In Memory Of

About one year ago, the young son of a friend of ours died. He was 4 years old and adorable. This post is in his memory.

To protect their privacy, I won't give his name or exact details of his death, but he died accidentally, just kids being kids. No one really at fault, just a freak accident, a bolt out of the blue. It was unexpected and devastating.

This death affected me so strongly; I'm not quite sure why. Obviously there is tremendous sadness and empathy for parents whenever a child dies; it's just something that seems so wrong and so contrary to what the natural order of things should be. And who could be unaffected by the pain of parents losing a child? Yet it seemed to have deeper echoes for me.

Intellectually, I know the fact that it fell near the first anniversary of the death of a member of our own extended family amplified the sorrow I felt. I was already raw and bracing myself for the anniversary of that death; to suddenly have this death happen so close to that was even more overwhelming.

And because our school is a very small, closely-knit community, this death echoed more deeply than it might have elsewhere. This child had older siblings who are in classes with my own children. I've worked with these siblings in special activities. We see them at school functions constantly.

In fact, we saw them the night before the accident at a school function, and I think that amplified the sudden nature of it all. We had just seen him happy and playing and romping about like everyone else the night before, only to get a call the next morning that he was dead.

The timing of it all just emphasized the fickleness of fate and how quickly things can change at any time, for anyone. As parents, we try to live in denial of that---an understandable coping mechanism---but this brought home that lesson very quickly and very hard, and made us all feel that much more insecure in our own lives.

Perhaps the strongest factor in my own grief was the fact that I too have a little one, not quite the same age as this boy but close enough. In fact, they might have been classmates eventually. Losing him was like vicariously losing my own youngest and most vulnerable child. It ramped up my fears and made me paranoid, wondering what unavoidable disaster was around the corner, waiting for my little one, waiting to break my heart. The grief and fear of that still lives with me, even now.

And oh, the sadness of it all was so hard. We went and sat with the family the next day, visiting with them, bringing them food for the freezer, etc. The issue of pictures really hit me the night of his death.....Oh my God, they now have all the pictures of this beloved child that they will EVER have.....so I spent a bunch of time searching out any images of this child from our own photos, enlarging and framing them for the family. They were only images from the backgrounds of other photos, nothing really good, but I figured if it were me I'd want ANY image I could get, anything more to remember him by.

One of the most heart-wrenching things was sitting with the mother, going through all her pictures of her little one. We were smiling over some of the pictures, reliving some happy moments, when she said sadly that she kept looking at pictures of him over and over again, trying to remember what he looked like in life instead of what he looked like in death. She was the one who held him in her arms as he died, and she said that all she could see now when she thought of him were all his injuries and what he looked like with them. She hoped that someday, if she looked at enough pictures of him from life again, she'd remember those healthy-and-alive images instead of the images of blood and trauma. Oh God, that just broke my heart. Imagine having trouble remembering your child whole.

So I write this in memory of this little boy, to honor him and everything his family has gone through. I honor the fact that they have made it through the first year, despite a health crisis in the father, difficult moments for all the siblings, and such soul-crushing loss for the mother that she almost seemed to waste away in front of our eyes for a while.

I am pleased that they are beginning to regain some sense of balance again, though I know their grief will always be with them and there is still much work to do. Sometimes the second year is harder than the first, because the denial and the shock and the magical thinking start to wear off and you are only left with the stark realities of the loss. We will do all we can to be there for them, but in the end of course, no one can walk this journey for them. They must find the way themselves, their own unique way of grieving, their own way of honoring and remembering this precious little boy.

I woke up early this morning, unable to sleep for thinking about this. It was a year ago it all happened, and we will be going to a memorial/celebration of his life this weekend, so I'm sure that's why it's so on my mind. But also, I recently ran across a post at the blog, The True Face of Birth, linking to an essay about death and loss by Robbie Davis-Floyd, a birth activist and author. It certainly echoed and focused the thoughts that were already on my mind as we approached this anniversary.

