stool when they deliver. If mom has MRSA or C diff, one sure way of passing it to baby is with a water birth. I have never had a case of maternal or neonatal MRSA or C diff in 21 years of practice.

      • fiftyfifty1
        March 24, 2014 at 9:26 pm #

        Babies seem to do well with C. diff. It colonizes them but doesn’t tend to cause disease. Fun fact: up to 30% of perfectly healthy young babies are colonized with C.diff. By age 3 it is less than 3%.

      • Durango
        March 24, 2014 at 9:55 pm #

        In Japan, you do share the bathwater (for baths), but you wash & rinse outside of the tub.

        • Trixie
          March 24, 2014 at 10:01 pm #

          I was at a lake in Switzerland once where they made you shower before you could get in the lake.

      • MJA87
        March 27, 2014 at 10:29 am #

        Have you seen any infections ( of any type) in the post c-section surgical sites? It would seem like a given that the birth process isn’t sterile. If you were extremely immature and poorly spoken you could tell a mom with meconium in her amniotic fluid that her baby was floating in a toilet bowl.

        My problem is not ACOG’s new position on water birth. My problem is Dr. Amy’s sweeping generalizations. She is just as bad as the home birth midwives when she chooses to ignore the risks of medical interventions and only focus on the risks of homebirth ( she lumps in natural birth, CNM’s, water birth). Homebirth advocates ignore the risks of home birth and only focus on the risks of medical intervention. If Dr Amy would actually acknowledge the benefits of natural birth she wouldn’t come off as biased and willfully ignorant. It’s clear that’s she is intelligent but she seems to want to ignore certain evidence.

        • Ash
          March 27, 2014 at 10:44 am #

          This blog (and commenters) have nothing against women who deliver vaginally without an epidural or pain medications. No commenter has said “all women should get epidurals in the hospital”. Some have said they certainly prefer to deliver with medical pain relief (or not!) but no one is forcing a choice on women. Has this blog posted about how to improve maternal and neonatal outcomes? YES. Look at the post about reducing maternal mortality, or enforcement of the “39 week rule” causing an increase in neonatal mortality. Dr Amy has not said all CNMs are wrong and in fact, homebirth midwives should be required to be CNMs. There is a problem, however, with the The American College of Nurse Midwives aligning themselves with organizations such as MANA and NARM when these organizations do not follow professional standards.

          Professional organizations should dedicate themselves to improving the lives of their patients. They publish clinical practice guidelines based on best evidence. USA direct entry midwives have not published any clinical practice guidelines to reduce morbidity and mortality (5 out of 222 breech deaths in the MANA survey is AWFUL)

        • The Bofa on the Sofa
          March 27, 2014 at 10:52 am #

          She is just as bad as the home birth midwives when she chooses to ignore the risks of medical interventions

          Has she? You better update us, which risks of medical interventions do you think she ignores?

          If Dr Amy would actually acknowledge the benefits of natural birth

          Which benefits of “natural birth” do you think she is not acknowledging?

          • MJA87
            March 27, 2014 at 11:19 am #

            Please, point me to any post where she mentions the risk of a medical intervention during child birth or a health benefit to mother or baby due to natural birth. When I say “natural birth” I mean vaginal birth without medication in any setting. I’ve read quite a few of her posts and often see natural birth and home birth used interchangeably which couldn’t be further from reality.

          • The Bofa on the Sofa
            March 27, 2014 at 11:32 am #

            Please, point me to any post where she mentions the risk of a medical intervention

            Where does she ever deny it? They come up here and then in the course of discussion here, and no one ever denies them.

            When I say “natural birth” I mean vaginal birth without medication in any setting. I’ve read quite a few of her posts and often see natural birth and home birth used interchangeably which couldn’t be further from reality.

            I don’t know what this has to do with anything. Where are those benefits that you say she refuses to acknowledge?

          • Guesteleh
            March 27, 2014 at 1:32 pm #

            A reader asks for help in answering the question “Why natural
            childbirth?” Understanding the simple story of normal, natural birth,
            what helps and what sabotages nature’s plan for birth, and the
            appropriate use of interventions are discussed and form the foundation
            for coming to the conclusion that nature’s plan makes sense. Women are
            inherently capable of giving birth, have a deep, intuitive instinct
            about birth, and, when supported and free to find comfort, are able to
            give birth without interventions and without suffering.

            Take a stroll through an old cemetery and see the number of graves with names for mothers and infants, and then get back to me on “nature’s plan” for birth. FFS.

          • The Bofa on the Sofa
            March 27, 2014 at 1:45 pm #


            Can you please show me the part about the benefits of natural birth in that document?

            Even if we buy this “nature’s plan” nonsense, explain why that is beneficial?

          • Bombshellrisa
            March 27, 2014 at 11:34 am #

            She knows the difference, she had a couple of those much lauded natural births herself

          • The Bofa on the Sofa
            March 27, 2014 at 11:38 am #

            And the reason I put “natural birth” in quotes was because it was MJA87s phrase – I wouldn’t use it myself (I don’t know what an “unnatural birth” is)

          • Irène Delse
            March 27, 2014 at 12:24 pm #

            Maybe a waterbirth? As Dr. Jen Gunther points out, waterbirth itself is an intervention:

          • Guesteleh
            March 27, 2014 at 12:41 pm #

            It was on her Homebirth Debate blog and not here, but here are two posts by Amy discussing CS risks:



            I read through the Homebirth Debate blog and her tone has gotten more strident over the years, probably because it increases her readership and also because she’s spitting mad over the babies being killed by nonsense.

          • MJA87
            March 27, 2014 at 1:52 pm #

            Thank you for answering the question. I have seen nothing like this as of late.

          • Young CC Prof
            March 27, 2014 at 12:44 pm #

            OK, it is none of anyone’s business whether a woman chooses pain relief in labor or not. (I think that all women should have access to it, and get the best possible information about the risks and benefits, but otherwise I do not care at all.)

            The parts of the NCB movement that people here primarily object to are the ones encouraging women to not only question, but resist and even outright refuse medically necessary interventions.

          • MJA87
            March 27, 2014 at 1:39 pm #

            And I 100% agree with you. But these posts by Dr. Amy tend to lump natural birth, home birth, non-vaccinators etc etc (woo) all together, and damages credibility in a big way.
            My closest friends who are young health professionals (FNP’s, DPT’s and DO’s) all strive for natural births because of the health benefits which are evident in research. They *might* actually give Dr Amy’s blog/opinions a chance if it didn’t come off as crazy biased. The DO friend is the only one who wants a homebirth…. I wish I could direct her to this website but I don’t think she would take it seriously.

          • The Bofa on the Sofa
            March 27, 2014 at 1:47 pm #

            all strive for natural births because of the health benefits which are evident in research.

            So now, instead of actually explaining those “benefits”, you resort to an appeal to authority?

