Water birth does not pose an additional risk for morbidity and/or low-risk newborns compared to traditional birth methods, researchers report in a study published earlier this year (2016). This is the first such extensive study in the USA focusing solely on water births, with Marit Bovbjerg, an instructor of epidemiology at the College of Public Health and Human Sciences at Oregon State University, as its lead author. RESEARCH (click): Maternal and Newborn Outcomes Following Waterbirth: The Midwives Alliance of North America Statistics Project, 2004 to 2009 Cohort; Journal of Midwifery & Women’s Health; Volume 61, Issue 1, pages 11-20, January/February 2016
The findings indicate that water birth is a reasonably safe method of delivery, with few interventions, but we must be aware that the woman’s (and baby’s) condition must allow for it. Therefore, we are talking about low-risk pregnant women. The decision of whether a woman will give birth in water or not must be made by the woman together with the healthcare professional (who is managing her pregnancy and knows her), whether it’s a doctor or a midwife in countries where midwives practice independently.
The study included more than 17,000 women who gave birth at home or in independent birth centers between 2004 and 2009. The vast majority also chose to have their birth attended by an independent midwife. Births in hospitals were excluded. Of these 17,000 women, 6,500 chose to have a water birth.
The authors found that water birth did not increase the number of necessary hospitalizations for newborns and/or mothers compared to women who did not opt for water birth. They conclude that water birth carries no additional risks for neonatal morbidity and/or mortality; the only thing they observed was a slightly higher risk of birth canal injuries for women.
Their results are consistent with findings from research in other settings and contradict recently published clinical guidelines from ACOG (American College of Obstetricians and Gynecologists) / AAP (American Academy of Pediatrics).
Water birth in a birth center
https://www.youtube.com/watch?v=uvvuE2WrBs4
Water birth at home (author Mesec maj )
https://vimeo.com/127384327
In Slovenia, there are two maternity hospitals (Murska Sobota and Postojna) where water birth has been an option for a long time. I have gathered information below from their websites, and links are also provided. However, Ptuj maternity hospital is also supposed to offer water birth since 2016, but nothing has been published on their website yet-> Ptuj General Hospital – Gynecology and Obstetrics Department (click).
You can also choose to have a water birth at home with a chosen independent midwife from Slovenia or abroad, or you can choose a birth center, which is not (yet) available in Slovenia.
Water birth is suitable for healthy women whose pregnancy proceeded without complications and whose labor began at term. It is offered at the explicit request of the birthing woman who has understood all the advantages, risks, and contraindications of this method of birth in parenting classes. Pregnant women who have not attended parenting classes are informed about the possibility of water birth upon admission.
Advantages: Warm water favorably affects the birthing woman’s well-being, relaxation, duration of labor, elasticity of birth canal tissues (reducing the likelihood of tissue damage), reduces pain during contractions and the need for pain relief medication, and allows the baby a gentle arrival into the world.
Conditions:
- healthy pregnant woman
- onset of labor between 38 and 41 completed weeks of pregnancy
- normal fetal condition assessment
- contractions every 2-3 minutes, strong and of adequate duration
- cervix dilated 6 cm for first-time mothers, 4 cm for multiparous women
- birthing woman in water continuously for a maximum of 2 hours
- placental delivery on the birthing bed
at any stage of labor, the birth continues on the birthing bed at the birthing woman’s request.
Contraindications:
- onset of labor before 38 or after 41 weeks of pregnancy
- breech presentation and other fetal positions where natural birth is not possible
- multiple pregnancy (twins, triplets)
- irregular fetal heart rate
- thick green amniotic fluid
- severe fetal growth restriction
- disproportion between the birthing woman’s pelvis and the size of the fetus
- intrapartum pain relief with epidural anesthesia
- induction of labor with continuous intravenous infusion
- history of cesarean section
- low-lying placenta
- bleeding during labor or heavy bleeding in the third stage of a previous labor
- diabetes in the pregnant woman
- low blood pressure in the pregnant woman
- high blood pressure, presence of protein in urine, and swelling in the pregnant woman
- infection of the pregnant woman with HIV, hepatitis B and C, Str. Agalactiae
- elevated body temperature in the pregnant woman
- neurological diseases in the pregnant woman
Possible complications:
- increased risk of infection for the fetus and birthing woman
- water aspiration by the fetus
- embolism in the birthing woman
- bleeding in the birthing woman due to vasodilation
- shoulder dystocia
- possibility of injury to the birthing woman from slipping in the tub
The birthing woman must confirm with a signature that she has understood the conditions, advantages, contraindications, and complications of water birth.
- Postojna Hospital – Obstetrics (click)
Procedure
A birthing woman who wishes to have a water birth must be healthy, and her pregnancy must proceed without complications. If the obstetrician determines that labor is not progressing as it should, the birthing woman is moved to the bed. For water birth, in addition to routine examinations, we also require testing for HIV and hepatitis B and C infection, as there is a higher risk of infection for the midwife and baby with this type of birth.
The hospital admission procedure is the same as for other birthing women, but it is advisable for expectant parents to attend parenting classes before birth and familiarize themselves with the water birth procedure. The expectant mother decides when to enter and exit the water, but contractions must be regular and labor in progress. Similarly, the decision is hers whether she wants to stay in the tub only until the baby is expelled or if she also wants to give birth underwater.
The water temperature in the tub is 36–37 °C, with some kitchen salt added. Water birth is more difficult to manage than a conventional birth, so continuous monitoring of the fetal condition with cardiotocography is necessary.
After birth, the newborn is slowly lifted from the water (head and face first) and placed on the mother’s chest, where it takes its first breath. If the newborn is not hypoxic (lacking oxygen), the breathing reflex is triggered upon contact with air and a sudden temperature change. This also prevents water aspiration, which is a concern with this type of birth. To avoid the risk of water embolism in the mother, the mother delivers the placenta on the bed.Advantages
Warm water and massage, which alleviate painful contractions, especially lower back pain, as well as high humidity in the air and the desired atmosphere—all these factors have an analgesic effect, thereby reducing the use of additional pain relief medications. The birthing woman relaxes, and the soft birth canal tissues also relax, leading to fewer episiotomies (perineal cuts) and rarer tears.
Despite some initial reservations when this method was introduced into obstetrics, our experiences with water birth have been positive. Compared to conventional birth, there are no differences in labor duration, and so far, there have been no complications for either mothers or newborns.
If you wish to take advantage of the water birth option, you can come for a consultation with a midwife and a tour of the water birth room one month before your estimated due date. Prior appointment for the consultation is not necessary.
