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There is a complex chain of chemical, hormonal and physical responses, resulting in the baby breathing when the environment changes from water to air. Babies born in the water tend to breath slower due to the initiation of the breath stemming from the lower lobes o f the lungs.
Some midwives have stated the babies remain blue a bit longer but they are alert and have tone in their bodies. Studies have indicated it is better to give the first APGAR score at one minute 30 seconds and not at one minute due to this difference.
Physiologically what happens at birth is: the shunts in the heart close; fetal circulation turns to newborn circulation; the lungs experience oxygen for the first time; the umbilical cord is stretched causing the umbilical arteries to close down.
The fluids that are present in the lung alveoli are pushed into the vascular system from the pressure of pulmonary circulation increasing blood volume for the newborn by 1/5th or 20 %F. The lymphatic system absorbs the rest of the fluids through interstitial spaces in the lung tissue. The increase of blood volume is important for the baby's health, taking about six hours for all the lung fluids to disappear. (4)
When should the baby be lifted from the water?
The baby should be gently lifted from the water as soon as the entire body is born. The reasoning behind this is if the placenta separates quickly and the baby remains under water, oxygen to the baby may be compromised. The umbilical cord continuing to pulsate isn't a certain indicator that the baby is still receiving enough oxygen. If she desires, the new mother can reach down and lift the baby up to her chest. Alternatively, the father/partner or midwife may lift the baby up as well. It is important to lift the baby slowly so as not to accidentally tear a short cord or dislodge the placenta. Some caregivers, however, feel that the baby should be given time underwater to compose itself and be lifted out of the water only when he or she begins moving the legs, indicating the organic crawl toward the mother's breasts for breastfeeding.
From 1985 to 1999, it's estimated there have been over 150,00 cases of
water birth worldwide. A study conducted in England between 1994 and 1996 and published in 1999,
reports on the outcomes of 4032 births in water. Perinatal mortality
was 1.2 per 1000, but no deaths were attributed to birth in the water.
Two babies were admitted to special care for possible water aspiration.
(5)
A death reported early on with water birth was caused not by aspiration but by asphyxiation due to leaving the baby underwater too long after the full body of the baby was born. The placenta detaches from the uterine wall as or shortly after the baby is born and thus the supply of oxygen to the baby is compromised. An autopsy on one baby was reported to have no water in the lungs and its death was attributed to asphyxia. (6)
Can I birth the placenta into water?
This is a matter to discuss with your individual medical caregiver. Some women choose to birth their placentas into water in order to extend the bonding with their babies. Make sure there is an adequate sized 'waiting bowl' to hold the placenta as it floats in the water, attached to the cut or uncut umbilical cord. However, if the mother remains in the water and the placenta takes too much time to present (this is relative to your caregiver perception of time,) it is best to get out of the tub.
Is it important that the doula I hire is not highly experienced in water birth or water labor?
There is so much information made readily available to the public on water labor and water birth that it is relatively easy and worthwhile for a doula to read up and educate herself. The Internet, books, articles, magazines and videos offer a plethora of information. Going to a "Water birth Consultant" for a consultation is also advisable. It is most important you have a strong connection with the doula who will attend your birth. Educating and participating is a moment-to-moment experience.
How to support someone to have a water birth ?
Hospitals are more cooperative today than ever before as more and more women begin to start asking for what they want. The process can be started by inquiring if a tub might be brought into the hospital to labor or birth in. The motivation within the mother or couple is paramount. Next she/they need to seek a provider willing to assist this sort of labor or birth whether it is a nurse midwife or obstetrician. The most vital component is a cooperative nurse manager can be the making or breaking point of the game plan. The busy nurse manager needs to communicate the mother's desires effectively to engineering, infection control, OB staff, nursing staff, administration and risk management. Approach the nurse manager from a factual, no nonsense place and provide the tools she needs to be an advocate.
Download these water birth protocols from online: 1. RCOG and RCM Joint Waterbirth Recommendations 2. Guideline for a Safe Water Birth 3. Safety recommendations for Pool Use 4. Hospital Waterbirth Policy in the UK 5. RCOG Waterbirth Guidelines - January 2001 6. Parto en agua protocolos- En Español.
Read through the articles on Birth Balance to get familiar with the latest research and studies on water birth statistics and procedure: Waterbirth Latest Articles and Protocols. Contact Birth Balance directly to attend a private water birth consultation to find facilities in the NYC, New Jersey, Connecticut and Pennsylvania area: 212-222-4349. Rent a birth pool kit from Birth Balance
Contact Waterbirth International: www.waterbirth.org for support references and additional research.
Keep a strong heart, mind and focus on bringing in the team you deserve to help fulfill your wishes. Good luck getting into hot water!
1. Johnson, Paul (1996) Birth under water – to breathe or not to breathe. British Journal of Obstetrics and Gynecology, Vol. 103, pp.202-208
2. Fewell, JE, Johnson, P (1983) Upper airway dynamics during breathing and during apnea in fetal lambs. Journal of Physiology Vol 339, pp 495-504
3. Harding, R., Johnson, P., McClelland, M. (1978) Liquid sensitive laryngeal receptors in the developing sheep, cat, and monkey. Journal of Physiology, Vol 277, pp 409-422
4. Karlberg, P. et al. (1987) Alteration of the infant’s thorax during vaginal delivery. Acta Obstetrica Gynecol Scandavia. Vol. 41, p 223
5. Gilbert, R, Tookey, P, (1999) Perinatal mortality and morbidity among babies delivered in water: surveillance study and postal survey. British Medical Journal Vol 39, 21 August pp 483-487
6. Personal interviews (1989) Barbara Harper