          • MJA87
            March 27, 2014 at 1:57 pm #

            What authority? I’m trying to give some perspective about how all of this appears. Even to healthy educated women.
            Benefits of natural birth for Low Risk women:
            Quicker healing time
            Quicker labor
            More likely to breastfeed (but hey let’s not even mention those benefits)
            No interruption of the hormones responsible for labor and bodies natural pain response
            No *additional* risks inherent in taking medication

          • Amy Tuteur, MD
            March 27, 2014 at 1:59 pm #

            How quickly can a baby heal if its dead?

          • Amy Tuteur, MD
            March 27, 2014 at 2:01 pm #

            How quickly can a baby heal if it is dead? How quickly does a mother heal if her baby is injured or dead?

          • The Bofa on the Sofa
            March 27, 2014 at 2:04 pm #

            Quicker healing time

            Why does a natural birth have a quicker healing time compared to having an epidural?

            Quicker labor

            Does it really? I thought that the current best knowledge shows that epidurals don’t delay labour?

            More likely to breastfeed

            How does an epidural interfere with breastfeeding?

          • The Bofa on the Sofa
            March 27, 2014 at 2:07 pm #

            What authority?

            The authorities of FNP, DPT, and DO. As if that is supposed to impress us (you realize that probably half of the people responding to this are medical professionals in their own right, and pretty much the rest of us have friends that are, too)

          • Young CC Prof
            March 27, 2014 at 2:11 pm #

            Vaginal birth, if no major complications occur, has a shorter recovery time than c-section. Pain medication does not enter into it.

            Pain relief does not affect breastfeeding or “interrupt hormones.” Pitocin adds extra hormones, but it also almost completely prevents severe PPH, which used to be a major killer of mothers.

            The effect of epidural on labor duration is unclear, due to the obvious confounding factor that women having longer harder labors are more likely to ask for one. Best evidence seems to show that it makes the first stage a little shorter and the second stage a little longer.

          • The Bofa on the Sofa
            March 27, 2014 at 2:27 pm #

            This is why I have been pushing to get MJA87 to tell us about those supposed benefits of natural birth that Dr Amy won’t acknowledge. I suspected it was going to a bunch of crap.

            At best, the benefit is that the epidural MIGHT make the second state a little longer, you say, and I don’t see that Dr Amy would refuse to acknowledge that if it’s true.

          • Amy Tuteur, MD
            March 27, 2014 at 2:30 pm #

            How quickly does a woman heal from 20 hours of screaming in agony?

          • moto_librarian
            March 27, 2014 at 2:43 pm #

            So this is all you’ve got for “benefits” of natural birth? You really need to rephrase this to “benefits of natural birth for low risk women MAY include…” If you tear badly, you may not recover as quickly from a vaginal birth as you would from a c-section. In fact, I was up and around within a couple of hours of delivering with an epidural, but I was still in a wheelchair 24 hours after my “natural” birth. Also, statistically speaking, an epidural lengthens labor by approximately 20 minutes, so I’m not sure how big a benefit that really is. When you’re not in pain, 20 minutes isn’t much. I think that the “more likely to breastfeed” is probably based more on a commitment to “natural” parenting rather than any effect of medication. And by “natural pain response,” I assume you mean endorphins? Yeah, those didn’t do a damned thing for me during my natural birth.

          • Bombshellrisa
            March 27, 2014 at 2:45 pm #

            Unless you have a second degree tear or worse, in which case you get prescription pain meds to take. Not everyone who gives birth via C-section recovers slowly and takes pain meds, and plenty of women who had fast labors ended up tearing and recovering very slowly and needed the prescription pain meds.
            Do you have clients who come to you as a result of having gestational diabetes? I ask because I recently had gestational diabetes. I saw an ARNP who specialized in diabetes education. She gave absolutely no opinion about how she felt I should gave birth. I would hope you would be as professional as she was.

          • The Bofa on the Sofa
            March 27, 2014 at 2:51 pm #

            Not everyone who gives birth via C-section recovers slowly and takes pain meds,

            I think you are missing something: the benefits she is claiming is for “natural birth” which she defines as without medication. It is not just vaginal, but, for example, epidural and oxytocin free.

            So the claim that natural births have quicker healing time, it is not just that they are quicker than c-sections, but also in comparison to epidurals.

            That’s what she’s claiming.

          • Renee
            March 27, 2014 at 2:46 pm #

            This should say “Benefits IF everything goes perfectly”. Well, no shit, its always better when you can VB without tearing, and with little to non pain.

            People like YOU screw up BF- not us. Telling a mom BF depends on all these minute interactions is not just wrong, but harmful. She doesn’t need to feel like a failure from the start over shit that isn’t really relevant.

            You love anecdotes so much- my DD is an EBF toddler. I mean, she LOVEs the boob, never took a bottle. I didn’t see her for over a day, and could nurse for over a week, because she was in the NICU. SO GLAD no one told me I was missing the hormonal dance.

          • The Bofa on the Sofa
            March 27, 2014 at 2:54 pm #

            This should say “Benefits IF everything goes perfectly”.

            But I don’t even agree with that.

            How does a non-epidural birth heal more quickly than one where there was an epidural?

            Is there any indication that how quickly you heal from a VB depends on whether you had an epidural or not? All other stuff being equal, if you choose to have an epidural, does it make healing occur more slowly?

            The same deliveries, but one has an epidural one does not. Are the epidural deliveries more likely to tear or something?

          • Renee
            March 27, 2014 at 5:02 pm #

            I am sorry, it was a generalization.

            My point was that the best case scenario is obviously going to be better than any variation thereof, (for most Moms, I am generalizing). I define “best case” where the mom has little to no pain (so no need for pain relief), and baby comes out easily, without tearing, and without any damage or PPH.
            I think all NCBers think this is what they will get, if they just do what they are “supposed to”.

            I had a birth like this- I slept through the entire, short, labor, and in 13min, with 4 painless pushes, DD was born. It might as well have been teleportation, it was like nothing happened. Literally. Zero recovery.
            I cannot imagine there could be any improvement on this.

            You are right that an epidural makes no difference in healing. But no epidural does mean one less poke (or 2 in my case), even if it means zip for healing, etc. I am a huge epi fan, but not needing one was still awesome.

          • Renee
            March 27, 2014 at 3:22 pm #

            Actually, there ARE downsides to NCB, and they are serious.

            One is that Unmedicated birth more often leads to PTSD than in those that got pain relief. You may have avoided the small risks of pain relief during the birth, but then given yourself YEARS of pain and mental health problems, that may require even more meds than the delivery would have! PTSD is no joke, and its been proven to be linked to pain, unrelieved, servere, pain.

            This severe pain can also bring on the start of pain disorders, like fibro. More than one mom I know credits her NCB with kicking off her fibro, and their docs agree. Though no one knows why this is for sure. Who knows if these moms would have gotten fibro (etc) sooner or later, but even one additional day with fibro, is one too many. NCB pain can also aggreivate other existing pain issues, and add to and intensify mental health issues.