Davis-Floyd's own daughter, her eldest child, died just short of her 21st birthday. She died in a car accident on her way home to celebrate her birthday with her family. Davis-Floyd wrote this essay several years after the loss to describe her own perspectives on birth and death and on living with loss.

Twenty years and 361 days later, after diapers and walking, blissful breastfeeding, chauffering her to gymnastics and dance lessons, and sharing her joys and sorrows late at night while she poured out her heart to me from behind the shower curtain, I stood by her body in the hospital room, surrounded it with my arms, and poured out my own heart to her corpse. She had been dead for 22 hours, but my mother’s heart could not believe that I could not call her back until I tried. I talked, I screamed, I sobbed, I begged her to live and breathe again. I told her I could not live without her. I touched every part of her body and begged the skin to twitch, the head to turn, the legs to move--anything to show me that this wasn’t reality, that this inert but gorgeous body lying in front of me was not really lifeless, that those stunning dancer’s legs were never going to plié again, that those graceful hands would never again arc, that those lips would not move to kiss mine or to smile, that her voice would never again say, "Mommy."

...I have been happy all my life, living out of a deep wellspring of joy bubbling up within me. When Peyton died, I lost that deep bubbling happiness--it comes back now only in fleeting moments all the more precious for their scarcity. I have a wonderful son, many friends, and a fulfilling career. But I have lost the very most precious thing in my life, and no platitudes about how I will see her again in heaven, or we will be united past this life, or she is always with me in spirit (which I know to be true) can alleviate for more than a little while the exquisite agony I always feel about her death. I thought I knew the meaning of suffering before she died--I had already experienced a good deal of pain and loss in my life--but I had absolutely no clue what real suffering was.

The rest of Davis-Floyd's essay can be found here. I highly recommend reading it, but you should know ahead of time that it's a hard read. She graphically describes seeing her daughter's body after the car accident, spending time with its wounds, washing the body and cleaning it up, but she also describes the things that she and others did that helped her along her way in those first days of shock and grief.

As painful as this essay is, it's also powerful and even healing. I sobbed and had to take a few breaks to get through it, but it was profound and deeply-affecting reading. I know that many people will not follow the link and read it (and if you are in a fragile or vulnerable place, feel free not to), but I hope some people will go there and check it out, because really, who among us will not experience the death of a loved one at some point? Or the death of a friend's loved one?

It's an amazing essay, gut-wrenching but also thoughtful and ultimately affirming. She concludes:

When I gave birth to my son at home, I learned the power of surrender to the tremendous force of life. Now I am learning the power of surrender to the tremendous reality of death. May these two kinds of surrender balance and sustain me, teach me to let go of my fight to understand, and embrace the paradoxes my life encompasses. Like a mother who has just had the courage to give birth without knowing who her child will become, I am here, not knowing who I will become, but open, cracked wide open, to whatever life may bring.

There is a saying that is passed around so often on the internet that it has become trite and mundane, yet there's a reason why it's become so well-circulated---it speaks to a universal truth. I am reminded of it in this situation:

"Making a decision to have a child- it's momentous. It is to decide to have your heart go walking around outside your body." Elizabeth Stone

Yup, it really is like that. You feel THAT vulnerable. And yet, think of all the beautiful and wonderful things you would have missed had that child not been a part of your life. It is the greatest blessing that can be given to us, which is why it can be the greatest grief that happens to us too.

The capacity for joy is also the same capacity for loss, and it's so hard to acknowledge that double-edged sword. It's why pregnant women feel so vulnerable, it's why we check our baby's breathing 4,972 times a night, it's why reading about other people's losses is difficult, and it's why watching another family go through your greatest fear is so incredibly hard.

God grant strength and healing to our friends who are mourning their little boy this week, God grant peace to all families who have experienced such a loss, and God grant strength and wisdom to all of us who fear such a loss and must watch others endure it.

So Why the BMI Restrictions in Waterbirth?

