Posted by My OB said WHAT?!?.
Oct
20
Posted by My OB said WHAT?!?.
“…There’s A Good Change That The Baby Will Gasp When Born, Aspirate And Drown.”
“If you try to give birth in a tub after you’ve gone past your due date there’s a good chance that the baby will gasp when born, aspirate and drown.” – Midwife to mother who wanted to know if she could birth in the tub.
There are 63 comments to this post.
Jessica Turner had this to say,
Oct 20, 2012 @ 4:31 pm (Quote)
Ugh, I heard this SO many times throughout my pregnancy! Guess what? She didn’t take any breaths until she was out of the water! I wouldn’t birth any other way!
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Birthherstorian had this to say,
Oct 20, 2012 @ 4:31 pm (Quote)
This why I so f*cking hate licensed medical midwives.
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Cord-Clamping.com Reply:
October 20th, 2012 at 9:13 pm (Quote)
Really? What a hostile thing to say. In the UK, Canada, Australia, New Zealand etc ALL midwives are highly educated, clinically trained and licensed. Hasn’t appeared to stop them providing safe water birth options for many women, including hospital birth.
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Lee Reply:
October 21st, 2012 at 2:24 am (Quote)
You’re right! So much better when they’re unlicensed and untrained.
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Lisa Reply:
October 21st, 2012 at 5:37 am (Quote)
“Unlicensed” does not equal “untrained”. I’d take my unlicensed midwife over this licensed moron any day.
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amy Reply:
October 21st, 2012 at 5:20 am (Quote)
Any professional has the duty to keep up on their education. Thing like this wouldn’t be commonplace if the just picked up a medical journal once in a while. :/
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Amy Reply:
October 21st, 2012 at 7:35 am (Quote)
Except it doesn’t say anywhere that this was a licensed midwife.
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Heidi Reply:
October 22nd, 2012 at 11:27 am (Quote)
Really good point–there is no context here other than that there is a midwife, a mother, and a tub. It could even be a homebirth. Of course, it seems ridiculous that a homebirth midwife would be unfamiliar with waterbirth, but it’s best to withhold judgment without more facts.
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genniemom Reply:
October 21st, 2012 at 7:47 am (Quote)
My fully qualified midwife (who is also licensed) was wonderful at my birth. She provided just the right amount of support for me as I birthed and caught my own baby.
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Good thing my daughter was born at 39-6 and 22 hours…..an hour and 1/2 later and she would have drowned!!
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Note that *trying* to give birth in a tub of water causes the cascade of catastrophes. That means that even if you change your mind and climb out of the tub onto a bed, the baby still gasps and drowns.
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Kristin Reply:
October 20th, 2012 at 5:55 pm (Quote)
No, no. If you get out of the tub and into a bed EVERYONE drowns. That’s why water births are SOOOO dangerous. *wink*
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Jane Reply:
October 20th, 2012 at 5:59 pm (Quote)
It’s tragic. Last time she attended a waterbirth, the mother’s goldfish even drowned.
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Kristin Reply:
October 20th, 2012 at 7:46 pm (Quote)
And Heaven forbid you get out of the tub and then get back in. You might as well call FEMA in advance, because the whole town will flood.
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Mommy23Melody Reply:
October 21st, 2012 at 10:44 pm (Quote)
Ok, I’m laughing so hard I am waking up my husband.
We have proof of all this:
Noah’s wife tried the water-birth option three times with her last, and the whole world flooded!!! Fortunately, Noah was up-to-date on all these medical issues, knew his wife would change her mind, and had the foresight to build a boat.
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Jessica Turner Reply:
October 22nd, 2012 at 5:59 pm (Quote)
I’m reading these off to my husband (who caught my daughter in the tub, I might add)… This is great!
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Didnt anyone tell that poor woman in nursing school OR midwifery school( if she was a CNM she has a Masters degree) that babies don’t start to breathe til their face hits AIR? I know, I know about primary and secondary apnea, but that’s not caused by being born in water, that’s caused by stress in uterine, which water birth generally avoids…
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Goldilocks Reply:
October 21st, 2012 at 6:53 am (Quote)
Babies take the first breath because the placenta quite providing enough oxygen to meet their total need and the CO2 levels in the blood start to rise. The rising CO2 levels create carbonic acid that then stimulate the chemoreceptors in the aortic and carotid bodies. It also creates nerve impulses in the medulla oblongata and pons of the brain. These travel the phrenic nerve and thoracic nerve to cause a breath. It has noting to do with air on the face, the first breath is triggered in the same way every other breath is for the rest of their lives. Also babies breath in amniotic fluid in the womb for practice, so I can’t see how having air on their face would trigger breathing.
