Saturday, July 31, 2010

Water Birth

Though I've mentioned water birth before, and read a lot about it, I realized I've never really blogged about water birth!

Water Birth has been shown to provide excellent birthing experiences for both mother and child. The mother experiences a more relaxed environment in which she feels in control and free to follow her body's urges. The buoyancy of the water does wonders to alleviate labor pains without the need for IV pain medication. Perineal trauma is also reported to be less severe. Additionally, you don't have to worry about clean-up or stains... everything goes out with the bathwater.

Advocates for water birth also state that a water birth eases the transition for the baby from the birth canal into warm liquid that resembles the intra-uterine environment.

- Water birth can take place at home, in a birthing center, or in a hospital. 

- Temperature of the water: should be somewhere between 95 and 100 degrees, so that the mother is comfortable.

- The cost to purchase or rent a birthing pool runs between $118-375 plus shipping.  However, it's possible that your insurance company may reimburse the pool rental or purchase fee. If you give birth at a hospital there is no need to bring your own. Types of birth pools


Want to read/watch some Water Birth stories?

Kristen at one of my fave blogs, Birthing Beautiful Ideas, writes about her In-Hospital VBAC Water Birth

A Beautifully-made video of a Water Birth

Rixa at Stand and Deliver blog writes about the birth of her second child at home, including video. 

A video of an "unusual" water birth in a hospital where the couple are left quite alone.

A short video where mom catches her own baby.

Waterbirth International has a page with several water birth stories.

I will definitely labor in water, an excellent form of pain relief that has no negative side effects but a multitude of positive effects.


Frequent concerns with water birth:

- Infection: Hospital staff, especially L&D nurses, will frequently cite "infection" as the reason for not getting into a bathtub, either to simply labor or to give birth. Some will say you can only get in if your water has not yet broken, others will say not at all. Most OB's will refuse water births because they do not want to deliver a baby by bending over by the tub.
(The truth is, YOU can deliver your baby in a tub, simply by reaching down and pulling your baby up once he/she is born. Or dad can! Moreover, with a full birthing tub (as opposed to a regular in-wall bathroom tub), your support team and midwife, etc can be all around you 360 degrees, and can be wherever they are needed, such as to help deliver the baby.)
As long as the bath has been cleaned, there is little to no risk of infection for the baby. Also, the baby will be colonized by its own mother, anyway, on the way out, and by her skin and breast immediately after.

- Slowed Labor: There is a possibility that the relaxing effects of the water, and the tendency to lay immobile for some time, sometimes slow labor. For this reason, many professionals suggest that mom wait until 5 cm dilation to enter the tub. If you are birthing at home and not receiving cervical checks, I would recommend entering and exiting the water whenever you felt like it.

- And the big one...
What prevents baby from breathing under water?
There are four main factors that prevent the baby from inhaling water at the time of birth:
1.  Prostaglandin E2 levels from the placenta which cause a slowing down or stopping of the fetal breathing movements. When the baby is born and the Prostaglandin level is still high, the baby's muscles for breathing simply don't work, thus engaging the first inhibitory response.
2.  Babies are born experiencing mild hypoxia or lack of oxygen. Hypoxia causes apnea and swallowing, not breathing or gasping.
3.  Water is a hypotonic solution and lung fluids present in the fetus are hypertonic. So, even if water were to travel in past the larynx, they could not pass into the lungs based on the fact that hypertonic solutions are denser and prevent hypotonic solutions from merging or coming into their presence.
4.  The last important inhibitory factor is the Dive Reflex and revolves around the larynx. The larynx is covered all over with chemoreceptors or taste buds. The larynx has five times as many as taste buds as the whole surface of the tongue. So, when a solution hits the back of the throat, passing the larynx, the taste buds interprets what substance it is and the glottis automatically closes and the solution is then swallowed, not inhaled.
For a more complete description, click "read more."



The first and foremost question in everyone’s mind and the lead in all these newspaper accounts is simple: How does the baby breathe during a waterbirth?
(from Waterbirth Basics, by Barbara Harper, RN)

Inhibitory Factors
Several factors prevent a baby from inhaling water at the time of birth. These inhibitory factors are normally present in all newborns. The baby in utero is oxygenated through the umbilical cord via the placenta, but practices for future air breathing by moving his/her intercostal muscles and diaphragm in a regular and rhythmic pattern from about ten weeks gestation on. The lung fluids that are present are produced in the lungs and are similar chemically to gastric fluids. These fluids come up into the mouth and are normally swallowed by the fetus. There is very little inspiration of amniotic fluid in utero.
Twenty-four to forty-eight hours before the onset of spontaneous labor, the fetus experiences a notable increase in the prostagl andin E2 levels from the placenta which causes a slowing down or stopping of the fetal breathing movements (FBM).