            NCB also leads to uncontrolled pushing, which can, and does, lead to bad tears. Try telling a mom w no pain relief to slow down, or stop pushing, even for a minute, so you can stretch or support her perinium. No can do, baby will come out full speed ahead. The Mom with an epidural? She isn’t going to shoot a baby out like a cannon because she can slow down, and control her pushing and work with her OB/CNM to get baby out gently, if possible. This isn’t paternalistic, its smart management.

            Just going unmedicated (aka no pain relief) can hurt moms, but many NCBers *do* deny/avoid all interventions, even when it ends badly for them. You cannot call NCB “no pain meds” when it really refers to an entire way of thinking about birth (avoiding the “unnatural”, including technology, and trusting birth, is central).

            NCB, when followed in this common way, also leads to lots of little issues. One is increase in PPH, and increased severity of PPH, because moms refuse the pitocin and active management of the 3rd stage. NCB moms also wind up with more CS, because they refuse the interventions that would have allowed a VB (like augmentation), or pain relief that would have allowed rest (they do get too tired to push, and get CS in the end). This is just observation from real life. There are more, but these stand out to me because of how often it happens.

            NCB is like a self fulfilling prophecy, and its so obvious that nurses even say “the longer the birth plan, the more likely a CS”.

            As for BF-
            You cannot separate out confounding factors as far as BF goes- moms that NCB will be more likely to BF simply because of their philosophy. Also, more moms that are in the socioeconomic class that most often BF (white, educated, middle class moms) try for NCBs, than in other social groups.

            BF has ZERO to do with the mechanism of VB itself. If it did, no CS moms would be able to BF, and moms with pain meds couldn’t either, which is obviously untrue.

            But, an NCBer that has had a PPH because of refusal to use piton in 3rd stage, MAY have issues BF because blood loss hurts supply.

            You know who BFs? Those that are the most determined to do it, those that have it the easiest, and those with the best life situations for supporting BF (i.e.: not going back to work at 3 weeks PP).

          • Amy Tuteur, MD
            March 27, 2014 at 1:55 pm #

            They are all woo.

            Why would you take the medical advice of FNPs, DPTs and DOs over the people who know the most about childbirth, neonatal physiology and medicine, obstetricians and neonatologists?

            You don’t notice many obstetricians choosing natural childbirth for themselves; that’s because they know it’s a bunch of baloney made up by an industry of “birth workers” who would be out of business if they couldn’t sell woo services and woo products.

          • MJA87
            March 27, 2014 at 2:00 pm #

            Since when are D.O.’s not OB’s?
            My OB didn’t choose natural birth because he was a man. But he was still happily telling me how labor feels… He was wrong.

          • Renee
            March 27, 2014 at 2:43 pm #

            D.O’s may or may not be OB’s. They are like MD’s, and would require a specialty in OB to be an OB.

          • Amy Tuteur, MD
            March 27, 2014 at 1:58 pm #

            There are NO health benefits to natural childbirth. It is not better, healthier or safer in any way than childbirth without interventions. In fact, it is probably less safe since by refusing interventions, women are in reality refusing early diagnosis of and quick reaction to childbirth emergencies.

          • MJA87
            March 27, 2014 at 2:01 pm #

            I’m NOT talking about refusing medical interventions at all costs. You ASSUME and generalize.

          • Renee
            March 27, 2014 at 2:42 pm #

            If she is not talking about YOU, don’t take it so personally.
            And no, your friends won’t listed to her, but she would lose readers if she changed.

        • Renee
          March 27, 2014 at 2:41 pm #

          This is why she doesn’t list them.

    • Renee
      March 27, 2014 at 2:40 pm #

      What an ignorant fool! I hope never to run into someone like you in a hospital or doctors office.
      Ancedotes mean NOTHING, and your ideas are rubbish.
      MRSA is MORE OFTEN found in the COMMUNITY. You are more likely to catch it at home than in a maternity ward. If you are really in healthcare I am sure you know the difference, right? C Dif is ALL OVER. Again, you aren’t getting this anymore at a birth suite than at home.
      ALthough, I would take the odds of infection, even if they were accurate, than to risk DEATH and brain damage at home. Priorities I guess,
      What do you make of this:
      My CS, EFF baby has had perfect health for YEARS.
      His VBAC, EBF, sister, that is just a bit younger? She just got out of the hospital- we all had the same illness, but she as the only one so sick she needed hospital care.
      I know why!!! Its because she is still nursing past 2yrs, that is why she got sicker than anyone else… That is about as true as YOUR assertion, btw.

      • The Bofa on the Sofa
        March 27, 2014 at 2:46 pm #

        Is there any way to figure out how many babies and mothers die of MRSA in the US?

        There was a maternal mortality post a couple of days ago that included infections, I know. That would put an upper level on maternal deaths by MRSA.

        • Young CC Prof
          March 27, 2014 at 2:57 pm #

          That post suggests roughly 60 deaths per year from all infections. I don’t actually have any idea what organisms they might have been, or whether that includes things like flu/pneumonia acquired during pregnancy from the community.

          (H1N1 killed 50 pregnant women in the USA during the 2009 epidemic, for example.)

  3. Manabanana
    March 23, 2014 at 2:52 pm #

    A quote from waterbirth “expert” Barbara Harper:

    “One more factor that people do not consider, but is vital to the whole waterbirth and aspiration issue, is the fact that water is a hypotonic solution and lung fluids present in the fetus are hypertonic. So, even if water were to travel past the larynx, they could not pass into the lungs based on the fact that hypertonic solutions are denser and prevent hypotonic solutions from or coming into her presence.”

    -Midwifery Today Issue 54, Summer 2000

    • Young CC Prof
      March 23, 2014 at 5:18 pm #

      Don’t these people cook? If you’ve ever mixed a sauce you realize that’s nonsense.

      • Trixie
        March 23, 2014 at 9:35 pm #

        Barbara is hoping people don’t know what “hypertonic” and “hypotonic” mean. Sounds fancy.

        • Box of Salt
          March 23, 2014 at 10:19 pm #

          Hypertonic means there’s not enough gin in your cocktail.

          Hypotonic means the bartender gave you a double.


          I recall watching a Deep Sea Detectives episode about cave diving in Mexico on the History Channel years ago, with absolutely awesome shots of the division between salt and fresh water within the cave. I poked around for some links to good pictures of this but no luck. In any case, I don’t think that’s what’s going on inside a baby’s lungs.

          And anyway aren’t all the fluids supposed to get squeezed out during the passage through the birth canal, which is one of reasons c-sections are bad?

          • Young CC Prof
            March 23, 2014 at 10:33 pm #

            That is an awesome mnemonic. It has improved my life.

      • anion
        March 27, 2014 at 7:13 am #

        Or wet- brined a piece of meat.