Waterbirth offers unique advantages to women in labor. According to http://www.waterbirth.net/,

Lying in warm water increases venous pressure so that veins can return blood to the heart more efficiently and your baby receives more oxygen. It enhances cardiac action and slows the pulse rate. Total relaxation in the warmth and comfort of the water helps the uterus to contract more effectively. Water also counteracts the force of gravity and any pressure a woman feels inside her body, so there is a further pain relieving effect. Water helps the woman surrender to the birth process and it creates a feeling of tranquility to the whole birth experience.

However, as we discussed previously, some birth facilities have restricted fat women from having access to water during labor and/or birth.

On the other hand, some facilities are very supportive of it, even in very large women. It all depends on the facility and the provider.

However, with the increasing trend towards seeing fat women's pregnancies as extremely "high risk" (regardless of whether they actually experience complications), I anticipate that we will see more and more BMI restrictions against waterbirth and other "alternative" birth modalities take root.

But are they justified?

So Why Not Have Waterbirth Access for Fat Women?

The following are some of the reasons typically given for restricting fat women's access to waterbirth, along with an analysis of the attitudes and reasoning behind them.

Waterbirth Is Only For "Low-Risk" Women

Of the hospitals that have embraced waterbirth, some have embraced it tepidly, with many restrictions. In particular, hospitals that are tentative about waterbirth usually restrict its use to "low-risk" patients only.

Since fat women are automatically seen as "high-risk" by many doctors (even when they have not developed any complications at all), some hospitals have BMI cutoffs, above which waterbirth is not an option anymore.

Applying the "high risk" label (and accompanying restrictions) across the board to all women of size is ridiculous. If a fat woman has had a healthy pregnancy, developed no complications, and is a reasonably active and mobile person, there is no justification for keeping her from resources in labor (like walking, immersion in water, a birth ball, position changes, etc.) that just might help her labor progress more "normally" and avoid an unnecessary cesarean.

The Ticking Time Bomb Theory

Another reason some hospitals restrict waterbirth in women of size is the perception of all obese women as having blood pressure issues (latent or overt), and therefore being at risk to stroke out at any moment during labor. This is a direct result of hyperbole about the perceived risks of obesity and increasing promotion of the idea that a fat woman's pregnancy is ultra high-risk.

Ironically, research shows that being immersed in water actually tends to lower blood pressure, and may actually be a good way to help prevent such an issue. Although it's not true that fat women are ticking time bombs just waiting to stroke out in labor, if it were, hospitals might actually be preventing these women from one intervention likely to help them KEEP normal blood pressure. Talk about short-sighted!

The Shoulder Dystocia Fear

Another concern is shoulder dystocia (baby's head is born but the shoulders get stuck on the way out). Fat women are perceived to be more at-risk for shoulder dystocia, and doctors are afraid that taking time to get the mother out of the water might delay emergency measures needed to get the child born safely.

However, several studies have shown that when baby size and diabetes are controlled for, obese women are no more likely to experience shoulder dystocia than women of average size. Just being fat does NOT increase the risk for shoulder dystocia, and forbidding waterbirth on that basis alone is illogical and unfair.

However, fat women do tend to have bigger babies, on average (although it should be noted that even so, MOST fat women do not have big babies). Because bigger babies have higher rates of shoulder dystocia, many healthcare providers fear having ANY fat woman birth in the water.

Their concern is that being in water might cause a delay in the maneuvers that may be needed to relieve shoulder dystocia. But healthcare providers experienced in waterbirth know that shoulder dystocia may be less likely in waterbirth because of the mother's ability to shift position easily and open up more space in the pelvis by being off the tailbone. One study found a shoulder dystocia in waterbirth rate of 0.16%, hardly a raging epidemic.

Experienced waterbirth providers point out that when they have encountered a shoulder dystocia in the water, often all that needed to be done was have the mother shift to hands and knees, or to stand up in the water with one leg on the side of the tub, creating an asymmetrical space in the pelvis that helps free up the baby's shoulders.

If that didn't work, they note that the process of helping the woman get out of the tub was usually enough to rotate the mother's pelvis around baby's shoulders and get the baby out without further maneuvers. And if it was not, the birth attendant can then do all of the usual maneuvers once the woman is out of the water.

