Baby Inhaled Water for Home Waterbirth

[CaptCourt]

I just had my DD 6 days ago at home and need some help with processing what happened...

I ended up giving birth to her in my bathtub and it was a beautiful birth. Everything was perfect. She responded well too me when I was holding her. Everything seemed fine to my husband and I, until my midwife said she wasn't breathing well, that she had inhaled some water, was too cold, and that we needed to go to the hospital. My midwife said she needed oxygen, but didn't carry any on her. All of a sudden we have an ambulance at our house with EMT's around. It just seemed so unreal. I was seperated from my baby for around two hours as I tried to recover myself before going to the hospital and I was given two shots of Methergine. My husband told me afterwards though that her oxygen levels were fine in the ride over and she throw up the water on her own and looked fine after that just in the ambulance.

So to make a long story short I am trying to understand how she could have possibly inhaled the water and if the hospital trip was even worth it in the first place. I have a lot of wavering feelings about it. Was it better to error on the side of caution? She did look very purple when I see the pictures and she never had a strong cry, she sounded very weak. When I saw her in the incubator she looked healthy, pink and beautiful. I have good days and bad.

The midwives said she inhaled the water b/c my husband and I were touching her head and body before she had completely came out of my body and that triggered a reflex. My husband and I never saw any part of her body or umbilical cord touch the air, as that is what I always thought was what triggered the reflex to inhale. It was all a blur to us anyway though so our minds aren't very reliable. Her cord was very very short and I think somehow as I repositoned and my husband was lifting her up that maybe that is where the water got inhaled.

Can anyone give me there thoughts on this? How could she have inhaled the water? Does touching the baby before they completely come out cause the reflex to breath? And was the hospital trip even worthwhile?

Edited by CaptCourt - 4/6/11 at 5:42am

[LilacMama]

Hopefully someone else can answer your questions about the waterbirth specifically. If touching their head can cause problems, I think your midwife should have informed you of this. I know that sometimes babies that are born on dry land (heh) can swallow big gulps of mucus/amniotic fluid/meconium/whatever and have some trouble breathing and transitioning to life outside the womb. This can be dealt with fairly easily with some suction and oxygen. I'm surprised your midwife didn't carry those things.

If your DD came out with Apgars of 8/9 but then started to turn blue and have trouble oxygenating, I think it was the right decision to transfer her. I am REALLY sorry that this tainted your homebirth.

[zoebird]

here is what i think. this isn't an issue of whether or not you should have gone to the hospital.

it is an issue of placing blame that has upset you.

your midwife placed the origin of the problem on what you and your DH did naturally. she "blamed" you for your daughter's issue.

and that is what sucks.

now, it may be true, and it may not be true. I can't say because i don't know about the reflex stuff, and i agree with the PP that your MW should have told you during if she thought it was a concern, not after. in fact, she could have told you about it before the birth because she has been to many and knows that parents touch their children WHILE those children are being born, and that this might be an issue.

but, i think--i just suspect--that it isn't an issue.

i think that it was one of those 'it just happened' thing. no direct origin. you did everything right; DH did everything right; even MW did everything right.

sometimes, things 'just happen.'

and you take care of it, and it's fine--all good.

and you did that, and now your cutie DD is home, fine and healthy.

[mwherbs]

So I am going to say I don't believe that touching the baby's head caused a gasp- now it may very well be that your baby did gasp in the water at birth or it could be that the baby's lungs were wet from amniotic fluid and was breathing fast, sometimes that just happens born in air or water- that you ended up in the hospital and the baby was fine , well that has happened to us before- I have done a full resuscitation on a baby that was floppy, not breathing and the heart rate was below 40 and when starting the resuscitation we called the ambulance , and the baby perked up by the time they got there but the baby did not seem perfectly fine, not our usual pink, regular breathing baby so we said yes go in , just to be sure and by the time we walked into the hospital they wondered what the fuss was about the baby was perfectly pink and nursing... well if we had not made the call to go in and the baby didn't pink up it would have been a great regret- so I can understand the hard call but for us it was clearer because the baby was not ok right at the start, we have also had babies some who stayed home and some that were transferred because of fast breathing and wet lungs (air births not water births) those are also judgement calls and had to do with if the baby would nurse, how fast the breathing, color tone, temp, any other signs like low blood sugar, did we have a shoulder dystocia, what the parents wanted to do... but I do not think that any of the transfers we have made came as a big surprise to mom and dad, they already knew that we felt things are not quite normal ... take care

