Immersiion In Water During Labor And Delivery

     Immersion in water has become popular in certain circles and many facilities offer it as an alternative way to give birth. The April, 2014 issue of Pediatrics published a joint clinical report on immersion labor and delivery issued by both the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists.

     Advocates of immersion during labor and delivery argue that it decreases pain, decreases maternal stress, decreases trauma to the vagina and gives the infant a gentler transition into the world.

     The report in Pediatrics examined the statistical data available for immersion during both the first and second stages of labor and during delivery. They found that immersion in the first stage of labor was associated with a decreased need for epidural, spinal and cervical pain relief. It also reduced the first stage of labor by about 30 minutes. However, there was no difference in vaginal tears and no reduction in the need for cesarean delivery. They found no benefit to the mother with immersion during the second stage of labor. There was no measurable benefit to the infant from immersion during either labor or delivery.

     The report did find that immersion caused an increase in complications for both the mother and the infant. There were higher rates of maternal and infant infections, especially if there had been rupture of membranes. There were reports of infants having severe bleeding from ruptured umbilical cords, infants having hypothermia and infants having episodes of drowning and near-drowning.

     The most serious complications were the drownings and near-drownings. The advocates of immersion birth claim that the infant is protected from inhaling water by the mammalian diving reflex. A Cochrane review in 2009 stated that they found no adverse effects on the infant from immersion, but this study excluded 12% of the infants delivered by immersion who had to be admitted to the Newborn Intensive Care Unit as compared to none in the group delivered without immersion. It also ignored reports of drowning and near-drowning from England in 1995 and a report in 2010 of 4 infants who had severe respiratory distress after water birth. There is a great deal of evidence in both experimental animals and in human infants that the decrease in oxygen which occurs during delivery causes the infant to gasp (which is exactly what Nature intends the infant to do) and the need to take that first breath overrides the diving reflex.

     The conclusion of the 2014 report was that immersion during labor and delivery should be considered an experimental procedure and that the risks involved dictate that it should only be done as part of a closely controlled scientific study.