Study Shows Benefits of Underwater Birth 2003

Information from Medscape Nursing [Nurs_news@mp.medscape.com]

By Hannah Cleaver. BERLIN (Reuters Health) Jan 22, 2003 - Giving birth in water should no longer be considered an "alternative" method restricted to specialist centres, according to European researchers who evaluated the outcome of more than 1500 births.

Drs. Albin Thni and Konrad Mussner, from the regional hospital in Sterzing in the South Tyrol region of northern Italy, compared data from 969 water births, 515 births in bed and 172 using a birthing stool.

After removing complicated births that required vacuum extraction, other manual help or epidural anaesthetic, the results show a clear advantage for water births. They report in the December issue of the German-language journal Geburtshilfe und Frauenheilkunde (Obstetrics and Gynaecology).

"Our results suggest that water birth is associated with a significantly shorter first stage of labour, a lower episiotomy rate, fewer perineal lacerations and reduced analgesic requirements compared with other delivery positions. Water birth appears to be safe for the mother and the foetus-neonate if candidates are selected appropriately," they write. Average duration of first-stage labour was 381 minutes for women in water compared with 473 minutes for those using the other delivery methods. There was no difference in the duration of the second stage of labour. The rate of episiotomy was significantly lower when the women were in water (0.52%) compared with 17.2% of those in traditional beds and 7.6% on stools. Water births were not associated with an increase in perineal tears, which remained at 23% in all groups. Of women having their first child, 58% experienced no lacerations during a water birth compared with 36% of those on traditional beds and 48% of those on a stool. None of the women giving birth in a pool needed analgesics. Other factors examined included arterial cord blood pH, and maternal haemoglobin levels at baseline and postpartum. No differences among the three groups were found. The researchers report that much criticism of water births has been based on ideas that are no longer valid, such as that the child might aspirate water and drown. This can be ruled out, they wrote, as the reflex to breathe air is only activated once the child's head comes into contact with air.

"We believe that the water birth will lose its 'outsider' status and will, in the next few years, will take up a fixed place in obstetrics. It leads to minimal intervention and is a woman-friendly method and thus results in higher satisfaction of the mother," they conclude. Geburtshilfe und Frauenheilkunde 2002;62:977.

Büscher T, Noordermeer Y, 2010

Afstudeer onderzoek naar de bereidheid van Nederlandse verloskundigen om een waterbevalling te begeleiden. http://prezi.com/mn-hikg7q65e/een-sprong-in-het-diepe/.

Birth Facts

Site over alle ins-and-outs van bevallen in water. http://www.thebirthfacts.com/site/content.asp?id=104

Large-scale study Waterbirths, 2011

A large-scale study of waterbirths in the UK showed a decrease in perinatal mortality from 4 per 1,000 conventional births down to only 1.2 per 1,000 for waterbirths. http://en.wikipedia.org/wiki/Water_birth.

Siegel, P. 1960

OB/GYN 15, 660-61

Does water enter the vagina? 10 Woman, 5  in last two weeks of pregnancy, 5 in first days of puerperium. Potassium iodide added to tub water. Lukewarm water, avoid evaporation. Parity (para 2-para 10). No instance of tampon contamination.

Rosenthal, M. 1991

The Female Patient 16, 44-50

Water Immersion most beneficial for the “exhausted” woman in labor and/or one whose labor is “dysfunctional”.   “Helpful to a majority of women” .

Burke, E. & Kilfolyle, A., 1995

Midwives Journal, January, p 3-7. Retrospective comparative study of water birth and bedbirth.

50 Water births and control group of 50 bedbirths. Cervical dilation, state of membranes, AROM vs. SROM, length 1st stage, length of 2nd stage, state of perineum p delivery, analgesia in labor, neonatal assessment, interventions in labor:

-overall incidence of perineal trauma higher in bedbirth group-more intact perineums in waterbirth group-mean Apgar scores were the same for both groups

-no women in the waterbirth groups received any other intervention in their labour

-when questioned, 100% felt their contractions were easier to cope with once they entered the tub; 98% of multips said it was easier than previous land birth; the women's comments "highlight     women's desire to be in control and to move freely, and the self-satisfaction at giving birth naturally without drugs."


Enning, C. 2006 studied Psychologies and Education at the Free University of Berlin (Germany) besides the Midwifery Training in Berlin-Neukölln and Waldorf Teacher in Stuttgart. She is the head of Parents´Association Waterbabies awarded by State and Community Ba-Württemberg 2001, author of 5 books about Aquamidwifery/Aquaobstetrics and many international literary and training work.