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Shirley Reply:
October 21st, 2012 at 9:32 am (Quote)
You seem to know what you are talking about. Can I ask what your experience is? And is there any documented evidence of a baby trying to take a breath in a water birth?
(I know it is impossible to read tone. This is not hostile at all. I am genuinely curious and would love to learn more.)
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Goldilocks Reply:
October 21st, 2012 at 11:27 am (Quote)
I’m a Student Doctor and just someone who reads a lot.
This was the best I could do from the open access journals, it takes about infant admissions from water aspiration in water birth, so yes there have been cases of babies breathing in under water.
http://www.bmj.com/content/319/7208/483
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Jane Reply:
October 21st, 2012 at 12:19 pm (Quote)
“No deaths were directly attributable to delivery in water, but 2 admissions [out of 4032 births] were for water aspiration.”
I’m reading this as one in every two thousand waterbirth babies suffered water aspiration. Neither of those babies in the study drowned (or died of another mechanism.)
You’re going to reply that two aspirations is still two too many, which is hard to argue with. 
But allow me to go afield a moment: when you become a doctor, are you going to encourage any of your patients to undergo an amniocentesis? Because I believe there’s a spontaneous miscarriage rate of 1 in 400 after amnio. That’s a mortality rate that’s five times higher than the non-fatal aspiration rate after a waterbirth.
Most doctors consider amnio to carry an insignificant risk. Your posts here indicate you consider waterbirth to be unduly risky.
I’m not saying you’re not entitled to your opinion. But telling amother “there’s a good chance the baby will gasp when born, aspirate and drown” is not an accurate representation of “two babies out of four thousand studied aspirated and were treated at a hospital.” Part of informed consent is properly informing the parent, which the midwife in this quote didn’t do.
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Details Reply:
October 21st, 2012 at 12:33 pm (Quote)
Thank you Jane! Goldilocks, there is no such thing as a risk of ZERO! Would you like to go back a few day to the risk of baby being cut during a c-section. I believe it was 3% with only .09% being serious. Risk of rupture during VBAC 0.7%, not real clear on the risk of fatal rupture since some studies included windows as ruptures. Anybody got numbers on the risk of tear that go all the way to the anus with and without episiotomy. I don’t have the numbers at hand but the risk is much higher once the perinium has been cut. This is also demostrated with fabric and glass.
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Jane Reply:
October 21st, 2012 at 1:53 pm (Quote)
Goldilocks, since many women opt for waterbirth because it’s a very good pain management technique, I went around and searched for side effects from epidural anesthesia, which most hospitals offer as a safe method of pain management during labor.
30% of women receiving an epidural will experience a sharp drop in blood pressure. 25% will experience some urinary dysfunction after the birth. 10% will experience backache that may last for years after the birth, some of which may be attributable to nerve damage.
15% of women with an epidural in place for longer than 4 hours will experience a fever.
One to ten percent of epiduralized women will experience a spinal headache afterward.
And then there are the very rare complications such as women who become unable to breathe because the epidural anesthesia paralyzes their lungs, women who experience convulsions, women who experience cardiac arrest, etc. These are very rare complications, of course. The source I looked at said the most common of those happened in one in three thousand births.
I didn’t look at potential risks to the baby due to epidural anesthesia.
This is considered safe, and I’m not going to argue about that.
Compared to that, if one in two thousand waterbirth babies experiences a nonfatal aspiration…that’s not really so bad in comparison. If the mother chooses that risk instead of a 10% risk of a spinal headache or years of backache, I think this is a reasonable choice which should be respected by the medical establishment.
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C.Pratt Reply:
October 21st, 2012 at 2:41 pm (Quote)
Check, and Mate.
I worry about my 9 year old drowning too. That’s why I watch &/ swim where there is a life guard.
As another poster pointed out, there is no such thing as a risk of zero. It is not the doctor’s job to decide for any patient what risks they take. Failure to fully inform is the most agregious failure of all.
