Kari Munoz

ENGL 301
April 22, 2014
Bringing Together Water Births and Midwives with Physicians and Nurses
Think of something that has been on the planet since the beginning of time. Think of
something every human who has ever lived has used. Think of something pure and natural.
Think of something people depend on every day. Its water. It is one of the simplest things found
in nature, and life revolves around it. What better, than a way to start life in water? It is
something historians believe has been done since times as early as during Ancient Egyptian
civilization, and while options become more diverse, it becomes a subject of discussionwater
births (Babycentre, 2013). While water births are supported at the homes of women in the United
States with the use of personalized birthing pools and hired midwives, the process has yet to
become warmly welcomed in many hospitals. Very few hospitals have begun to let the water
birthing mothers through the hospital doors, adapting to their wants and needs, but most of these
mothers have been isolated in the home. They should have a choice. Water births should be
prepared for and supported within more hospitals in the United States because giving mothers
and fathers more freedom in birthing options outweighs the likelihood for complications and the
inconveniences it may pose to hospitals.
According to Babycentre, historians believe that water birth is something that has been
around since Ancient Egypt, where mothers relied heavily on the benefits of water in everyday
life. It is understandable that they would turn to water as a housing unit for an infants birth. The
first documented water birth however, was one performed in 1803 in France (Babycentre, 2013).
Since this time, water births have spread around Europe, eventually making its way to American,
Australia, and other far countries (Babycentre, 2013). The idea of new water birth is appealing to
mothers looking to expand their horizons and explore their birthing opportunities. Initially, the
idea of water birth was not something for everyday women, but rather, for poor women looking
for a, easier and more cost-efficient way to give birth at home (Babycentre). However, this trend
soon evolved. The first forays of certified nurse-midwives beyond care for the poor
developed during the 1970s, Judith Rooks, former President of the American College of Nurse-
Midwives and present-day consultant and epidemiologist in Portland, Oregon, stated. These
midwives, according to Wikipedia, are practitioners who provide care to women during
pregnancy, birth, reproductive health, family planning, childbirth, postpartum, and overall health
care. These men and women led the movement. Many earlier womens health movement efforts
to support midwifery and birth centers were successful, but the picture has changed in recent
years (Rooks, 159), reports Rooks, who has not only done research of water birth in America,
but also in other countries. She adds, in her recollection that instead of the trends continuing to
rise, access to midwives is shrinking rather than expanding in many parts of the U.S., (Rooks,
160). The change is due to many different factors; according to Rooks these factors include, a
complex set of economic factors, physician-residency training needs, and cultural changes in
womens perceptions and expectations about pregnancy and birth. Rooks goes on to say that
ideas about birth in American women have shifted more toward births regulated through
hospitals and medication as opposed to natural births performed with midwives. These
conclusions could be due to advances in technology and therefore higher dependence on
technology. Along with technological advances, women may also believe in higher rates of
safety within hospitals. However, just as traditional land births have benefits, water births do as
well.
In a study done from March 2001 to March 2004, a study was done by those at Corbar
Birth Centre, led by Liz Baxter, who acted as the midwife team leader throughout the process
(Baxter, 2006). Throughout Baxters study, women who intended to give birth in a birthing pool
were analyzed; according to Baxter and her team, pool births were categorized as those in
which the entire birthing process was performed, whereas pool users were those who initially
started on the pool, but came out to complete the birth (a common occurrence). For both pool
births and pool users in the study, those whom had initially not planned on water birth had
responses such as, I felt so relaxed and in control with the midwife and my husband supporting
me, and stating that the process was an effective pain-relief, (Baxter, 370). The findings were
that overall, women felt empowered, due to their support system (midwives, friends, family, etc.)
and sense of control (Baxter, 2006). In addition to this sense of control and empowerment, the
Babycenter website and WebMD, both conclude that water birth helps a mother with pain
reduction, buoyancy, emotional support, and vaginal tearing. While testimonies collected on
water births are merely recollection and opinion, the feedback seems to be positive. However,
birthing process does not merely benefit the mother. The infant experiences beneficial aspect as
well, including the easier transition from womb to warm water being less traumatic on the infant,
which in turn, leads to a much calmer baby at time of birth (Babycenter).
It is important for knowledge-seeking mothers to know that water birth has benefits; but
more importantly, it is important that the mothers know it is relatively safe. A major concern
mothers typically have includes, wondering how the infant does not drown underwater. As the
newborn begins to enter the water, it is important to know two key things about what is going on.
According to Barbara Harper in her article, Waterbirth Basics, babies experience hypoxia, or a
lack of oxygen throughout the birthing process. This, according to Harper, causes apnea and
swallowing, not breathing or gasping, (Harper, 2). Another factor to take into consideration is
one of biology. The fluids in the lungs when compared to the fluid in the fetus vary, one being
hypertonic and one being hypotonic (Harper, 2000). This difference means that since hypertonic
solutions are denser, the hypotonic solution (water) would be inhibited from entering the fetus.
The last, and possibly most important factor newborns have is their dive reflex, which is
something newborns have upon birth until the age of six to eight months (Harper, 2000).
According Harpers article, this reflex is designed to help newborns during breastfeeding, and
inhibits solutions from being inhaled, but rather, swallowed. It is a meticulous science, water
birth, but it is something infants and mothers can do safely.
Worry about water birth is not illogical, however. Many, if not most, of the benefits for
water birth are opinion, with not much evidence to back it up. Mothers who have performed a
water birth report things like lessened pain and empowerment, where mothers seeking
information want to know about numbers, statistics, and percentages. Understandably, these
mothers want their newborns to be safe. In a study done by Michael Pinette, 74 articles were
reviewed and analyzed. Pinette found that risks attributable to water birth include, hypoatremic
seizures, drowning, waterborne infections, the potential of delivering an unexpectedly
compromised fetus in a difficult to resuscitate environment, potential for fetal hemorrhage from
snapped umbilical cords, as well as injuries that also occur in land-births, such as, shoulder
dystocia and injuries related to moving the patient throughout delivery (Pinette, para. 10). In
addition to physical injury and harm done to the newborn, the mother also faces the risk of
infection. A woman giving birth in the water must use certain temperatures of water,
temperatures that also happen to be perfect for housing bacterial infections such as neonatal
pseudomonas sepsis. Similar to many choices in the medical field, the water birthing method has
its pros and cons, but with adequate training, preparation, and support, many of these risks can be
avoided.
This birthing method is not merely a trend within the United States, but is also an option
gaining popularity in Western Europe and Australia. In her article featured in International
Journal of Childbirth Education, founder of Waterbirth International, Barbara Harper states that,
things are wonderful in other places, like the national use of midwives as the gate-keepers of
maternity care and the inclusion of water immersion in all hospitals in the UK, (Harper, 11).
A problem we face in the United States however, is our lack of education toward ICU and other
specialized nurses, who gain very little experience and knowledge about natural births, let alone
water births (Harper, 2009). In an interview done by Harper, a nurse manager by the name of
Karen Galloway stated, When a woman comes in here asking for an unmedicated birth or to use
water, they are baffled and dont know what to do. In conclusion, it becomes not only the
gatekeepers(financial consultants in hospitals, nurse managers, etc.) job to support water births
by financing pools and other equipment, but it also becomes educators job to educate nurses,
physicians, and midwives. In addition, nurse managers need to regulate the process and make
sure these components all work well together (Harper, 2009).
In the United States specifically, the journey has been one full of obstacle and adversity,
primarily led by certified nurse midwives (as defined by Wikipedia, an advanced practice
registered nurse who has specialized education and training in both nursing and midwifery)
(Harper, 2000). According to Barbara Harper, director of Waterbirth International, America is far
behind Europe in its acceptance of water births and midwives, yet the American midwives have
been fighting far longer. Now, the process of water birth in hospitals is not a cheap one, and it is
not the easiest transition for hospitals. However, Harper makes it sound simple. In her article
Waterbirth Basics: From Newborn Breathing to Hospital Protocols she states that three things
need to happen just to get the process in the works: 1) a motivated mother; 2) an open and
supportive practitioner; and 3) a compassionate nurse manager or perinatal coordinator who is
willing to take on the training of staff and the creation of new policy, (Harper, 28) It is at this
point, that a mother can be granted her wish of having a water birth.
The idea of water birth is something foreign and mysterious, yet enticing. There are many
things still unknown about it, including the true advantages and true risks associated. It is
important that mothers whom have any amount of curiosity, reach out to nurses, physicians,
health educators, and in timesthe internet for discussion boards and news articles. However,
it is far more important for medical professionals to be just as educated, if not more. Nurses and
physicians need to be able to work with midwives, just as midwives need to be able to adapt to
the hospital setting. It is possible for water birth to become more accepted in hospitals. It is not
necessary to keep at-home midwives and hospital nurses separate, when they can work so
wonderfully together.