Water is helpful at external versions, breech births, preventing tears and hemorrhages, and even to normalize pre-eclampsia births. Under water immersion intensifies the maternal perception and the non-verbal communication by slowing down movements. Waterbirth preparation focusses more on an individual birth biotope, and a selfdetermined antenatal care. The water application, sometimes combined with naturopath medicines, decreases maternal distress and by that regulates down the newborns´ distress tolerance, a blueprint for life. To give birth in water allows to save the intact membranes. Unborn babies do not store endorphines in their brain, but in their amnion fluid. To save the caul means to save the fetal endorphines and to avoid birth distress.  The secret of water application has been revealed by so called “Waterhealers” since the 16th century. They handed down, that water works as a conductor for temperature: The cooler the water, the more buyoncy. Knowing the water effects aquamidwives have a tool to substitute vaginal examinations. The Aqua-Partogram shows the birth process in hours to temperature. If women are allowed to stay connected with their biological birth pattern, babies will be able to labour themselves at the rotation through the maternal pelvis. Birth reflexes will maturate to voluntary motion by fetal birth activity. Consciousness at birth will result into lifelong motivation to learn. A successful kinesthesia will help to complete the excellent fetal capability of adaptation to different environments on earth.

Waterbirth and and continuing Early Babyswimming give the chance to observe scientifically newborn´s  behaviour. With these datas of waterbirth and Early Babyswimming researchers will profit as midwifery does.

Odent, M

The Lancet, December 24/31, p 1476

None-report of 100 waterbirths attended by French obstetrician

-"water seems to help many parturients reach a certain state of consciousness where they become indifferent to what is going on around them."

-Nearly all the women who enter the pool leave it before the birth

-"water seems to facilitate the development of the mother-infant relationship."

-"(we) have found no risk attached either to labour or to birth under water.."

-“immersion during the second half of the first stage of labour is helpful."

-"(we hope) that (other experiences would confirm) immersion in warm water is an efficient, easy, and economical way to reduce the use of drugs and the rate of intervention in parturition."

Walden-strom U. & Nilsson, C., 1992

Birth 19(2), 57-63

Investigate the effects on maternal and infant outcomes of women taking a warm tub bath after SROM at term.

Retro-Spective analysis of 89 women took a warm tub bath after SROM- matched control group of 89

Independent:  time interval from SROM to delivery, IP antibiotic treatment for maternal fever.

Dependent:  Apgar scores, neonatal morbidity, neonatal LOS, maternal C/S & vacuum extraction

Women in the control group used more analgesia and oxytocin stimulation during labor and delivery than those in the bath group.

NO statistical difference was observed between the groups for Apgar scores at 1 and 5 minutes.

Differences in neonatal morbidity and length of hospital stay were not statistically significant.

No effect of the duration of bathing on neonatal outcome was demonstrated.

"Warm water is a valuable means to achieve relaxation and pain relief during the first stage of labour".

Kitzinger, S., 1995

Birth 22(3), 172-73

None- descriptive report from an attendee of the International Water Birth Conference in London in 1995

Report gave synopsis of reports from Austria, Belgium, Malta, France, Germany, Denmark, the United States, & Britain.

"(The use of water) represents an approach to childbirth that enables the birthing woman to have autonomy. It changes the enviroment and the quality of interaction among all thos involved.

Gilbert, R & Tookey, P., 1999

BMJ vol 319, 483-487.

To compare perinatal morbidity for babies delivered in water with rates for babies delivered conventionally (not in water).

Surveillance study (of consultant paediatri-cians) and postal survey (of all NHS maternity units).

British Isles, England & Wales.

Babies born between 1994-1996. 4032 deliveries.

Labor, delivery, use of water, baby’s condition, diagnoses, treatments post delivery, admission to special care nursery.

The similarity in perinatal mortality and morbidity in low risk women suggests that delivery in water does not substantially increase adverse perinatal outcomes.

No deaths were directly attributable to delivery in water.

Waterbirth Bibliography (short version)

Alderdice, F., R., Mary, Marchant, S., Ashurst, H., Hughes, P., Gerridge, G., and Garcia, J. (April 1995). Labour and birth in water in England and Wales. British Journal of Medicine, 310: 837.

Alderdice, F., Renfrew, M., Marchant, S., Ashurst, H., Hughes, P., Gerridge, G., and Garcia, J. (July 1995). Labour and birth in water in England and Wales: survey report. British Journal of Midwifery, 3:7:375-382Andersen, B. Gyhagen, M. Nielsen, TF (1996 Sept) Warm bath during labour. Effects on labour duration and maternal and fetal infectious morbidity. Journal of Obstetrics and Gynaecology, Vol 16, No 5, pp 326-33

Balaskas, J. (2004). Water Birth. London: Thorsons.