    • fiftyfifty1
      March 24, 2014 at 8:02 pm #

      “So, even if water were to travel past the larynx, they could not pass into the lungs based on the fact that hypertonic solutions are denser and prevent hypotonic solutions from or coming into her presence.””

      What a joke. When you have a hypotonic solution separated from a hypertonic solution by a semi-permeable membrane (such as a cell membrane) you get some serious osmosis. The water rushes from the hypotonic solution and invades the relatively hypertonic cells until, typically, the cells pop. Lord, this is 7th grade biology. Pathetic lack of basic biology knowledge.

  4. Ennis Demeter
    March 23, 2014 at 11:19 am #

    There is a lot of woo going on in the Facebook comments of an NPR story on ACOG and waterbirth. Very few voices of reason. https://www.facebook.com/NPR

    • Amy Tuteur, MD
      March 23, 2014 at 12:00 pm #

      I’ve also been commenting on the original NPR article.

  5. Captain Obvious
    March 23, 2014 at 10:53 am #

    Sorry if this was already posted.

    • Trixie
      March 23, 2014 at 1:13 pm #

      Someone needs to ask TFB if she can get an exact number on the amount of blood in that pool. Because, you know, her training in water birth lets her know exactly how many ccs it takes to turn a pool that exact shade of red.

      • Amy Tuteur, MD
        March 23, 2014 at 1:30 pm #

        It’s easy to get an exact number if you are just making it up.

        • Trixie
          March 23, 2014 at 2:01 pm #

          Really begs the question of how accurate those MANA blood loss stats are.

        • Trixie
          March 23, 2014 at 9:36 pm #

          And she’s back in the comments over there! I knew she was still scanning the comments for her own name.

    • LadyLuck777
      March 23, 2014 at 2:02 pm #

      Um…please tell me that is photoshopped. That is disgusting.

      • Captain Obvious
        March 23, 2014 at 2:43 pm #

        By looking at the blonde headed boy, it is not photoshopped.

      • Zornorph
        March 24, 2014 at 12:47 pm #

        No, that wasn’t photoshoped. It was a family who lived in a nudist colony, in fact. The baby boy (who is now grown up) posted a rather peeved reply when this started getting mocked on the internet.

    • Jocelyn
      March 23, 2014 at 8:06 pm #


      • Jocelyn
        March 23, 2014 at 8:07 pm #

        I think I’m going to try to go bleach my brain.

    • Jessica S.
      March 23, 2014 at 9:33 pm #

      My. God. I don’t know what else to say.

    • Coraline
      March 24, 2014 at 2:51 am #

      I seriously just almost vomited. That is so utterly disgusting, it’s beyond words.

    • March 24, 2014 at 6:56 pm #

      you guys that cola birth not water birth

    • Florence
      March 24, 2014 at 7:49 pm #

      And Gina has yet to enlighten us on how her midwife evaluate blood loss in a birth pool…

  6. Meredith Watson
    March 22, 2014 at 3:26 pm #

    I was told by a CNM that there are other problems with waterbirth too, including the impossibility of managing shoulder dystocia but perhaps that was specific to the hospital I was in and their labor tubs.

  7. Coraline
    March 22, 2014 at 8:39 am #

    Thank you for this. Even as a girl (which is when waterbirths seemed to have become popular), I have always been perplexed by this practice. Why would any human want to give birth in water? It’s NOT natural; it’s counter-intuitive. Seriously … why do NCB and homebirthers claim that it’s natural? I’d really love to hear their explanation. Is it because the water offers “natural” pain relief during labor, and so it’s “natural” for a woman to not want to leave the pool to give birth, and therefore waterbirths must be ok? It’s still ridiculous, of course, but I honestly can’t think of any other reason why they could claim that a waterbirth is a “natural” thing. Someone please enlighten me!

    • LMS1953
      March 22, 2014 at 10:14 am #


      I think it all stems back to the Aquatic Ape Hypothesis – a rather romantic notion of hominid seaside evolution.

    • CognitiveDissonaceHurts
      March 22, 2014 at 11:44 am #

      When I was still childbearing, I remember reading about the Russians doing waterbirths, and thought that is where the idea started.

    • Rochester mama
      March 22, 2014 at 3:24 pm #

      As a pregnant woman I LOVED being neck deep in water. It was the only time my feet and legs didn’t hurt. I labored in water and it was awesome. The only thing that hurt were the contractions. When I had to get out of the tub to deliver everything got heavy and hurt-arms, legs back, I couldn’t change position easily, along with the contractions. Woo aside, it’s not much of a jump to say, “hey if I don’t want an epidural a pool or deep tub would be a great way to get through labor”.

    • Melissa
      March 23, 2014 at 10:48 pm #

      Along with the fact that laboring in water might offer comfort (although not as much as actual pain relief like an epi), I think there’s something about the symbolism of water representing cleansing and new beginnings that makes waterbirth resonate so much with people. If you were to replace the water in the tub with anything else it doesn’t have the same poetry to it, and I think people would be less interested. But it’s the fact that water is so symbolic in culture that it seems to have stuck so much. (My theory anyway)

  8. LMS1953
    March 22, 2014 at 8:31 am #

    A few observations:
    I have had babies cry after the head delivered but before the shoulders. I recall one case where I was doing vigorous perineal stretching and mom and I could hear baby cry BEFORE the head even delivered. That was very strange. The problem was, I had no idea how long before the baby’s respirations would shunt the fetal circulation pattern. So I put on forceps and delivered a baby with 9/10 Apgars. The point is, it would be deleterious to have a baby cry on the perineum underwater.

    I have noticed that when babies deliver vaginally, the “squeeze” they undergo as the thorax comes through the introitus like an old washer ringer. Fluid bubbles out of baby’s nose and mouth. It would seem to be a sponge effect. When you release a squeezed sponge underwater, it sucks the water back into its pores. (Aspiration mechanism even if the “diving reflex” were true.

    I have noticed that not infrequently the cord is too short to place the baby directly on mom’s abdomen before clamping and cutting it (as some mom’s request). The height of the water in the picture of the industrial strength hospital birthing tub seems to be deep enough to prevent the baby from coming to the surface without breaking the anchor chain (cord avulsion).

    I also noticed that, as usual, there is a list of disqualifiers. By what calculus are these conditions selected whereby the risk exceeds the benefit above and beyond a “normal pregnancy”? As if there is any scientific evidence based medicine to demonstrate what might be a disqualifier, a benefit, or a risk. Again, I counterpose this attitude of cavilier acceptance of the woo of water birth in the hospital setting with the zero tolerance of an “elective” delivery by either repeat C-section or induction in the 38th week as predicated by the well-reason judgment of a Board Certified expert rendering the most appropriate individualized care.