With the work of the musculature of the diaphragm and intercostal muscles suspended, there is more blood flow to vital organs, including the brain. You can see the decrease in FBM on a biophysical profile, as you normally see the fetus moving these muscles about 40 percent of the time. When the baby is born and the prostaglandin level is still high, the baby’s muscles for breathing simply don’ t work, thus engaging the first inhibitory response.

A second inhibitory response is the fact that babies are born experiencing acute hypoxia or lack of oxygen. It is a built - in response to the birth process. Hypoxia causes apnea and swallowing, not breat hing or gasping. If the fetus were experiencing severe and prolonged lack of oxygen, it may then gasp as soon as it was born, possibly inhaling water intothelungs.

If the baby were in trouble during the labor, there would be wide variabilities noted in the fetal heart rate, usually resulting in prolonged bradycardia, which would cause the practitioner to ask the mother to leave the bath prior to the baby’s birth.

The temperature differential is another factor thought by many to inhibit the newborn from initiating the breathing response while in water. The temperature of the water is so close to maternal temperature that it prevents any detection of change within the newborn. This is an area for reconsideration after increasing reports of births taking place in the oceans, both now and in eras past. Ocean temperatures are certainly not as high as maternal body temperature, yet babies that are born in these environments are reported to be just fine. The lower water temperatures do not stimulate the baby to breathe while immersed.

One more factor that most people do not consider but which is vital to the whole waterbirth and aspiration issue is the fact that water is a hypotonic solution and lung fluids present in the fetus are hypertonic. Even if water were to travel in past the larynx, it could not pass into the lungs based on the fact that hypertonic solutions are denser and prevent hypotonic solutions from merging or coming into their presence.

The last important inhibitory factor—the dive reflex—is associated with the larynx. The larynx is covered all over with chemoreceptors, or taste buds. In fact, the larynx has five times as many taste buds as the whole surface of the tongue. When a solution hits the back of the throat and crosses the larynx, the ta ste buds interpret what substance it is and the glottis automatically closes; the solution is then swallowed, not inhaled. God built this autonomic reflex into all newborns to help them breastfeed, and it is present until about the age of six to eight months when it mysteriously disappears. The newborn is very intelligent and can detect what substance is in its throat. It can differentiate between amniotic fluid, water, cow’s milk or human milk. The human infant will swallow and breathe differently when feeding on cow’s milk or breastmilk due to the dive reflex.

All these factors combine to prevent a newborn who is born into water from taking a breath until he is lifted up into the air.

Baby’s First Breath
What initiates the breath in the newborn? As soon as the newborn senses a change in the environment from the water into the air, a complex chain of chemical, hormonal and physical responses initiate the baby’s first breath. Water born babies are slower to initiate this response because their whole bod y is exposed to the air at the same time, not just the caput or head as in a dry birth. Many midwives report that water babies stay a little bit bluer longer, but their tone and alertness are just fine. It has even been suggested that water born babies be    given the first APGAR scoring at one minute thirty seconds, not at one minute, because of this adjustment.

Several things happen all at once in the baby. The shunts in the heart are closed; fetal circulation turns to newborn circulation; the lungs experience oxygen for the first time; and the umbilical cord is stretched causing the umbilical arteries to close down. Nursing and medical schools taught their students for years that the first breath was dependent on the pressure of the passage through the birt h canal, and then a reflexive opening of the compressed chest creating a vacuum. That action has no bearing on newborn breathing whatsoever. There is no vacuum created. The newborn born into water is protected by all the inhibitory mechanisms mentioned above and is suspended and waiting to be lifted out of the water and into mother’s waiting arms.

All the fluids present in the lung alveoli are automatically pushed out into the vascular system from the pressure of pulmonary circulation, thus increasing blood volume for the newborn by one -fifth (or 20 percent). The lymphatic system absorbs the rest of the fluids through the interstitial spaces in the lung tissue. The increase of blood volume is vital for the baby’s health. It takes about six hours for all the lung fluids to disappear.

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