As I am assisting an amazing woman with her birth in a local hospital, her doctor made several remarks about the need for this intervention or another intervention. Supposedly the doctor had agreed to her birth plan and had agreed to allow her to avoid such interventions. However now, while she is laboring, vulnerable, he does an about turn. But, the icing on the cake was when he states with certainty, out of the clear blue, since the laboring mother was not intending a water birth, “Water birth is not safe, all the research has proven it.” I can only guess that this remark was directed toward me, a doula but also a midwife, who assists women at home with water births.
It is so frustrating how TRADE associations, ACOG (American College of Obstetricians and Gynecologist) and the AAP (American Academy of Pediatrics) can publish an OPINION with such flawed rhetoric and then the masses blindly take it seriously. On the other hand, I feel sorry for Obstetricians who are embarrassed by the obviously biased faulty opinion statements that their trade association publishes.
The opinion paper issued by ACOG and AAP, of 2014 is still being used by members of the medical community to depict water birth as unsafe even though it has been replaced by a new 2016 opinion paper. Some of the flaws of the 2014 paper are;
- Literature review in the opinion statement was outdated and did not reflect current evidence. Although current literature was available, it did not support the basis of the authors’.
- Citednine case reports that show complications of water birth “for the mother and the neonate.” Two of these studies had nothing to do with water birth. One of the “case reports” was not a case study and was essentially counted twice. So the reference to nine case studies is misleading.
- Reference #19 is not a case report. It is a randomized, controlled trial of water immersion during the first stage of labor. Water birth was not studied in this trial (Eckert et al. 2001)
- Reference #22 is not a case report(Gilbert 2002). It is a letter to the editor about a different case study that had already been discussed once in the opinion statement (Nguyen et al. 2002, reference #25).
- Reference #24 is a study of pregnant laboratory ratswho were randomly assigned to exercise swim in cold water during pregnancy or swim in warm water. The rats were killed and the fetuses were examined. No laboratory rats gave birth in water (Mottola et al. 1993).
- Misrepresented the results from a study, leading the reader to think that there were water birth drownings in a study when there were actually none. (Alderdice et al. 1995). The authors of the ACOG/AAP opinion statement misrepresent this study and state that “Alderdice et al. summarized case reports of adverse neonatal outcomes, including drownings and near drownings.” The author of the study confirms there were NO such drownings or near drownings reported in this study.
- Data was used to support the dangers of water birth, infection of the newborn. However, the entire story was not told. Of the four other case studies mentioned by ACOG and the AAP, they did not tell the whole story. Two of the cases were caused by the hospital’s contaminated water supply, and in the other cases, all of the infants made a full recovery.
So how does the 2016 opinion paper compare to the 2014 opinion paper.
The faulty references where removed. The conclusion was, “There are insufficient data on which to draw conclusions regarding the relative benefits and risks of immersion in water during second stage of labor and delivery. …. Therefore, until such data are available, it is the recommendation of the College that birth occur on land, not in water.”
Maybe they don’t want to get wet? But bottom line…. The conclusion of their own last opinion statement is that there is not enough data to prove water birth is unsafe.
Out of date literature was still prevalent. Of the 39 references, 17 of them were 10 years or more old. Again more current literature was available with current evidence to reduce the concern of risks and highlight the benefits of water birth. Stay tuned for an exploration of the benefits of water birth!