    • LMS1953
      March 22, 2014 at 3:05 pm #

      This is the insidious nature of CNMs. They get an RN and then go screw around at some woo infested birthing center where they become anointed as CNMs and have everyone bow down to them as “experts” for their “clients”. Then they foster water birth so they can show off how avant garde/intelligent/client empowering they are. To add to their “credibility”, they promulgate a list a disqualifiers to make water birth seem “evidence based”. CPMs feel they are every bit as much midwives as CNMs – it says it right there in the initials after their names. Only, CPMs feel they are much better because they “trust birth” so much more than CNMs and know that the list of disqualifiers are merely variations of normal. Hence they recruit some of the highest risk “clients” to prey upon for a cleansing/healing/empowering HB waterbirth. Now, CNMs are just as woo infested as CPMs and most of them do not have the integrity to fight the good fight to exterminate the CPM licensure. To do so, they would have to admit the risk of WB for the “high risk” disqualifiers they have pulled out of their butts – which would invite the inquiry, if WB is too risky for these diagnoses, why is it not too risky for everybody? In contrast, an epidural has proven BENEFIT for non-severe pre-eclampsia/PIH. And CNMs are some of the most annoying hypocrites when they encapsulate placentas and moxibust breeches and do acupressure and all the other non-sense woo and then with the utmost indignation demand “evidence based medicine” for nearly every medical/surgical intervention an obstetrician might make based on her/his superior training, experience and expertise.

      • Mer
        March 22, 2014 at 7:05 pm #

        From what ive seen, you’re right that CNMs are pretty invested in the woo. The one that taught my hypnobirthing class (dead giveaway that she was in the woo to begin with) told us that our hospital did not allow water delivery, but that some people got around that by not telling anyone that they were ready to push until it was too late to get the woman out of the tub. I thought that was so unethical, unfortunately I didn’t say anything at the time and now keep wishing I would’ve. There are dozens of midwives at this hospital and probably at least half that are really into the woo, minimal US, hypnobirthing, natural birth, at least one of them even recommended books by henci goer and Ina may to me, all that garbage. Luckily the population they serve isn’t too susceptible to the woo and it’s all hospital based with plenty of OBs around.

      • Manabanana
        March 23, 2014 at 9:19 am #

        I’m afraid you are describing a small percentage of CNMs and stereotyping of an entire profession. I work in a large hospItal based practice – with CNMs and OBs. Your description is true of none of the CNMs with whom I work. No moxibustion, no placental encapsulation, no homeopathic remedies. Sorry. Not saying the nuts aren’t out there -(and some appear to be at the helm of the ACNM at the moment) but you are wrong to attribute these traits to the entire CNM profession.

        I’ve only witnessed competent, appropriate, science based practice among the midwives – and they are well-respected by their physician peers.

  9. T.
    March 22, 2014 at 7:30 am #

    OT: I don’t know if somebody already posted this, but a turtle had to have a CS for an obstructed labor. Yes, a turtle:

    Mother and eggs are reportedly fine.

    • An Actual Attorney
      March 22, 2014 at 11:01 am #

      I love this image! “The hardest part of the operation was anaesthetizing the turtle as she played hide and seek, retracting into her shell while on he OR table.”

      • Jessica S.
        March 22, 2014 at 12:46 pm #

        Oh my, that is hysterical!

    • Young CC Prof
      March 22, 2014 at 11:15 am #

      That’s awesome. This site has, for so many reasons, made me appreciate just how weird, wonderful and awful the world of veternary medicine is.

      • AmyP
        March 24, 2014 at 8:21 pm #

        Yeah–I had no idea how problematic dog birthing (whelping?) was.

  10. Irène Delse
    March 22, 2014 at 3:02 am #

    OT, but this would probably interest Dr. Amy: “NJ Judge Affirms That Women Take Precedence In Pre-Birth Decisions Because They ‘Bear The Child’”:
    (In a case where a father sued to force his ex-girlfriend to give him access to her hospital room during birth.)

  11. RetroPastiche
    March 22, 2014 at 1:18 am #

    But it’s mummy poop! Isn’t that the same as mummy milk?

    • Irène Delse
      March 22, 2014 at 3:05 am #

      Don’t joke, I bet the “microbirth” people would jump on this wonderful occasion for the baby to acquire mommy’s magical gut flora…

      • NoLongerCrunching
        March 22, 2014 at 6:04 am #

        Except it’s going into the lungs and not the gut…but oh well, who cares about actual anatomy?

        • anion
          March 22, 2014 at 8:28 pm #

          Eh, lungs, gut, what’s the difference?

    • LMS1953
      March 22, 2014 at 8:47 am #

      Studies have shown that mummy poop that is at least 50% kale residue is completely harmless to the baby. Indeed, there is enough benefit that it should be desiccated, encapsulated and consumed along with the placenta.

  12. areawomanpdx
    March 22, 2014 at 12:41 am #

    What’s interesting to me is that the same people who refuse an epidural for pain relief because of a bunch of moaning on blogs about how dangerous it is readily embrace water birth for pain relief in spite of the AAP and ACOG declaring the danger.

    • LMS1953
      March 22, 2014 at 10:19 am #

      No contradiction at all. The crunchies consider ACOG and AAP to be a part of a vast conspiracy of the penocracy to disempower women and separate them from their money.

  13. Spiderpigmom
    March 21, 2014 at 11:41 pm #

    “If you wouldn’t for a moment contemplate immersing your head in a pool of water with feces floating in it, why do you think it is a good idea to force your baby to do so?”: makes perfect sense to me. But on another hand, I wouldn’t immerse my head in amniotic fluid either, and I would definitely not shove it through someone’s vagina or open wound, so I may not be an expert on what’s suitable for neonates 😀

  14. Zornorph
    March 21, 2014 at 10:35 pm #

    That’s why you should give birth out in the rain forest in a gently flowing stream to wash all of mom’s diarrhea away.

    • Trixie
      March 22, 2014 at 9:05 am #

      Except for all the people who shat into the river upstream…

  15. anion
    March 21, 2014 at 10:28 pm #

    OT: I found this Facebook page today, and thought it might interest some of you, too. https://www.facebook.com/unheededwarnings

    Lots of posts about willful ignorance there, with a special focus on NCB (they share a lot of Dr. Amy’s posts) and on pit nutters–my two favorite “activist” subjects. It’s a pretty new page.

    (Please do delete this if it’s inappropriate to post links to other sites without direct discussion; I just honestly figured some of you might like the page. Um, as in “enjoy,” not, “Go click ‘Like!” I’m not affiliated with the page, and do not know who is.)

    • Karen in SC
      March 22, 2014 at 8:58 am #

      I thought pit meant pitocin. Note to others – it means pit bulls and it seems to be about dog attacks with at least one disturbing picture.

      I have no idea why they would share ANY of Dr. Amy’s posts.

      • Amy Tuteur, MD
        March 22, 2014 at 9:37 am #

        It’s probably Shame on Better Birth.

