Health concerns about using baths for labour and birth
Many parents and caregivers express concerns about the safety of water births, particularly for the baby. When considering water birth it is important to remember that there can be health problems for all mothers and babies, whether the baby is born in water or not. If a problem does occur, deciding whether it was a direct result of the water birth, or whether it would have happened anyway is an aspect that needs to be examined.
In over 22,000 documented water births in recent years there have been very few complications that can be directly connected with the actual water birth. The following is a summary of the main complications that are possible or have been reported in relation to water births.
Baby breathing in water
The most common question asked by people interested in water birth is 'What if the baby breathes in water?' While this is always a theoretical possibility, it is an extremely rare complication. Newborn babies have a natural 'diving reflex'. When their faces and head are born under the water, the liquid stimulates the nerves on their face allowing the baby to sense the water. Their desire to take a breath in is automatically stopped and their larynx (the opening to their lungs) closes over.
This means that the baby can cope with 'waiting' for the next contraction (3 to 5 minutes) with just their head out in the water until their body is born (this is the part that most people become concerned about). They still receive oxygen from the mother through the umbilical cord at this stage. Once the baby's body is born, the umbilical cord tends to 'spasm' soon after, reducing the blood flow (and oxygen) to the baby. (A pulsating cord does not mean the baby is receiving oxygen, it is simply a sign that the heart is beating).
It is then desirable to allow the baby to take a breath soon after birth. This is why the baby is brought to the surface relatively quickly (within 5 to 10 seconds), so they can start to breathe.
NOTE: Care must be taken not to bring the baby to the surface too rapidly as there have been cases where the caregiver has 'snapped' a short umbilical cord, being anxious to get the baby out of the water as soon as possible.
Once the baby's face leaves the water and comes in contact with the air, their facial nerves sense the change and the dive reflex ceases, allowing them to take a breath. Babies born after water birth have equally good Apgar scores as babies born 'on land'. They don't have any higher risk of breathing difficulties after birth nor are they any more likely to need care in an intensive care nursery.
Conditions that can override the 'diving reflex' are:
If the baby is distressed
If the baby is in distress when the head is born into the water, then there is a possibility that they will take an involuntary 'gasp' (called a terminal gasp reflex). This is the normal response at birth for a baby who has not been coping in the labour.
Of all the documented cases of water births (over 22,000) there has been one reported case of this happening. In 1993, in Stockholm a baby died after making gasping efforts to breathe as he was brought to the surface after a water birth. The paediatrician felt that the baby had been distressed, but had shown no obvious signs of distress (no unusual heart rate or meconium in the amniotic fluid, this is possible in about 0.2% of normal births) and as a result had an involuntarily gasp, taking water into his lungs. It has been suggested that salt be added to the water to make it similar to the amniotic fluid and reduce any complications if water is inhaled.
Cutting the cord early
In rare circumstances your caregiver may feel that the cord is too tight around your baby's neck to allow it to be born (usually the cord can be slipped over the baby's head or around the baby's body as it is born). They may suggest cutting the cord before the baby's body is born (this should not affect the delivery of the placenta). In this circumstance it is wise for the mother to stand and let the rest of the birth happen above the water. Cutting the baby's cord early closes off the blood supply from the cord to the baby's heart and triggers mechanisms in the baby's heart and lungs to stimulate it to breathe.
Another uncommon circumstance can be that the cord is unusually short. It may be only 25 centimetres rather than the average 50 centimetres. In this case once the baby is born the woman will have to stand to allow the baby to be brought to the surface and possibly cut the cord early so that the woman can make herself comfortable and hold her baby.
The mother is taking beta-blockers
These are medications used to help control high blood pressure. They are usually given names ending in 'ol' such as propanolol, atenolol, metoprolol, and labetalol. Beta-blockers can suppress the diving reflex in newborn babies (where the desire to take a breath is stopped until the baby surfaces). If you are taking beta-blockers you can labour in the water but should get out of the bath for the actual birth.