I wanted to recommend that you look at some of the water birth videos on You Tube- many moms start putting their hands up to protect their tissues and catch the baby while under the water and I am not seeing a problem - infact I find it very rare that no one is touching a baby as it emerges in the water-

[emnic77]

Did your midwife monitor the temperature of the water at all? If the water is too chilly, the baby might gasp and inhale. I've never heard of a baby gasping because it's being touched as it comes out. Maybe I'm wrong, but of ALL the things I've read about waterbirthing, I've never seen that listed as a possible issue. Water temperature always seems to be the main culprit.

I'm sorry this happened, but glad your babe is home with you now. I'm a little irked that your midwife would place blame on you for doing something totally natural, I have to say.

[CherryBomb]

I can't say what caused the water inhalation, but I'm shocked that your midwife didn't even have oxygen.

[TO Doula]

Originally Posted by CherryBomb

I can't say what caused the water inhalation, but I'm shocked that your midwife didn't even have oxygen.

Yeah, that. I would have thought that was a very basic requirement. If she can't do or begin a resus in the home, that's very scary. Midwives in my area are required to carry oxygen and masks for both mom and babe.

[sweet.p]

Talk with your midwife. Review what happened with her.
The baby was struggling to breath, and the oxygen in the ambulance bus helped her.
Did she really blame you, or just giving you the different scenarios of what could have caused a baby to inhale water. Or she was just covering her ass because she did do something wrong and was not prepared for an emergency?

On the other hand If she was not proactive when she noticed your baby struggling for whatever reason it was to breath, she would have never forgiven herself for not calling for help. And neither would have you!

On another note: Why was she not trained in neonatal resuscitation and not carrying oxygen ? Did you know this when you choose her as your midwife?

HB Midwives around here all carry oxygen and trained in neonatal resuscitation . It can avoid panic type of calls like this.

I'm gald to hear the baby is doing well!

[sweeetpea]

Originally Posted by TO Doula

Yeah, that. I would have thought that was a very basic requirement. If she can't do or begin a resus in the home, that's very scary. Midwives in my area are required to carry oxygen and masks for both mom and babe.

Unfortunately, CPMs in our area are prohibited from carrying oxygen, or anything else that can be remotely considered "medical". Don't get me started on the illogic of this.

However, she should have been performing basic blow-by with room-air/mouth to mouth (a la neonatal resuscitation), and if that was not enough, made the call to transfer.

OP, I agree with the pp that if the temp of the water was low, baby might have been triggered. I strongly disagree that touching the baby triggered it.

Glad baby is doing well now!

[channelofpeace]

Originally Posted by emnic77

Did your midwife monitor the temperature of the water at all? If the water is too chilly, the baby might gasp and inhale. I've never heard of a baby gasping because it's being touched as it comes out. Maybe I'm wrong, but of ALL the things I've read about waterbirthing, I've never seen that listed as a possible issue. Water temperature always seems to be the main culprit.

This is what I was thinking too.

[claddaghmom]

I'm sorry for your experience. I felt bad enough having to go to the hospital afterwards for stitches. It does kinda ruin the tail end of the birth.

I've never heard that touching the babe can cause them to inhale water. And all the videos I've seen of waterbirths show the mom, partner or provider touching the baby many times during the birth and while the baby is floating in the water.

I've often wondered to myself if lifting the baby out face up might present a momentary opportunity where water gushes into the nose/mouth right when the baby gasps. I don't know if this is true or not, but the idea bugs me enough to have talked to DH about it and we want to bring the baby out on his side.

One thing I have noticed, when the mom is reclined...after the baby is brought to her arms it seems almost that the baby is precariously close to the water. I wonder if in the blur of things, the baby's face was put into the water accidentally?

[womenswisdom]

Originally Posted by CherryBomb

I can't say what caused the water inhalation, but I'm shocked that your midwife didn't even have oxygen.

Current NRP guidelines do not require oxygen for resuscitation. Room air is considered acceptable and many midwives believe it is in fact preferable, so I wouldn't condemn the mw for not carrying oxygen.

[beckyand3littlemonsters]

Originally Posted by CherryBomb

I can't say what caused the water inhalation, but I'm shocked that your midwife didn't even have oxygen.

