Practitioners today are being asked by more and more women if they will help them in achieving a water birth. Women love the comfort and warmth that water provides during labor, and many women are expressing resentment or anger at being asked to leave the pool or bath for no apparent reason at the time of birth. Therefore, it is important and essential that clinical data from retrospective studies is passed on. We can benefit from the experience of hundreds of midwives and physicians around the world who have had to deal with some of the most common areas of concern for practitioners. These areas include should dystocia, fetal well-being, hypothermia, hemorrhage, perineal trauma and delivery of the placenta.
First, to understand the safety of water birth is to understand the mechanism of fetal breathing. Before birth, the fetus breathes or moves its lung muscles about 40% of the time. This is called fetal-breathing movement. At the time of birth, breathing is inhibited by a rise in the prostaglandin E2 hormone 24 or 48 hours before birth; this actually prevents fetal-breathing movements. At birth, the warm water inhibits breathing. Mild hypoxia at birth causes apnea, whereas severe hypoxia causes gasping. Severe hypoxia can be detected during labor by fetal-heart detection. Fresh water in the larynx causes the baby to respond with a dive reflex. Even one or two drops of water are detected and are sufficient to trigger the diving response in the newborn, which inhibits inhaling. Babies are not left under the water for any reason after the complete birth. The baby is out, the baby is up. That can be effected gently and smoothly in a time period of about 10 seconds.
All newborn assessments can be done while the baby is in the mother's arms. Water babies tend to take about an extra half-minute to minute to begin breathing. This is normal, so don't panic. Delivering the placenta in the water is a practitioner's choice, but most midwives in Europe do deliver the placenta in the water. There has never been any incidence of water embolism reported in any of the literature. Delivering the placenta in the water is a lot less messy.
How can you tell if a woman is bleeding too much in the water? The water will turn darker in color. All your other assessment skills are utilized in the same way to detect a postpartum hemorrhage. If you can still see the woman's skin color through the water, she is most generally fine.
Shoulder dystocia is an emergency that every practitioner dreads and tries to avoid. Women with history of dystocia or a woman who is expecting a large verdates baby should be asked to leave before the birth. If the head of the baby is out and there is not any movement after the next contraction, there is no harm in waiting one more full contraction before either asking the mother to stand, to get out, or to turn her over on her hands and knees. Usually, in standing or turning over, the baby is dislodged and the birth happens without problem.
Perineal trauma has been noted to be less in water. Episiotomy is almost nonexistent. Retrospective data shows that the severity and incidence of lacerations is less. The risk of infection for both mother and baby is not increased when women use the pool during labor or birth. Even if the mother has prolonged rupture of membranes, vaginal examinations in the water can be done without problem. Proper cleaning of all pool equipment, whether portable or permanently installed, can effectively eliminate any possibility of infection.
The water temperature should never exceed 100F or 38C in order to prevent fetal hyperthermia and maternal dehydration. The practitioner needs to maintain a continuous state of awareness about her posture to prevent back injury. Proper design and installation of tubs and pools is essential to prevent injuries of staff members. These are but a few of the areas of concern for practitioners.