Reference List

Babycentre. (January 2013). The history of waterbirth. Babycentre. Retrieved from
<http://www.babycentre.co.uk/a542003/the-history-of-water-birth>

Babycenter. The pros and cons of water birth. Retrieved from
<http://www.babycenter.com.au/a542015/the-pros-and-cons-of-water-birth>
Baxter, L. (2006). Research and education. What a difference a pool makes: making choice a reality.
British Journal Of Midwifery, 14(6), 368-372.
Harper, B. (2000, Jun 30). Waterbirth basics: From newborn breathing to hospital protocols. Midwifery
Today , 9. Retrieved from <http://search.proquest.com/docview/201573326?accountid=9840>

Wu, C., & Chung, U. (2003). The decision-making experience of mothers selecting waterbirth. Journal Of
Nursing Research (Taiwan Nurses Association), 11(4), 261-268.

Harper, B. (1997, Sep 30). Integrating waterbirth into maternity care: An agent for change. Midwifery
Today, , 35. Retrieved from <http://search.proquest.com/docview/201515140?accountid=9840>


Harper, B. (2009). Helping women achieve what they want in a hospital birth: education not alienation.
International Journal Of Childbirth Education, 24(3), 10-13.
Pinette, M.G., Wax, J., & Wilson, E. (May 2004). The risks of underwater birth. American Journal of
Obstetrics and Gynecology, 190 (5), 1211-1215.
Rooks, J., Ernst, E., Norsigian, J., & Guran, L. (2008). Marginalization of midwives in the United States:
new responses to an old story. Birth: Issues In Perinatal Care, 35(2), 158-161.