      • anion
        March 22, 2014 at 8:41 pm #

        Goodness, I’m sorry! I made the classic “I know what it means, so it’s common knowledge” error, and didn’t clarify. And I should have mentioned the potential for disturbing images. I really am sorry for not doing so, and hope you weren’t upset.

        • Certified Hamster Midwife
          March 23, 2014 at 6:52 pm #

          What makes someone a pit nutter? Curious where the line is. I don’t believe they should all be killed: does that make me one?

          I know and like lots of pit bulls, and even let my little dog play with some. But I go apoplectic when I hear about dogs who have killed cats, dogs, or bitten people and even multiple children being underground railroaded out of the state so they don’t get destroyed.

          • anion
            March 24, 2014 at 8:22 am #

            The people underground railroading them out of the state, or the people setting up “Save the killer doggie” FB pages while insisting the victims must have done something to deserve it, or assaulting and harassing victims, or insisting that the offending dog was some other kind of dog because no way would a pit bull ever attack someone, or repeating myths like the “nanny dog” nonsense, are the nutters.

            Most people who don’t like pit bulls support legislation that would force them to be spayed/neutered (because of the millions of them put to sleep in shelters or abused every year), and which would make the owners responsible for damages if their dog attacks a person or animal. I’ve only ever seen one person, in a comment on a new story, say that all pits should be put to sleep automatically. I support legislation because I like dogs and the number of pit bulls (and other dogs, and people) who suffer the way things are now is ridiculous. I won’t allow my kids to visit a home where a pit is present, at all, point blank. But I don’t support some sort of genocide.

      • LadyLuck777
        March 23, 2014 at 2:12 pm #

        LOL! I thought it meant pitocin also.

    • anon
      March 22, 2014 at 11:51 am #

      read the description. the page highlights deaths that were prevrntable, but happened because of ignorance, often willfull. This means attacks by the #1 canine killer of children, pit bull etc. dogs as well as home birth, drunk driving, not using seat belts, od,

      both pit bull and HB play from the same book. both harass victims, lie, use psuedoscince, etc. the only difference is in degree- pit bull advocates will send death threats and call your work tryi.g to get.you.fired, while.HB ers will harass the parents emotionally, and try to paint them as liars. both collect money and hire lawyers for the killers while victims face huge medical costs.and other.burdens unhelped.

      it is NOT Shame On. please dont post that because pit bull advocates are very violent,. and will harass, even harm, anyone that comes out against them. The page isanon for a reason, please respect that.

      • anion
        March 22, 2014 at 8:38 pm #

        It amazes me how familiar the nutter tactics are to those of the NCBers.

        And yes, it’s because of the focus on preventable deaths & injuries–with a number of causes, but all down to willful ignorance, basically–that I thought the page would be of interest here. They seem to me to have a special focus on NCB & pits, though; they shared the Gavin Michael information and the MANA stats stuff.

        I’m not sure where Shame On or I speculated on the people running the page or named names? I did say I have no idea who runs it, and am not affiliated with them. Which is true. I just followed a link and thought it was a worthwhile page. (Or have I misunderstood you?)

    • March 22, 2014 at 2:34 pm #

      omg you follow pit nutters too? Ugh its infuriating bc of the stupid campaign to save micky the mauler in arizona right now. The kid who lost vision in his right eye and has permanent facial scarring has way fewer likes and supports for his page on facebook. Its ‘for the love of kevin” if anyone is interested. He has an amazon wish list and fundraising to help pay the hospital bills.

      • anion
        March 22, 2014 at 8:31 pm #

        I do! 🙂 It’s insane and terrifying, isn’t it? And yeah, the “Save Mickey” thing is infuriating. A little boy was attacked and disfigured, and you’re worried about the dog that mauled him? And the dog is more important? Sheesh.

  16. theadequatemother
    March 21, 2014 at 10:19 pm #

    I was thrilled to see the anecdotal information that water immersion results in contraction spacing and more pitocin. I’d like to see a trial randomizing women to epidural or water immersion at first request for analesia. Let’s see which technique provides more effective pain relief, if there is any difference in pitocin use or intrapartum fever etc etc.

    epidurals offer amazing pain relief (> 95% of women can be made comfortable) and if anything happens in labour you have analgesia in place to manage pain during emergency procedures (like episiotomies, vacuum and forcep deliveries) and can be well on your way to surgical anesthesia while rolling thru the OR door….whereas being in water just delays definitive management.

    • araikwao
      March 22, 2014 at 6:19 am #

      Doing some homework and keep getting distracted by interesting articles, like this one (which I haven’t read yet due to pressing need to do said homework) on how timing of amniotomy, epidural and augmentation may be important in avoiding instrumental deliveries and CS. Thought you’d be interested, TAM, and Captain Obvious and LMS et al..


  17. stenvenywrites
    March 21, 2014 at 10:14 pm #

    Many of them probably would do just that. They spend a fair amount of time with their heads up their own backsides, after all, and a pool full of someone else’s feces is just a variation.

  18. toni
    March 21, 2014 at 9:41 pm #

    Continuing the discussion I was having with LMS here… if all the mothers wanting water births had enemas first (I mean well in advance) and they filled the tubs with pedialyte/dioralyte/something similar to amniotic fluid.. would that make it safe?

    • araikwao
      March 21, 2014 at 10:15 pm #

      It probably wouldn’t be desirable any more, after all, an enema is an intervention and Pedialyte isn’t natural!

      • Anj Fabian
        March 21, 2014 at 10:20 pm #

        A jello birth?

        • Zornorph
          March 21, 2014 at 10:36 pm #

          Well, I’m a fan of jello wrestling, so I could get behind that.

      • Trixie
        March 22, 2014 at 9:06 am #

        I’m telling you, LMS is on to something with his Pedialyte birth….

        • Young CC Prof
          March 22, 2014 at 10:52 am #

          Don’t people like to take a bath with bath salts? Here, have some sodium chloride and potassium chloride in your bath.

    • NoLongerCrunching
      March 21, 2014 at 10:46 pm #

      I doubt it; the baby is not supposed to take anything but air into his lungs after birth; even if you had a fluid identical to amniotic fluid, it would still carry bacteria from the mother’s skin into the baby’s lungs.

      • toni
        March 21, 2014 at 11:11 pm #

        But it would decrease the risk some? When Dr Amy talks about waterbirth she mostly mentions faecal contamination as the big danger but if the mother is all cleared out beforehand, and the water is ‘isotonic’ (just learnt that word today) and she’s GBS negative etc the risk would be much lower, right? I mean I think giving birth in pedialyte would be daft like any water birth I’m just wondering

        • Young CC Prof
          March 21, 2014 at 11:28 pm #

          That would prevent hyponatremia, and somewhat reduce the risk of infection (although the baby is still at risk of aspirating ordinary skin and surface bacteria deep into the lungs) but no matter how clean the pool is, you’ve still got the risk of sudden complications like shoulder dystocia or nuchal cord, which are much harder to resolve when the mother is under freaking water.