Baxter, L. (2006) What a difference a pool makes: Making choice a reality. British Journal of Midwifery. 14 (6), 1-5

Beech, (November, 1996). Water Birth Unplugged. Books for Midwives Press. London.

Benfield, R. D., Herman, J., Katz, V. L., Wilsonv, S. P., & Davis, J. M. (2001) Hydrotherapy in labor. Research in Nursing & Health, 24, 57-67
Bertram, Lakshmi (2000). Choosing Waterbirth – reclaiming the sacred power of birth. Charlottesville, Hampton Roads
Bowden, K., Kessler, D., Pinette, M., Wilson, D Underwater Birth: Missing the Evidence or Missing the Point? Pediatrics, Oct 2003; 112: 972 - 973.

Burns, E. (2001) Waterbirth. MIDIRS Midwifery Digest, 11 (3), S10-3

Cluett, E., Pickering, R., Getliffe, K., Saunders, N. (2004 26 Jan) Randomised controlled trial of labouring in wtaer compared with standard of augmentation for management of dystocia in first stage of labour.  British Journal of Medicine 328(7442):768

Cochrane Review (2001) (From The Cochrane Library) Immersion in water in pregnancy, labour and birth. Issue 2 Prepared and published by Update Software Ltd.
Enning, C. (2003). Waterbirth Midwifery: A training book. Hippokrates, Stuttgart, GermanyGarland, D. (Dec. 2002). Collaborative Waterbirth audit - "Supporting Practice with audit" MIDIRS Midwifery Digest, Vol 12, No 4, Dec 2002, pp 508-511

Garland, D. (2006). On the crest of a wave: Completion of a collaborative MIDIRS Midwifery Digest, Vol 16, (1)  81-85

Garland, D., Crook, S (March 2004) Is the use of water in labour an option for women following a previous LSCS.  MIDIRS Midwifery Digest Vol 14, No 1 pp 63-67

Garland, D., & Jones, K. (1997) . Waterbirth: Updating the evidence. British Journal of Midwifery, 5 (6), 368-373

Geissbuehler, V., Stein, S., & Eberhard, J. (2004).  Waterbirths compared with landbirths: An observational study of nine years. Journal of Perinatal Medicine, 32, 308-314

Geissbuhler, V., Eberhard, J., (2000) Waterbirths: A comparative study, a prospective study on more than 2000 waterbirths. Fetal Diagnosis and Therapy Sept-Oct; 15(5):291-300

Gilbert, Ruth E., Tookey, Pat A. (1999) Perinatal mortality and morbidity among babies delivered in water: surveillance study and postal survey. British Medical Journal ;319:483-487 (21 August)

Harper, B. (2005). Gentle Birth Choices. Vermont: Healing Arts Press, Inc.

Harper, B (Summer 2000) Waterbirth Basics: from newborn breathing to hospital protocols. Midwifery Today, 54: 9-15, 68

Harper, B (Dec 2002) Taking the plunge: reevaluating water temperature. MIDIRS Midwifery Digest, Vol 12, No 4, Dec 2002, pp 506-508

Nguyen S, Kuschel C, Reele R, Spooner C. Water birth – a near –drowning experience. Pediatrics. 2002; 110:411-413

Odent, M. (1996). We are All Water Babies - Berkeley: Celestial Arts.

Odent, M (1997) Can immersion stop labor? Journal of Nurse Midwifery, Vol 42, No 5 pp 414-416Odent, M (1998 March) Use of water during labour - updated recommendations MIDIRS Midwifery Digest, Vol 8, No 1 pp 68-69Schuman, A. J. (2006) When parents-to-be ask about water birth. Contemporary Pediatrics, 23 (11), 84-90

Thoni, A., & Muroder, L. (2004). Waterbirth: A safe and natural delivery method – experience after 1355 waterbirths in Italy. Midwifery Today, 14, 44-48

Thoni, A., & Mussner, K., Moroder, L. (2004) The risk of infection during waterbirths.  Midwifery Today, 14, 46

Woodward, J., & Kelly, S. M, (2004) A pilot study for a randomized controlled trial of waterbirth versus land birth. British Journal of Obstetrics and Gynaecology. 111, 537-545

Zanetti-Dallenback, R., Lapaire, O., Maertens, A., Frei, F., Holzgreve, W., & Hoslit, I. (2006). Waterbirth:, more than a trendy alternative: A prospective, observational study. Archives of Gynecology and Obstetrics, 274, 355-365