Human babies should not be born underwater

The Pediatric Insider

© 2014 Roy Benaroch, MD

You’d think, being land-based mammals, we’d all be able to agree on the basic fact that humans breathe air, and that newborn human babies ought to be born into the air.  You know, so they can breathe. That’s how human babies have always been born, and that’s how all other primates are born, and that’s how all other land mammals are born. (Hats off to our cetacean cousins for their sticking to their evolutionary guns on the water birth. Unlike humans, Flipper doesn’t do well in air.)

And yet, there’s always someone willing to wonder, “Could there be a better way?” Immersion in water during labor or birth is touted by some as beneficial to both mother and baby. What does the evidence show? I’m willing to suspend common sense, here—show me it’s safe, then, sure, let’s join the dolphins.

Except it isn’t safe. And the purported benefits? No so much.

In a joint statement from the American Academy of Pediatrics and the American Congress of Obstetricians and Gynecologists, physicians have reviewed what we know and don’t know about water birth. What we do know, really, is very little—studies are of limited quality and small scope, and use varying methods and varying definitions of “water birth.” Many of the “studies” are not in scientifically reviewed journals, and are more like collections of cherry-picked stories than actual objective evidence. Most of these “studies” show zero objective benefit during labor, though some pooled studies combining case series show a reduced use of anesthesia and a reduced time of labor during immersion in water. However, no matter how the data are combined, there’s no difference in perineal trauma, tears, c-section rates, or a need for assisted delivery. And there are no individual trials or pooled collections that show any benefit to the newborn infant at all.

What there are, though, are several case reports and case series of babies suffering harm from water birth. Because the numbers of women undergoing labor or birth in a water bath aren’t known, we can’t estimate the rates of these complications. But the complications are real and can be devastating: umbilical cord tears leading to hemorrhage and shock,  hypothermia, drowning, seizures, brain damage, and death. Are these kinds of risks an acceptable trade-off for the meager, unproven benefits of water birth?

The ACOG and AAP point out that immersion in water during what’s called the first stage of labor—the early part, when there are regular contractions but the cervix isn’t fully dilated—may be appealing to some women, and may offer some potential benefit in terms of pain control. Even though there’s no evidence of benefit to the baby, as long as immersion doesn’t otherwise interfere with good care it’s not unreasonable. Rigorous protocols ought to be in place, though, to protect mom and baby—including maintenance and cleaning of the tubs, infection control and monitoring, and careful observation for signs that it’s time to move out of the tub. Before someone gets hurt.

However, immersion during the second stage of labor, when the cervix is dilated and Junior is making his way into the world we share—that’s of zero benefit, and can lead to great harm. Humans are not water creatures, and it’s not likely that our babies really ought to be born underwater.

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5 Comments on “Human babies should not be born underwater”

  1. CATT Says:

    I have been in attendance at 4 of my 8 grandchildren’s births.Two of them were C-section, one a normal delivery in a birth center and the 4th, in the birth center and born underwater. All the births were phenomenal moments. The water birth was wonderful and seems quite normal since a baby has been in fluid for 9 months and to be born into warm water and then gently raised out of it was magical. The very fact that the placenta is still attached to the uterus and the umbilical cord intact to the infant, continues to give the infant all the oxygen it requires and even if it does breathe underwater, it’s not something to be concerned about as the babe has been doing that, in utero, anyway. There really is nothing to be concerned about.

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  2. Scientist Mom Says:

    Catt: It does seem logical that the birth pool is just an extension of the womb, but that isn’t true for a few reasons.

    1) Amniotic fluid is sterile during pregnancy. The birth pool is definitely not sterile, not after it has come in contact with the mother’s skin and sometimes her bodily fluids. Even garden-variety skin bacteria can be dangerous if drawn deep into the lungs of a newborn.

    2) Amniotic fluid is basically saline, with a salt balance the same as the human body itself. The birth pool is plain water. A newborn baby’s body is not set up to process plain water, only breast milk (or formula) which has that same salt balance. Drinking plain water can really mess up a newborn’s body.

    3) On the journey through the birth canal, the fluid was squeezed out of the baby’s lungs, preparing him to breathe as soon as he gets out. Having the lungs fill up with fluid again makes it harder to start breathing air.

    4) Sometimes things go wrong just at the moment the baby comes out. It’s unusual but not extremely unusual. The cord wrapped around the baby’s neck, for example, or the shoulders getting stuck after the head comes out. If the mother is underwater, it’s a heck of a lot harder to fix it.

    5) Speaking of umbilical cords, sometimes the baby’s cord isn’t long enough to reach the surface of the water. If this happens, either the baby needs to stay under even LONGER while you cut the cord, which increases the risk of problem 1, 2, or 3, or, if the attendant doesn’t realize in time, the umbilical cord can be ripped, which puts the baby at risk of literally bleeding to death.

    All of these hypothetical risks have been documented, although as Dr. Benaroch said, we don’t know precisely how common they are.

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  3. CATT Says:

    Dr Roy. You make some excellent points here. Much food for thought.

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  4. CATT Says:

    Science Mom.. Sorry I mistook your response, to my comment, for Dr Roy’s. You raise excellent rebuttal points. Even though I have witnessed one of my granddaughters born underwater, your comment gives me plenty of food for thought.

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  5. Mellie midwife Says:

    As a midwife working in a midwifery led birth center who carries out water births on an almost daily basis ..Scientist mom some of your statements are unfounded and inaccurate there are lots of ‘sometimes’ in there.. please cite your facts, references and research to back up your statements.

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