waterbirth safety? Our scary experience

[Momtotwo2004]

What is your personal opinion on waterbirth safety? I know that there is very differing opinions out there. I know that advocates say that babies do not swallow or inhale water because they aren't breathing until they are removed from the water. On the other hand, I know that some disagree.

My 3rd baby was born slightly in the water. I say slightly because the water level was very low and I think my midwife actually kept her out of the water! LOL

My 4th was born on the 4th of this month into the water at home. My water broke only a minute or two before his head was born and then his body was born during the next contraction, just a minute or less later. He came immediately out of the water. Hours later he went into severe respiratory distress. He spent a week in the NICU after a very scary trip to the ER. The doctors say that they believe he aspirated pool water and got pneumonia.

My midwife definitely respects her clients needs and wants as far as where they want to birth. However, she personally has worries about water birth since the 3 babies that she's had to transfer (that weren't due to birth anomolies) were all babies born in the water who experienced respiratory distress. However, she's also had hundreds of healthy water birth babies.

While I am unsure of what happened with my sweet son, I don't think I'd ever feel comfortable giving birth in water again. I am interested in any personal stories or in any research anyone has to share.

[homebirthing]

Babies have to have air hit their face before they take a big breath. I have been to many many waterbirths and breathing issues have never been an issue. How is she bringing babies out of the water?

This is from a midwife here in the twin cities:

In addition, the baby has an autonomic reflex, called the dive reflex, which prevents it from inhaling any substance that is in the throat and causes it instead to swallow. (This reflex disappears after about six months.) There is a complex chain reaction of hormones and chemicals that cause the breathing process to begin; just know that it is impossible for a newborn to breathe until up in the air. However, the baby should not be left under the water for an extended period of time (longer than half a minute). There are several waterbirth videos that show babies under water longer than this who do just fine, since the placenta is still supplying the baby with oxygen; but it can’t be predicted when the placenta will begin to separate and stop the flow of oxygen. The safest approach is to remove the baby unhurriedly, face down so water drains from the nose and mouth. ~Vanessa Stephens Coldwater

[Momtotwo2004]

Hmmm... She let me bring the baby up. It was very quick, like I described in my first post, but I birthed the baby and then reached down and put him on my chest. There was a few brief seconds in between when the midwife made sure the cord wasn't going to be in the way but the baby definitely wasn't under water and out of my body for more than 10 seconds. Probably more like under 5 seconds.

I know that is the argument that water birth supporters have stated. But at the same time, I can't help but wonder. Especially after my own personal experience as well as the experiences of my midwife.

[MCatLvrMom2A&X]

Never had a water birth but wanted one. My thinking is any time water is involved like that then there is going to be a risk of the baby aspirating the pool water. I know that there is a certain way the baby should be brought up to the surface to prevent it but I have seen it done every which way watching water birth video's.

[loveneverfails]

Sounds danged plausible to me. I mean, we watch babies on ultrasound doing breathing exercises, and they're definitely in "body temperature fluid" then. Do I think that in most births being in the water is going to be an issue? Nope. But if the baby panics (not unheard of) they can gasp, and I'd imagine they can aspirate any liquid they're in whether it's amniotic fluid, meconium filled amniotic fluid, or bath water.

[erin_brycesmom]

I haven't been able to find any valid evidence of any risks associated with waterbirth. I think it's safe. My sister's baby went through a very similar experience in her dry land hospital birth. Later in the day of her birth, she developed respiratory distress and they found fluid aspirated in her lungs. I'm sure if it had been a waterbirth, they would have blamed that but it wasn't a waterbirth so they didn't...they said it was amniotic fluid. It happens.

[Momtotwo2004]

Loveneverfails, I actually just PM'ed you!

[Momtotwo2004]

Yeah, they never found fluid in his lungs though, interestingly enough. They found inflammation. They blamed fecal matter in the water (mine, supposedly, since he didn't have meconium) but his blood cultures came back negative.

It really is a mystery, I guess. We'll never know. I am extremely glad he is ok. At the same time, I wish I knew what had happened.

[Momtotwo2004]

Also, Erin, that's what's frustrating me.

Since this was my first homebirth, I'm getting the feeling that the naysayers amongst my family and friends are having an "I told you so" moment. When in reality, respiratory distress is very common amongst c-section babies because they don't express the fluid from their lungs like they would during natural birth. And if I had given birth in the hospital, I *still* would have had a water birth.

[erin_brycesmom]

I'm glad that he is ok too!! My sister's baby spent 5 days in the NICU. It was so strange because I came to visit after the birth but before she developed pneumonia. Everything seemed fine with her sweet little baby when I was there so I was shocked that things had turned. It's hard to go through that mama, I'm very sorry that two of you had that experience. I think it's important to process and question why things happened. Barbara Harper is an excellent resource for waterbirth research.

[MsBlack]

I don't know--it's just hard to believe that your baby's resp distress was caused by inhaling the pool water. From what you say, it just doesn't seem there was enough time for that to have happened before baby was out of the water. I have seen a couple waterbirths where it was apparent that the baby was ready to breathe while head was still underwater--dive reflex or not, if there is cord compression or a separating placenta while we're waiting for the baby's body to deliver, baby will do the next thing if oxygen level is compromised enough: try to breathe.

In the cases I saw, baby's head was born and then there was a good 2-3 min before next contraction. At first, babies were still and calm, maybe opening eyes a bit--but as time went on, they got 'more awake'--and opened their mouths, grimaced, while heads were getting that purple look (blood congesting in the head due to body-compression). On land, I would not have been alarmed --but in these couple of cases, I did believe the babies were about to breathe, so I had the moms stand up immediately. Once their heads cleared the water, these babies did start respiratory activity, one was fully crying before entirely born (shoulders came fine, but delivery of body was slow).