Most providers who are experienced in waterbirth do not believe that potential shoulder dystocia concerns are a reason for forbidding waterbirth.

The Fear of a Getting a Fat Woman Out of Water

Probably the biggest reason why women of size are restricted from waterbirth is the fear of a fat woman passing out or having a medical emergency while in the water, and what might be necessary to deal with that. Because they see fat women as SO high-risk, they view this as a likely possibility, and are acting accordingly.

Although one can understand how a hospital might be concerned about how they would get such a large person out of the water or initiate emergency treatment quickly, we must remember that such a medical emergency is rarely instantaneous and there are almost always warning signs that suggest a change in laboring location and closer monitoring.

The nightmare scenario they fear is extremely unlikely (especially in a spontaneous labor with no drugs or medications, which is what a waterbirth should be). To restrict ALL fat women based on such an unlikely scenario is an extremely unfair balancing of the risks/benefits ratio.

However, let's be frank....the hospital's administration is also worried about potential workmans' compensation claims if a worker injured his/her back trying to get a woman of size out of the water during an emergency. These are understandable concerns from a hospital's risk management point of view, but Barbara Harper (director of Waterbirth International) addresses this below. The long and the short of it is that they may actually put their workers at greater risk by making supersized women birth outside the water, especially since immersion in water tends to make obese women more mobile and easier to help maneuver.

The Solution: Individualize Waterbirth Decision-Making Instead

Barbara Harper suggests that instead of facilities instituting across-the-board BMI restrictions on access to water, they should make case-by-case judgments, taking into account the mother's blood pressure status, her fitness, her general mobility, and whether there there have been any complications during the pregnancy.

Instead of forbidding waterbirth to all women of size, decision-making could be individualized to acknowledge the differences in the spectrum of fat women giving birth. This is a common-sense approach that makes a LOT of sense.

Finally, an important question is whether such BMI restrictions on waterbirth are justified by actual research, or just hospital administrators' fears of risk. Doctors and hospitals are striving to become more evidence-based in their practices; what does the evidence say here?

I wrote to Barbara Harper and asked her this question, and this was her reply:

Thank you for writing in your question about waterbirth studies and policies concerning BMI restrictions for women wanting waterbirths.

I am very much in opposition to such practices, but acknowledge that they do exist in many hospitals and some birth centers.

The water is THE VERY BEST PLACE for an overweight parturient woman. She can move in the water, control her body, respond better to the movements of the baby and feel much better physically after the birth because of the buoyancy effect on her muscles and cardiovascular system.

I don't see why every hospital isn't seeing that they could save hundreds of cesareans on plus-size women by PUTTING them in water as an intervention.

But, the great liability monster raises its ugly head and the hospital then becomes fearful of employees hurting their backs if they had to get a woman out of the water during an obstetric emergency. Thus the development of policies to protect the hospital against workers compensation cases.

When I teach the professional Waterbirth Credentialing workshop I do address BMI weight restriction policies and insist that hospitals treat each woman individually and not restrict the woman who presents in labor at 250 pounds who has gained 60 pounds during her pregnancy, just on the basis of the final number. I implore them to look at activity levels and pre-pregnancy weight and pre-pregnancy activity levels.

I have been successful in having the BMI policies removed from some hospital protocols, but not with others.

There is no available scientific evidence one way or the other, with the exception that we did a search both in the US and in the UK to find workers compensation cases for back injuries in labor and delivery settings. There were some, but none related to water. Holding the leg of a 300 pound woman while she is pushing is much harder than helping her in and out of the bath.

--Barbara Harper, RN, CLD, CCE
Founder/Director of Waterbirth International
www.waterbirth.org

Waterbirth IS a Reasonable Choice for Fat Women

Waterbirth is a very viable choice for women of size. Although it offers advantages for all women, it offers additional advantages for women of size, ones which might help improve birth outcomes in this group.

If doctors and hospitals really are interested in lowering the rate of cesareans and other complications in women of size, waterbirth is one more important tool to have in their toolbox. It shouldn't be automatically removed from the equation, based simply on size.