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Mommy23Melody Reply:
October 21st, 2012 at 10:56 pm (Quote)
“There’s a GOOD chance…” Implies more than 0.05%, wouldn’t you agree? Even though she was informing, she was twisting the facts with vague terms like “good”.as far as Goldilocks’ comments, I can see your point. We might be misinformed as to what the trigger is…
I find it interesting that we will avoid water-births because of the risk of the baby inhaling water, but we will give moms “safe” drugs that increase risk of trauma due to lengthened labor and need for “medical intervention,” which never would have been needed if we hadn’t “medically intervened” in the Mom’s natural bodily functions in the first place.
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Jane Reply:
October 21st, 2012 at 10:15 am (Quote)
Assuming the mechanism you describe is accurate, then there’s nothing to stop a baby from trying to breathe in the birth canal.
We’re talking about a difference of perhaps two seconds in you-can’t-breathe-here-time between a baby born into the air and a baby born into a pool of water.
In that two seconds, the placenta most likely will not detach. The placenta usually takes about fifteen minutes to detach, correct? The detachment process has begun, but the cord is still pulsating with oxygenated blood for several minutes after the birth.
And again, a baby born into a pool of water is only under the water for two seconds at the most before being brought up to the air where breathing is possible. The baby is born into the mother’s or the midwife’s hands and then raised right up out of the water.
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Goldilocks Reply:
October 21st, 2012 at 11:10 am (Quote)
They don’t have the force to expand their chest against the pressure moms’s body exerts on their chest to breath in the birth canel. Also you are assuming that nothing goes wrong on that exit, what if the baby has shoulder dystocia? The baby may be stuck for several minutes. You are at this point either trying to get mom out of the tub (not easy and she might slip and fall on her own baby) or you are risking the baby who might experience cord compression taking their first breath underwater. Neither sounds like a great way to start life.
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Detail Reply:
October 21st, 2012 at 11:02 am (Quote)
I think you need to witness a birth where the cord is’t immedicatly clamped and then get back to us on that mechanism. You are also leaving out the part where the heart wall closes and the values shift over to sending blood to the lungs. You explaination sounds all great and wonderful, but it just doesn’t jive with reality. Please try again.
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Goldilocks Reply:
October 21st, 2012 at 11:15 am (Quote)
None of those things are even slightly related to the mechanism for starting breathing. They are important events of the shifting from interuterine life to outside, but they occur AFTER the first breath, they do not CAUSE the first breath.
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Details Reply:
October 21st, 2012 at 11:42 am (Quote)
But the placenta doesn’t quite providing enough oxygen when the cord isn’t prematurely clamped. The placenta can continue to provide oxygen until it is detaches its self from the unterine wall. That doesn’t occur instanteously. Miss Student Doctor, you might want to pull your head out of your books and go watch a real natural birth.
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Pam Reply:
October 21st, 2012 at 1:36 pm (Quote)
Goldilocks, you are under-informed about the causes of initiation of breathing in the newborn. I assume I am unable to post a link here without being stuck in moderator-purgatory, but if you google “Neonatal Resuscitation: Life that Failed” by Morley, FACOG, you will read an excellent and extensively-referenced description of the mechanism of resuscitation in the neonate, which has nothing to do with rising CO2 levels when the cord is not clamped. The mechanism you describe is a result of the medical model of immediate cord clamping but not the physiologically normal process that should be taking place after birth.
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Goldilocks Reply:
October 24th, 2012 at 8:15 pm (Quote)
Have you read this bibliogrpahy I mean really read it, 1958? Really we are using stuff that old? I had more then 24 sources on a 20 pg paper for my senior year of high school. Not to mention the fact that in the section where he describes is breathing mecahnism, he only has one cited source, and it’s a letter to the editor. Yeah I’m totally going to believe that over say an anatomy book…
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Karen Reply:
December 22nd, 2012 at 7:18 pm (Quote)
Goldilocks, you are trying to intimidate others into submitting to your allegedly supreme intelligence and knowledge by using big words you hope others don’t know or that don’t exist.
Just watch a few videos of water births and you will see that the babies are just fine and don’t breathe until they are brought up into the air even if they take a little while to come out. It really doesn’t have to be that complicated!
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. . . because drowning is instantaneous. One gasp and ::poof:: drowned baby. You know, L&D professionals never actually learn resuscitation techniques most of us learned in middle school. (Yes I know the baby is unlikely to try to take a breath underwater, my point was that it wouldn’t be disastrous if it did happen)
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Jane Reply:
October 20th, 2012 at 6:45 pm (Quote)
That’s a very good point. I wish women would think that fast when someone makes that kind of assertion.