          So, safer, not totally safe. I’m still in favor of getting out of the pool when fully dilated.

    • March 21, 2014 at 10:59 pm #

      Could the infection risk could be mitigated with better filtration?
      Maybe a high volume pump into a diatomaceous earth filter and an ozonator.

  19. Lombardi
    March 21, 2014 at 9:00 pm #

    Goodness, the pic on http://commonhealth.wbur.org Talk about birth as “performance art”! Lol who brings flower garlands to L&D?

    • CognitiveDissonaceHurts
      March 22, 2014 at 11:22 am #

      It was obviously planned ahead of time. I have to admit that posing for gorgeous photos after giving birth never entered my mind, but times sure have changed since then.

      • Haelmoon
        March 22, 2014 at 11:44 am #

        The flowers are to distract from the colour of the water. It is either meconium or poop, either way, I wouldn’t want to be sitting in it.

        • CognitiveDissonaceHurts
          March 22, 2014 at 11:47 am #

          That reminds me that back in my day, the midwives would always give us a soothing herbal bath after our land deliveries. The water turned the most disgusting shade of greenish brown, and I always felt a little grossed out by bathing in it with my newborn.

  20. Deena Chamlee
    March 21, 2014 at 8:21 pm #

    Thanks for the blog Amy. I trust you all so no need for literature review. After what I have been through, I question the validity and reliability of anything published by Ms. Harper or others. The profit sharing might be quite nice for all upper eschilon involved and Ms. Harper.

    Nothing is the same anymore after my experiences. One cannot trust blindly, motives, motives, motives. I say present to WHO and stop the practice. If you need CNM support I am there.

    Mothers can still practice water immersion, but delivery should be recommended on land. “Surf and Turf.”

  21. March 21, 2014 at 7:31 pm #

    I am betting that a warm blanket would provide the same pain relief benefits as water without any of the added danger.

    • Rochester mama
      March 21, 2014 at 9:14 pm #

      My experience laboring in water was that the pain relief came from being weightless in the water not the warmth. I am small enough and the tub in the deceiver room was big enough I could squat and get on all fours against the stairs etc… Moving around and relaxing in the water between contractions was awesome. I delivered “on land” and had a wireless underwater monitor.

      • toni
        March 21, 2014 at 9:33 pm #

        I only had a shower available (they put a chair in it for me) and it helped a lot so I think the heat is a big part of the pain relief. but think I read here afterwards that getting too hot in labour is not wise (I cranked the heat up all the way!) sitting in luke warm water would be unpleasant

        • Rochester mama
          March 21, 2014 at 9:42 pm #

          No different than hanging out in a pool, which I did A LOT of since I was due in late summer and it felt awesome.

          • anion
            March 21, 2014 at 10:16 pm #

            Ha, me too, with my first! I actually hate water and swimming in general, but she was an August baby, and we were having a drought in Miami that year. Our subdivision had a pool. I was there every single day–I haven’t spent that much time in the water since I was a kid–because the weightlessness was so incredible. It was the only time that I was able to fully bend my knees without pain.

    • Medwife
      March 22, 2014 at 1:22 am #

      Purely through my experience as a laboring woman, I say, no way. I’m not a bath person ordinarily and my doula talked me into trying out soaking in my tub. Laboring in water was a huge relief. I spontaneously brought myself out of it once I entered transition. But during active labor, floating in a tub, mostly at home, was a significant comfort measure.

      As a CNM, I more commonly see labors slow down when women get into the tub. Sometimes it helps, sometimes it doesn’t- it slows labor down.

      • CognitiveDissonaceHurts
        March 22, 2014 at 11:17 am #

        I am curious as to the physiological reasons for a tub slowing down labour. Could you explain?

        • March 22, 2014 at 11:36 am #

          I have to disagree with Medwife here. My experience with either a warm tub bath or jacuzzi has been different. IMO, the main benefit seems to be for women in EARLY or prodromal labor, and while I don’t know if there is any definite proof that a cervix opens more easily if a woman is relaxed*, I’ve frequently seen a woman who’s been 2-3 cm dilated for hours and hours become 5-6 cm after a short time in the water. By transition, however, a bath doesn’t seem to give much relief.

          *Same effect seems to happen frequently once an epidural takes effect.

    • OBPI Mama
      March 22, 2014 at 7:11 am #

      My experience: I liked being able to move around in the water, myself. I did not sit still for longer than 3 minutes with my labor and was stark naked the whole time (did not want anything touching me)… I would have freaked at a blanket. I was a little too tall for the birthing tub to get it’s full effect, but it did help more than nothing… I definitely see why women want to labor in a tub!

      • CognitiveDissonaceHurts
        March 22, 2014 at 11:19 am #

        I am a very modest person normally, but in labour, it all comes off, too. (Resulting in not being able to show too many photos from the labour and delivery without cropping, lol…)

        • Elaine
          March 22, 2014 at 12:12 pm #

          I can relate! There are no shareable pics of my son and me in the L&D suite, because the hospital gown was a casualty of my water breaking about 10 minutes before he came out, and I didn’t make it back into a gown for some time after. I was wearing a nursing bra and socks when he was born. Then we ditched the socks too because they were pretty disgusting.

          I mean, you can’t see any boob in the nursing bra shots, but it’s pretty obviously a bra.

      • FormerPhysicist
        March 22, 2014 at 12:25 pm #

        My first labor (back labor) the hot shower helped some. Or maybe it just helped me think I was doing SOMETHING to relieve the pain. It was still excruciating. Just, I could manage to moan instead of scream.
        But the epidural took the pain away completely. Much much better. Water is minimally better than nothing. I live in the first world, I want better than “better than nothing”.

  22. attitude devant
    March 21, 2014 at 7:27 pm #

    For the life of me, I have never figured out why hospitals have allowed waterbirths at ALL, particularly when every other technique has to be rigorously tested. I know of drownings, pneumonia, and one particularly cheerful case where a shoulder dystocia could not be resolved, and the mom fell ON HER BABY’S HEAD while being helped out of the tub, This is OK???

    • Mac Sherbert
      March 21, 2014 at 7:32 pm #

      I have friend that had a water birth in Australia in a birth center attached to the hospital with a midwife. She said when her baby was born the midwife asked her to stand-up! Apparently, her baby had a short cord and in order to get the baby above the water without breaking the cord my friend’s husband had to pick her up. She still raved about it, but I always think what would have happened if there hadn’t been some else there that was able to get her up.

    • Young CC Prof
      March 21, 2014 at 7:42 pm #

      A woman on my birth month club (January 14) had shoulder dystocia in the tub. She didn’t seem to know quite how it was resolved, but the baby’s one-minute Apgar was a 2. Luckily, she was in a hospital, so they managed to resuscitate that baby in record time, but still, it was an unnecessary crisis.