Although some fat women are discouraged from waterbirth, rest assured that many women of even very large sizes have labored and even birthed their babies in the water. If this is something YOU are interested in, it IS still a choice. As a woman of size, you might have to work harder in order to access this choice than a woman of average size, but it IS still a choice.

Some birth centers have waterbirth options. Some of these may have BMI restrictions, but some do not. Some may be amenable to negotiation about these restrictions; some may not. It can't hurt to ask. If they won't permit waterbirth in a woman of size, take your business elsewhere.

Most hospitals these days offer the option to at least labor in water. Again, some deny this to obese women, but many do not. However, if you encounter a hospital that won't allow you even to labor in water simply because of size, it's likely that they are not size-friendly in many other ways either, and you should strongly consider another birth place if at all possible.

Although waterbirth (actually pushing out the baby in water) is not as common in US hospitals as it is in European hospitals, there ARE a number of hospitals that do offer it. If you prefer to birth in a hospital, you can check with Barbara Harper to see if there are any in your area that are open to waterbirth. She keeps a list of waterbirth-friendly hospitals.

Additionally, Barbara's organization, Waterbirth International, has worked in the past with hospitals who have a "no waterbirth" policy. If you give plenty of advance notice so they can review this policy, if you have a provider supportive of the idea of waterbirth, and if you are willing to act as a strong advocate with the hospital, they may be able to help you establish waterbirth policies in that hospital, or to at least allow an exception to the rule for you as an individual. They do ask that you join Waterbirth International and make a donation to help cover their costs while doing this, but they say they are able to work with many hospitals and find an acceptable compromise.

And of course, waterbirth is always a choice at home, and homebirth is a more reasonable option than most people think. Many homebirth midwives offer waterbirth services (often including rental of a waterbirth tub, or information on other waterbirth choices) as part of the spectrum of their care. Many of the women of size that I have known who have actually given birth in water have done so at home. It's where I had my own waterbirth.....and it was an AWESOME experience.

Wherever you choose to give birth, waterbirth remains a possibility.....and it may be especially advantageous in women of size. It's definitely something for you to further research if you interested in it. I also urge hospitals, birth centers, and birth professionals to work to keep immersion during labor and waterbirth itself an option for women of ALL sizes.

*The waterbirth photo at the top of the entry is of a "morbidly obese" medical professional who gave birth to her third child in the water at home.

There is also a lovely waterbirth video at:http://www.youtube.com/watch?v=MrbXXZ2Fqg0

General Information about Waterbirth

In previous posts, we have been discussing BMI restrictions on laboring and birthing in water, and whether by restricting waterbirth in women of size, they are depriving fat women from an option likely to improve birth outcomes.

The first question that has to be addressed is why waterbirth isn't more common for ALL women, regardless of size. If it's so advantageous, why the resistance to waterbirth in general in the United States? And I'm sure many readers from the fatosphere have some basic questions about waterbirth in general.

So today's post contains basic information about waterbirth and addresses the typical concerns people might have about waterbirth.

In another post soon, we will discuss why some birth facilities have BMI restrictions on who can labor and birth in the water, and whether those restrictions really have any merit or not.

Why the Resistance to Waterbirth?

If laboring in water could help a woman have a shorter, less painful labor, lessen the chances of an episiotomy, and help her be more mobile during the birth......all without the significant risks of epidurals and pain medications...........shouldn't doctors and hospitals be interested in such a low-risk intervention?

You would think doctors and hospitals would be falling all over themselves to embrace waterbirth........but the sad truth is that they're not. Some are still stuck in the technological model of birth, resistant to information about the efficacy and safety of waterbirth.

The following are the main concerns about waterbirth usually brought up by doctors and hospitals, along with research showing lack of harm from these issues, and how they can be dealt with proactively and safely.

How Does The Baby Breathe?

The first concern usually raised is that the baby born in water might inhale the water with its first breath and drown. This concern is addressed in detail at the waterbirth FAQ from Waterbirth International's website. According to them:

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.