:
my mw's have always brought oxygen aswell masks for both me and baby, is this not a legal requirement.

[Tummy]

first of all, YOU DID N.O.T.H.I.N.G wrong! Nothing at all!

I am also one who is baffled that your MW did not carry oxygen! That is truly shocking to me. And as far as blaming you and DH for 'touching your babys head'... how absurd! I am sorry sweetie, but I believe your MW is 100% wrong in this one! I suggest not even using her for your follow up, if you do a follow up. She does not seem to be overly competent IMO!

[rajahkat]

Originally Posted by womenswisdom

Current NRP guidelines do not require oxygen for resuscitation. Room air is considered acceptable and many midwives believe it is in fact preferable, so I wouldn't condemn the mw for not carrying oxygen.

Just wanted to repeat this. You can find lots of interesting reading on the subject. Here is one article

[channelofpeace]

Upon further reflection about this, I think the bothersome fact is that the midwife was quick to point the finger at you and your husband for the baby's problem. I won't vilify the midwife because obviously I am basing this on third hand information, but I think that it warrants further conversation with your midwife about this. What makes her think that you and your husband touching the baby had anything to do with it? What are her sources for such information? It sounds like she is afraid that you will blame her so she is pointing the finger at you preemptively when in this situation, there isn't necessarily anyone to "blame". I hope that you can get this figured out so that you can further process your birth. Snuggle and enjoy your baby in the meantime and savor these precious days

[CaptCourt]

Thank you everyone for you replies. I don't want to make my midwife out to sound incompetent. She did mention that we shouldn't touch the baby before her fully coming out of me before the birth, in the heat of the moment though we just did it naturally, and my husband especially was very excited about catching her. It does bother me that we weren't gently reminded at least though! I had never ever heard aside from her that touching could cause such a reflex and I still feel that she is wrong on that, even though we were forewarned, I just think she doesn't do a whole lot of waterbirths.

As far as the oxygen issue...yes, I knew she didn't carry oxygen with her. This was troubling for me, but I hate to say it I picked her anyway b/c she was my only option for a homebirth where I live. Without revealing too much, I don't live in North America. The only thing that confuses me is that my daughter ended up not needing oxygen (which the ambulance couldn't provide for her eithier b/c they didn't have a proper mask), in the ambulance it was shown that her oxygen levels were fine, so the whole thing really confuses me. She did try suctioning out the baby at home.

Water temperature could very well have been the culprit. I do recall it feeling a little cold to me, it was not monitored with a thermometer.

[womenswisdom]

After suctioning, did the mw use an ambubag to give breaths to the baby? Or was it just suction then call EMS? It sounds like there wasn't anything really very wrong with the baby, but that your mw panicked and did not know how to handle the situation. Is she NRP certified? If she's not very comfortable with waterbirth, she may be buying into some of the myths surrounding it and assuming that the waterbirth was the problem when it really wasn't.

[rparker]

Your midwife might be wrong about the origin of the water your daughter swallowed...

My daughter was born on a bed in a hospital and still needed to have water suctioned out of her lungs. She also had high Apgar scores and didn't need oxygen. It was explained to me that the amniotic fluid in her lungs was most likely due to a short labor (6 hours)... i.e. that if she had experienced more contractions the water would have been naturally "squeezed out." I'm pretty sure that this is also the rationale behind allowing women to go into labor naturally and to experience some contractions (when safe) before planned c-sections rather than scheduling them ahead of the EDD.

I think that you did the right thing to take her to the hospital since your midwife wasn't equipped to handle the situation.

[CaptCourt]

Originally Posted by womenswisdom

After suctioning, did the mw use an ambubag to give breaths to the baby? Or was it just suction then call EMS? It sounds like there wasn't anything really very wrong with the baby, but that your mw panicked and did not know how to handle the situation. Is she NRP certified? If she's not very comfortable with waterbirth, she may be buying into some of the myths surrounding it and assuming that the waterbirth was the problem when it really wasn't.

No ambubag was used. I'm not sure what NRP stands for, neonatal resucitation? She used to be a hospital based midwife, she has only been doing homebirths for 5 years now, so I assume she was following all the legal requirements this country provides. Her hospital experience may have affected her judgment as well. The language barrier between her and I has gotten in the way quite a bit.