Tuesday, December 14, 2010
Italian Waterbirth Study
I can't tell you how much I loved it, how much it helped with labor pain, and how it made it easier to be really mobile during labor.
It's a terrible shame that it is not offered as an option more widely in the United States. Certainly, more hospitals in Europe seem to be incorporating it before we do.
One of the objections you hear voiced on occasion by the doctors who resist waterbirth is the idea that it's not sterile enough and babies would be put at risk for infection.
This study contradicts that idea. Yes, there were microorganisms in the water, but the babies seemed largely unaffected by them, and in fact had a lower rate of infection/antibiotic use than babies born after "land delivery."
Alas, the study is in Italian so the only information I have is in the abstract, but note that the episiotomy rate in the water was less than 1%, a rate rarely seen in most hospitals. There's a tremendous benefit right there.
Also note that only 13% of women needed drugs for the pain. This is the "aquadural" effect; many women find that pain is greatly lessened (or at least more manageable) when in the water.
It's not that it totally relieves pain ─ I can attest that it doesn't. I still felt labor pains intensely during my waterbirth. However, they were manageable. The warm water felt WONDERFUL, it helped lessen the pain enough to get by, and I was able to be quite mobile in the birth tub in a way that helped me respond proactively to the pain.
So we shouldn't over-exaggerate the pain-relieving effects of water in labor. For some people it really does take the pain away. But for many of us it merely takes a significant edge off and helps you cope more proactively with it. (And if it helps shorten labor, I'm okay with that!)
But the point is, waterbirth is helpful and not harmful. Infection is not really an issue.
Time for more U.S. hospitals to get a clue and start incorporating more waterbirths.
Thöni A, Mussner K, Ploner F. [Water birthing: retrospective review of 2625 water births. Contamination of birth pool water and risk of microbial cross-infection]. Minerva Ginecol. 2010 Jun;62(3):203-11. [Article in Italian]
Reparto di Ginecologia e Ostetricia, Ospedale di Vipiteno, Bolzano, Italy.
The aim of this study was to document the practice of 2625 water births at Vipiteno over the period 1997-2009 and compare outcome and safety with normal vaginal delivery. The microbial load of the birth pool water was analyzed, and neonatal infection rates after water birth and after land delivery were compared.
METHODS: The variables analyzed in the 1152 primiparae were: length of labor; incidence of episiotomies and tears; arterial cord blood pH and base excess values; percentage of pH<7.10 and base excess values >/=12 mmol/L. In all 2625 water births, the variables were: analgesic requirements; shoulder dystocia/ neonatal complications; and deliveries after a previous caesarean section. Bacterial cultures of water samples obtained from the bath after filling (sample A) and after delivery (sample B) were analyzed in 300 cases. The pediatricians recorded signs of suspected neonatal infection after water birth and after conventional vaginal delivery.
RESULTS: There was a marked reduction in labor duration in the primiparae who birthed in water; the episiotomy rate was 0.46%. Owing to the pain relieving effect of the warm birth pool water, pain relievers (opiates) were required in only 12.9% of water births.
Arterial cord blood pH and base excess values were comparable in both groups. Shoulder dystocia/neonatal complications were managed in 4 water births; 105 women with a previous caesarean section had a water birth.
In sample A, the isolated micro-organisms were Legionella spp. and Pseudomonas aeruginosa; in sample B, there was elevated colonization of birth pool water by total coliform bacilli and Escherichia coli. Despite microbial contamination of birth pool water during delivery, antibiotic prophylaxis, as indicated by clinical and laboratory suspicion of infection, was administered to only 0.98% of babies after water birth versus 1.64% of those after land delivery.
CONCLUSIONS: Results suggest clear medical advantages of water birthing: significantly shorter labor duration among the primiparae; a net reduction in episiotomy rates; and a marked drop in requests for pain relievers.
During expulsion of the fetus at delivery, fecal matter is released into the birth pool water, contaminating it with micro-organisms. Despite this, water birthing was found to be safe for the neonate and did not carry a higher risk of neonatal infection when compared with conventional vaginal delivery.