As long as the baby is not in distress and as long as the baby is brought to the surface in a timely manner, research shows that waterbirth is safe. After all, babies were in a liquid in-utero environment already; being born in water simply eases the transition from the uterus to the outside world.

Concern about Infection

Some doctors are concerned about potential risk for infection, even though research shows no greater risk for neonatal infection or maternal infection in waterbirths.

Proper hygiene measures are vital of course, but as long as these are followed, there is no increase in the risk of infection.

Lack of Access to the Perineum

Some doctors object to anything impeding their view of (and access to) the perineum at birth. Of course, less access to the perineum means less chance to cut episiotomies, which is one of the major advantages of waterbirth.

Because they have been trained to be very "hands-on" during delivery, less access to the perineum tends to make doctors feel less in control, and this makes them nervous. But once doctors become experienced in attending waterbirths, they adjust to this approach just fine. It's all a matter of willingness to learn a new approach.

Difficulty of Evaluating Blood Loss During Waterbirth

The difficulty of evaluating blood loss during waterbirth is a legitimate concern. In all births, care providers must watch mothers carefully to be sure they are not bleeding excessively after the placenta detaches. Care providers learn how to estimate blood loss in land births, but this is more difficult in water because the water dilutes the blood. As a result, some hospitals forbid waterbirth altogether, while others require women to get out of the water after the baby is born and to birth the placenta on dry land.

However, this is not necessary....most providers learn how to estimate blood loss in waterbirths over time. As with every other obstetric skill, it is acquired through teaching from other experts, observation, and practice. As they learned to estimate blood loss in land births, so they will learn to do so with waterbirths. Again, it simply requires the willingness to learn.

Cost of Facilities

Costs of facilities is another potential concern as well. However, costs of adding permanent waterbirth facilities could be easily accounted for by charging extra for access to them. In addition, waterbirth is immensely popular as a concept; having these facilities and promoting their use should bring extra business to the hospital, thus helping to pay for themselves in time.

However, if the capital outlay for permanent waterbirth tubs is too high, portable pools can be rented by parents instead and brought into the hospital; many companies carry them. With these, a hospital incurs no capital outlay at all.

Conclusion

While many doctors have professed concern about waterbirth due to worries about newborn breathing, infection, lack of immediate access to the perineum, difficulty in evaluating blood loss, and cost of facilities, research has shown that each of these concerns can be addressed. When approached with attention for hygiene and appropriate care guidelines, waterbirth is a safe and reasonable choice.

Waterbirth: A Choice Whose Time Has Come!

More and more hospitals are beginning to embrace the use of water in birth. Many hospitals now offer access to tubs for labor, although they still make the mother get out once she starts pushing. Others have waterbirth "suites" where women can both labor and birth in water.

Waterbirth is increasingly popular particularly in European countries, and can be found as well in many Canadian, Australian, and New Zealand hospitals. In the U.K., the majority of hospitals are reported to have water immersion options, and the government has recommended that all hospitals provide women with the option of a birthing pool. Some third-world countries also have options for waterbirth, particularly in specialty birthing clinics.

Although slower to catch on in the U.S. than abroad, waterbirth has been added to a number of U.S. hospitals as well. Monadnock Community Hospital in Peterborough, New Hampshire was the first hospital in the United States to install a permanent waterbirth pool in 1991. Many other hospitals have followed suit since then.

If your local hospital does not have waterbirth choices available, Waterbirth International can work with you to try and change their policy. They have been successful in a number of facilities already. And of course, you always choose waterbirth at home if your hospital is not amenable.

For more information about waterbirth in general, see the following sites:

• http://www.waterbirth.org/


• http://en.wikipedia.org/wiki/Water_birth


• http://www.waterbirthinfo.com/


• http://www.waterbirth.net/


• http://www.gentlebirth.org/archives/watrbrth.html

There are many other online resources about waterbirth available. Do a simple search and you will find many. If you would like to see what waterbirth might look like, "Birth Day" is a lovely waterbirth video of a Mexican midwife giving birth to her own baby in water with her family nearby. YouTube has a number of brief waterbirth videos as well. And stay tuned to this blog for more pictures of women of size laboring and giving birth in water!!

