When parents-to-be ask about water birth

Many hospitals and birthing centers offer this controversial birthingmethod to reduce the stress and pain of labor. But questions aboutsafety persist. Includes a Guide for Parents.

DR. SCHUMAN is adjunct assistant professor of pediatrics at Dartmouth Medical School, Lebanon, N.H., and practices pediatrics atHampshire Pediatrics, Manchester, N.H. He is a contributing editor for Contemporary Pediatrics. He has nothing to disclose in regard toaffiliations with, or financial interests in, any organization that may have an interest in any part of this article.

Sometime in 2002, a lone pediatrician was walking through the labor and delivery ward of a small rural hospital where construction was taking place. A large fiberglass tub that looked somewhat like a Jacuzzi caught her eye. When she inquired about the purpose of the tub, a nurse informed her, "This is our new birthing tub-this hospital is going to begin to deliver babies underwater."

The birthing of infants underwater has been practiced in this country and around the world for several decades. The method is popular among advocates for "natural" childbirth and maternity hospitals seeking to increase their market share by offering services that competing hospitals do not. Water birth has also been the subject of significant controversy-several articles over the past few years have questioned its merit and safety.^1-3

In May 2005, the AAP Committee on the Fetus and the Newborn classified water birth as an "experimental procedure that should not be performed except in the context of a randomized clinical trial after informed parental consent."⁴ Nevertheless, substantial numbers of water births continue to be performed in the United States. The American College of Obstetricians and Gynecologists (ACOG) has never taken a position on their safety.

Water Births International, an advocacy organization, lists on its Web site more than 82 US hospitals and 97 US birthing centers that provide a water birth option for interested parents. While researching this article, I learned, much to my surprise, that my local community hospital delivers about two babies by water birth every month and that a medical school-affiliated community hospital in another part of the state delivers approximately 400 babies a year by this method-about half of vaginal births at the facility. As advocates for newborns, pediatricians need to be familiar with the controversies surrounding water birth so that we can advise parents when they ask our opinion about this common "alternative" birthing method.

A short history of water birth

Underwater births originated in France in the late 1970s. An obstetrician, Michel Odent, who supervised deliveries at a state-run hospital in Pithiviers, allowed women to labor in warm water to improve comfort and control pain. He observed that laboring in a tub of warm water provided significant relief from pain associated with contractions and accelerated the first stage of labor once cervical dilation reached 5 cm or more. Many mothers actually delivered the baby in the tub, before they could emerge from the water.

Odent reported that, in his experience, underwater birthing had little adverse effect on the newborn; underwater birth eventually became routine practice at his facility. He subsequently wrote a book about the subject and reported his observations in the Lancet in 1983.⁵

Water birthing was brought to America in 1985 by obstetrician Michael Rosenthal, at the Family Birthing Center in Upland, Calif., who became an advocate for the method. Over the next two decades water birth grew in popularity in the US as women began to react to what has been called "the medicalization of childbirth" by seeking to reduce the use of drugs for pain relief and help them feel more in control of their labor.