Maybe I don't know enough--such as how much time there was, between delivery of your baby's head and body. And I suppose anything is possible, really. But I do know that docs tend to make declarations of certitude that often are not at all correct. Knowing you had a waterbirth, it would be so easy to call that the culprit! But it really doesn't sound like the evidence bore that out. As for finding inflammation...when did that occur in the chain of events? Had deep suctioning already been done by staff, before signs of inflammation were noted? Or any other invasive procedures...lung tissue is so delicate, it is not hard to cause inflammation to them, with deep suctioning or other invasive things.

[Momtotwo2004]

Msblack, that's exactly what my midwife said. My son's CRP level was only at a 2 in the ER and his lung XRay was clear. The next morning, after many, many hours of CPAP and lots of suctioning, his level was at 17. Anything over 10 is considered cause to be concerned. My midwife believes that the damage they saw on the second XRay (not alot but one lung had some "white spots") and the high inflammation level was very possibly caused by the forced air and suction.

I wish I could say exactly how long he was under water but in the moment I was pretty busy I do know my water broke and with the next contraction his head was out. It was most definitely less than a minute before his body was born. So his head was under water for less than a minute. Except for the midwife making sure the cord wasn't in the way, he came up out of the water very quickly.

But I can't figure out what the green/brown fluid was that he spit up...? That's why they're claiming he swallowed/aspirated pool water. He had no meconium but I did have a bowel movement in the water.

BTW, he was a BIG guy. He weighed 11 lbs 15 oz. I do wonder if that could have anything to do with it although I have no reason to think so. I had no GD and his blood sugars were always fine when tested in the hospital.

[mrsdewees]

Originally Posted by Momtotwo2004

Hmmm... She let me bring the baby up. It was very quick, like I described in my first post, but I birthed the baby and then reached down and put him on my chest. There was a few brief seconds in between when the midwife made sure the cord wasn't going to be in the way but the baby definitely wasn't under water and out of my body for more than 10 seconds. Probably more like under 5 seconds.

I know that is the argument that water birth supporters have stated. But at the same time, I can't help but wonder. Especially after my own personal experience as well as the experiences of my midwife.

The first waterbirth I ever apprenticed at, we had to resuscitate the baby. My midwife is a big supporter of waterbirths for the moms, but she says it poses problems because it's extremely difficult to resuscitate in the pool. She had to clamp and cut the cord before it stopped pulsating in order to get the baby on a flat service so we could administer oxygen.

I think a waterbirth allows for a slower, calmer transition - but I don't want one for myself. Biologically speaking, I can't think of another land mammal that gives birth in water. I also want my baby to smell like me. I've heard a few waterbirth moms say that their babies smelled different.

That being said, that's a personal decision of mine. If waterbirths were unsafe, midwives wouldn't do them IMO. And, even if it were "iffy" - then hospitals DEFINITELY wouldn't do them - and some hospitals do. I've never minded attending waterbirths - and most of them go off without a hitch.

[loveneverfails]

Those CRP levels are definitely low enough that I do not buy the sepsis diagnosis. CRP is a non specific marker for inflammation, and it should not ever be the sole reason for a diagnosis of sepsis, especially if the clinical picture doesn't jive with infant who has sepsis. And even if he DID started getting infected, given the clear initial x-ray, I would really be wondering if all the suctioning caused the problem by forcing stuff down towards his lungs.

Ugh, I'm so sorry!

[Sijae]

Originally Posted by mrsdewees

That being said, that's a personal decision of mine. If waterbirths were unsafe, midwives wouldn't do them IMO. And, even if it were "iffy" - then hospitals DEFINITELY wouldn't do them - and some hospitals do. I've never minded attending waterbirths - and most of them go off without a hitch.

Water birth is safe but hospitals do things that are unsafe, unscientific and bad for babies all the time.

[Sijae]

I really doubt that your baby aspirated pool water. The dive reflex is not easy for babies to overcome. Gasping is a last ditch reflex response to a lack of oxygen which would mean the baby somehow was deprived of oxygen from his cord. If your baby was fine during labor, was born that quickly and was vigorous at birth it seems very unlikely that your baby gasped during the 5 seconds he was in the bath.

as for the 'breathing movements' in utero, that is true that you see those movements, but the baby isn't actually breathing amniotic fluid into his lungs.

[ShwarmaQueen]

I've heard of at least a couple of cases where HB babies have had respiratory distress and they weren't water births... I think there are many many reasons and I wouldn't pin it on water birth alone.

[CrazyCatLady]

But I can't figure out what the green/brown fluid was that he spit up...? That's why they're claiming he swallowed/aspirated pool water. He had no meconium but I did have a bowel movement in the water.

I am not any kind of birth expert. But all my brand newborns (all born on land) have spit up green/brown/red! stuff in their first couple days. It was enough to make me panic a good bit each time. But the nurses and doctors always just said it was "normal". Just thought I'd throw that out there.

Sorry you had such a scary experience.

[rajahkat]

I'll say that in my personal case, waterbirth makes me nervous. I've had two babies born where the cord was not pulsing and the placenta followed baby out immediately with my last birth. I tend to have short cords and I think that might contribute to it, but it seems dangerous in a case like that. Not that I think this applies to you at all! Just wanted to share my experiences. I know women choose waterbirth all the time with no issues at all, and I do respect it as a choice. It's just not for me.

Kat

[babyjelly]

I'm no expert, but I'm voting "witch hunt". Given the information here...it sound a lot like the hospital thought, "She gave birth at home? And in the water? Well OF COURSE that caused the problem!"
I'm sorry you and your baby had to be put through the NICU experience, for any reason.
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