Why Waterbirth Is So Great for Women of Size

[Part Two in a Series on Obesity and Waterbirth]

As we discussed previously, some birth facilities have restricted fat women from having access to water during labor and/or birth. On the other hand, some are very supportive of it, even in very large women. It all depends on the facility and the provider.

I believe that waterbirth is uniquely beneficial for women of size because it offers a number of advantages over "dry" labor and birth. For example:

• Waterbirth makes women of size much more mobile and buoyant, so they are able to change positions easily and quickly


• Waterbirth helps women assume a variety of positions, which may help create more room in the pelvis and help big moms labor and push more effectively


• Waterbirth lessens the need for pain medications/epidurals


• Waterbirth often shortens labor


• Waterbirth makes you less likely to have an episiotomy

The Mobility Factor

The mobility factor is one of the best things about waterbirth. Being hugely pregnant at term is a challenge for women of ANY size, let alone a woman who already started out larger than average. Being in the water makes you feel lighter and more mobile, and fat works to our advantage in water, making fat women particularly buoyant. That's why swimming and water aerobics are so frequently recommended for women of size in pregnancy.....so why not use the same thing to our advantage during labor and birth?

If you are in a bed and you want to change positions during labor, you have to haul yourself up and over.....not the easiest thing to do when hugely pregnant! And especially so for women of size. But if you are in water, it's simply a matter of shifting position a little; the water supports your weight and makes it easier to move.

Furthermore, there is less risk to the backs of support personnel when helping you shift because, in effect, you "weigh less" in the water than you would on land due to buoyancy.

Position Changes May Open Up The Pelvis More

Waterbirth makes it easier to change position so you can create more room in the pelvis for the baby to come out.

In the water, it's easy to sit upright, kneel, get onto hands and knees, have one knee up/one knee down, stand, or even float on your back. These position changes tend to reduce pain and give the baby more room to descend than the usual semi-sitting position we see so often in typical hospital bed births.

Think about it.....the tailbone is one of the most mobile joints in the pelvis. If the woman is semi-sitting or on her back, her weight rests against the tailbone and presses it into the pelvic outlet, reducing the space available for the baby. But if the mother is upright or on hands-and-knees, the tailbone and the sacrum actually move outwards with the descent of the baby, allowing more room.

Being in water facilitates this kind of positioning much more easily than being on dry land, and allows mothers to change positions quickly in response to the baby's needs during pushing.

Many doctors believe that in women of size, extra fat "pads" the pelvis of the mother, reducing the space for the baby to pass through. Although I personally think this is highly dubious, if so-called "soft-tissue dystocia" were real, wouldn't getting a little extra space from opening up the tailbone area be particularly important in women of size?

If waterbirth can help women of size into "non-traditional" positions more easily, then it may just help create more pelvic space for their babies too.

Less Need for Pain Medications

Being in warm water helps lessen labor pain a LOT. This is one of the best parts about waterbirth!! You step into that lovely warm water when you are in serious labor and your body just goes, "Ahhhhhhh!" Think of how relaxing sitting in a hot tub is; consider how good this might feel during the strongest labor contractions!

To be fair, laboring in water doesn't take away all of the pain, and mothers should maintain realistic expectations about it.....but it does help lessen the pain, and more importantly, it helps you cope with it more constructively.

Research supports this; several studies show that laboring in water results in "reduced analgesic requirements" (less pain meds and epidurals). Studies also show that upright positions (which are easier to assume in water) tend to reduce pain also.

There's a reason why laboring in a birth-tub is jokingly called "the aquadural" by a lot of moms! It's sort of like an epidural....but without the risks.

Remember, all medications present potential risks. Narcotics can cause respiratory depression in the baby, epidurals can cause a mother's blood pressure to crash, and there are small but real risks of rare events like paralysis, infection, and even death.

Furthermore, epidurals are particularly difficult to perform adequately in women of size and tend to be less effective; therefore, wouldn't it make sense to encourage these women to be in the water and thus lessen their need for medications/epidurals?