      • Medwife
        March 21, 2014 at 10:22 pm #

        There’s a YouTube video of a home water birth in a standard size bathtub where there was a dystocia. I may have linked to it from this site actually. It beautifully/awfully illustrates both the difficulty of managing SD in such a setting and the CPMs’ total incompetence with neonatal resuscitation.

    • auntbea
      March 21, 2014 at 8:23 pm #

      Um. Was the baby’s head okay?

    • realitycheque
      March 22, 2014 at 6:11 am #

      I know that with some hospitals, they’re supposed to be there *just* for labouring in, and that you’re supposed to get out when the time comes to push. With that said, when I was pregnant and looking at hospitals with birthing pools, at least 2 of the midwives told me, “You’re not *meant* to give birth in the pool, but when it comes time to push, you can just refuse to get out. Nobody can force you”.

      One midwife even added that it was “ridiculous” to expect women to get out of a nice, comfortable warm pool and onto the bed right when she’s about to push. I don’t know if they were ignorant of the risks, knew them but didn’t believe them, or just didn’t care.

    • Ash
      March 22, 2014 at 6:06 pm #

      I think part of it is getting market shares for local hospitals. There are 2 hospitals with L&D units in my city and they are both less than a mile away from each other. Many of the big insurance companies in town cover both hospitals for L&D, so the hospitals duke it out for amenities in their birthing centers. The hospital that offers waterbirth does list some potential risks of waterbirth online and does have eligibility criteria, so that’s something I guess.

      • Captain Obvious
        March 23, 2014 at 1:04 pm #

        It’s like DaVinci robotic surgery for benign gynecology. You don’t need robotic surgery but it is a gimmick to attract patients. You can perform a LAVH with 3 small 5mm holes or use a single port Omega incision in the umbilicus. Robotic surgery requires 5 holes, three of them 10-15 mm, usually takes more OR time and cost with anesthesia associated risks, and costs the insurance company $2000-3000 more for use of the DaVinci. Have you seen OR costs? There is an initial 15 fee in the thousands and a lesser every 15 minute fee. Basically charging per minute. And patients love having surgery via robot.

        • Certified Hamster Midwife
          March 23, 2014 at 6:58 pm #

          I don’t want the robots having any more information about my internal organs before they enslave humanity.

  23. Comrade X
    March 21, 2014 at 7:18 pm #

    Given this data, why are waterbirths permitted for uncomplicated vaginal deliveries in NHS hospitals in the UK? It does not seem reasonable to me for a hospital to provide this service when it is clearly not safe.

  24. March 21, 2014 at 6:57 pm #

    I was always a bit weirded out by midwives wearing gloves that go to the wrist while their client was in a pool. You can’t do anything of worth without getting your forearms wet and introducing more contaminants into the pool.

    • Amy M
      March 21, 2014 at 7:16 pm #

      Yeah, they need those shoulder length gloves farmers use for inseminating cattle.

      • March 21, 2014 at 7:31 pm #

        lol those are totally naturallll

      • Rochester mama
        March 21, 2014 at 9:16 pm #

        That is what my CNM used in the hospital while I was laboring in the tub.

      • Deena Chamlee
        March 21, 2014 at 9:55 pm #

        that is what I wear with a rubber band under my armpits

      • Mer
        March 21, 2014 at 10:50 pm #

        The OB I work with made a joke about needing a pair of those when she was doing a manual placenta removal. She really could’ve used them!

        • MJ
          March 22, 2014 at 4:09 am #

          I had a manual placenta removal with my second child. During the procedure the sweet male nurse came and asked if I needed anything. I asked if he could go down to the other end and see if the doctor was wearing those gloves that go to the shoulders that vets use when they stick their hands in cows. Poor love looked faintly horrified but dutifully went off to check.

          • S
            March 22, 2014 at 10:48 am #

            What was the answer?

          • MJ
            March 22, 2014 at 8:09 pm #

            I suspect he was actually a little too embarrassed to ask and just went down the other end and faffed around a bit before coming back and mumbling something along the lines of ‘er, dunno’. I would have thought it was fairly obvious, but anyway, no big deal.
            The orderly, on the other hand was both sweet and absolutely wicked. Didn’t bat an eyelid when he come to wheel me from the birth suite to the OR and I asked if we needed to do anything about the multiple clamps hanging between my legs because I clanked every time I moved. He put on his most (almost) serious face, took a look and said he was no expert but thought perhaps clanking wasn’t in order.

          • Dr Kitty
            March 24, 2014 at 4:01 am #

            I love Belfast hospital porters.
            The last time I was in hospital the porter sang “The Rose of Tralee” when he wheeled me down to the OR.

    • attitude devant
      March 21, 2014 at 7:24 pm #

      What makes you think homebirth midwives wear gloves? There was a case in Oregon where a midwife passed the flesh-eating bacteria infection on her HANDS to her clients vulva and vagina. The poor mom wound up with (I kid you not!) a colostomy. And no the midwife had no malpractice insurance.

      • March 21, 2014 at 7:30 pm #

        most pictures have them wearing gloves. That is why I think they wear gloves. They wear normal gloves you can buy at a grocery store or a pharmacy, which only go to your wrist. What good is it when your client is in more than an inch or two of water???

        • Guest
          March 21, 2014 at 9:01 pm #

          In the Business of being born the midwife reached into the tub during the water birth with no gloves. It was the most disgusting thing I had ever seen.

      • Are you nuts
        March 21, 2014 at 7:53 pm #

        Running the bleach bath now….

      • prolifefeminist
        March 21, 2014 at 8:35 pm #

        O.M.G. Are you kidding me? I did not hear about this story. That’s beyond horrible. Do you have a link?

      • R T
        March 22, 2014 at 2:32 am #

        Yep I remember that!

      • Trixie
        March 22, 2014 at 9:24 am #

        There’s no gloves on Lisa Barrett in that crazy twin birth story.

    • areawomanpdx
      March 22, 2014 at 1:02 am #

      In the hospital, the midwives use gloves that go up to their shoulders and tape them across their back. And tub water still gets in them. Then they put sterile glove on over the shoulder length gloves for the delivery. Which strikes me as bizarre.

  25. alannah
    March 21, 2014 at 6:34 pm #

    Maybe it would be more accurate to make a distinction between laboring in water (with intact membranes) which can be wonderful pain relief and isn’t harmful in any way, vs having the actual birth in the pool. I agree that dunking babies in fecal soup is an extremely bad idea but please don’t throw the whole birth pool out with the bath water.

    • Amy M
      March 21, 2014 at 7:16 pm #

      I don’t think anyone has any major issue with a woman laboring in water if that what she wants to do and there’s no medical reason preventing that.

    • Young CC Prof
      March 21, 2014 at 7:37 pm #

      I believe that’s exactly what the report said, that relaxing in a tub during labor is fine, but women should get out of the before the actual birth.

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