A Shorter Labor

Several studies also show that being in water may shorten the length of labor, especially the first stage of labor (dilation). On average in these studies, being in water shortened the first stage of labor by an hour to an hour and a half. Remember, every little bit helps when you're in pain and waiting anxiously to meet your baby!

Furthermore, other research shows that women of size tend to have longer labors. If simply putting fat women into water could help their labors progress more efficiently, wouldn't that be worth trying? Seems like a low-risk intervention that might help prevent some cesareans for "failure to progress."

Less Chance of an Episiotomy

Waterbirth also significantly lessens the chances of episiotomies (deliberate cuts made by doctors to widen the vaginal opening, which often result in significant perineal trauma to the mother).

One study found a 0.38% episiotomy rate in the waterbirth group (less than one-half of one percent!) vs. a 23% episiotomy rate when birthing in a bed.

Because women of size tend to heal more slowly and have more wound infections than women of average size, avoiding surgical wounds like episiotomies whenever possible is greatly to their advantage.

Conclusion

If laboring in water could help you have a shorter labor, a less painful labor, could lessen your chances of an episiotomy, and help you be more mobile during the birth......all without the significant risks of epidurals and pain medications...........why wouldn't you be interested in that?

And why shouldn't fat women have equal access to such options? Especially when they offer fat women such unique advantages?

Obesity and Waterbirth: A Match Made in Heaven?

When I first started this blog (before I enabled comments), I got emails with questions on various plus-sized pregnancy and parenting topics. I will try to respond to them periodically as I have time.

First up is whether waterbirth is contraindicated in obese women. One woman wrote:

I have recently discovered that there are some care providers that are telling women that if their BMI is too high that they risk out of having a waterbirth.

This is not the first time I have encountered this question. I have heard similar questions from others over the years, wanting to know if waterbirth is okay in women of size, whether waterbirth was restricted from women of size across the board in all facilities, or whether there was real research justifying weight-based restrictions in waterbirth.

The answer is a little complex and will take me several blog entries to adequately answer.

But yes, there are some birthplaces where women of size are risked out of waterbirth (or even laboring in water) entirely. However, this is not an across-the-board policy. Policies vary greatly from facility to facility.

In many birthplaces, women of size are "permitted" to labor in water, and in some they can actually push the baby out in water too. In fact, many women of size have given birth in water just fine. You'll find many such waterbirth stories on my website in the BBW Birth Stories FAQs.

Are these restrictions against waterbirth in women of size justified? In my opinion, no, they are not. Barbara Harper, a leading waterbirth expert, also agrees. More on that in a future post.

In fact, for a variety of reasons, many people feel that waterbirth is the perfect choice for women of size. I agree wholeheartedly. Frankly, waterbirth is uniquely well-suited to women of size, as well as being one of the COOLEST experiences ever. I would urge women of size to explore the possibility and consider it for their own labors whenever appropriate.

Disclaimer: Of course, I have to admit I am biased in the matter. I labored in water for 3 of my 4 births (including one hospital labor), and my last child was actually born into the water. My waterbirth was by far my best birth, and I found being in the water TREMENDOUSLY helpful. I have heard from many other fat women who feel similarly about their waterbirths.

So I am a INCREDIBLE fan of waterbirth, particularly for women of size. But even had I not had personal experience with it, waterbirth makes simple common sense for healthy women of size. Restricting access by BMI is an incredibly short-sighted rule on the part of hospitals and birthing centers, and it needs to be changed.

Rest assured, if you are interested in waterbirth, there ARE birthplaces where fat women can labor (and birth) in water, if they choose to.....including hospitals, birth centers, and of course at home. But you have to choose your place of birth carefully and ask a lot of questions if you want the waterbirth option.

I look forward to the day when waterbirth is universally available to all women, regardless of size.

P.S. The photo above is of labor in water in a "morbidly obese" woman, just before crowning (just before the head appears). The baby was born safely into water shortly after this picture was taken.

Coming Soon: Why Waterbirth Is So Great For Fat Women