OB: Your baby could take a breath underwater and drown.
Woman: Yeah, and if only a DOCTOR were available to help! Or if only we were in a hospital with medical staff and lifesaving equipment!
OB: …
Woman: …
OB: Um…
Woman: Yes? Doctor?
OB: Well, it’s actually more complicated than that.
Woman: I’ll be able to birth in the tub, then.
OB: I need to come up with some other reason it’s insanely dangerous. No one ever pointed this out to me before.
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Goldilocks Reply:
October 21st, 2012 at 6:55 am (Quote)
Why is risking aspiration pneumonia a good idea? Drowning or near drowning is never a good idea no matter where you are at.
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Jane Reply:
October 21st, 2012 at 7:49 am (Quote)
The point is, there isn’t a risk the baby will breathe and get water into his lungs because babies don’t start to breathe until air hits their faces. That’s why they don’t start to breathe in utero. The same mechanism that keeps them from attempting to breathe in the birth canal is going to keep them from breathing underwater.
But you’ll notice if you go back through this site that “aspiration pneumonia” is never the objection doctors and nurses have to waterbirth. It’s always drowning, and as Rebecca pointed out, drowning isn’t really the problem. Neither is near-drowning.
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Lori Reply:
October 21st, 2012 at 8:51 am (Quote)
Goldilocks, I think I love you! Honest, factual and non-judgmental. Watch out though, on this site if you disagree with the usual commenters too much they will trounce you!
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Wendy Reply:
October 21st, 2012 at 4:44 pm (Quote)
That’s right, pointing out the errors in a pro-medicalized-birth post = being erroneous and judgmental.
As pointed out above, if the cord is not prematurely clamped (ie: before it stops pulsating) the baby will not try to take a breath. How is that so hard to understand?
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Kathy Reply:
October 21st, 2012 at 10:38 am (Quote)
Cut/paste from another water birrh post here:
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 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 interpret what substance it is and the glottis automatically closes and the solution is then swallowed, not inhaled.
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Show me the study comparing aspiration during waterbirth before due date vs. after due date. Show me one study where due date was even a consideration. I bet you can’t even find a study of past 42 weeks vs. anytime before 42 weeks. There is nothing magical about 40 weeks. If the date had been calculated correctly then 50% of all babies would be born after their due date. 50%!!!! Have you ever seen a bell curve? Do you know what Sigma means? Did you pass algebra or statistics at any time during you education? The truth is that if this midwife said she was willing to have this mom labor or birth in the tub before due date she was lying through her teeth and just waiting for an excuse to bait and switch. She probably has a couple other excuses all lined up so she doesn’t have to risk getting wet herself. There is zero medical rational for this line of BS which if I can count has 1) baby drowning due to one gulp of water which would probably be swallowed instead of inhaled 2) the 40 week mark being magical 3) the trying to give birth vs. only laboring in the tub thing that several previous posters had such fun with. That is 3 lines of BS. We know you are lying to us when the story gets that big!
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Charity had this to say,
Oct 21, 2012 @ 12:53 pm (Quote)
I had a midwife tell me she was uncomfortable with water births because of this same reason. She said, “We don’t flock to the ocean to have our babies, why would you want to birth in a tub?” I hung up and decided to take my chances with the new CNM at the OB office I went to with my first 3.
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You know, a lot of care providers like to pull that “baby will drown” card when it comes to a water birth. I can understand why people that aren’t very educated in birth might think that. What I don’t get is how a midwife could be the one to say that! Even more so, I certainly don’t understand what being past your EDD has to do with anything!
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I dont know nearly enough to know whether or not a baby can and is likely to drown in a waterbirth.
What I do know is that from a natural standpoint, primates dont give birth in water. Primates also dont get epidurals, so it doesnt necessarily mean anything, but its interesting that it so often gets filed under the natural childbirth heading.
I think for me, I would be concerned about the sanitation issue. I suspect I pooed a little when I was in labor. I most definitely had the squirts the day before.
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Jane Reply:
October 24th, 2012 at 3:35 pm (Quote)
It’s presented as a part of “natural childbirth” because the counterpressure of the water is a natural method of pain relief. You’re correct that it’s not “natural” per se, and it probably should be grouped as something more like “non-medicated childbirth.”
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Hahahaha! Yeah, don’t you know that the baby is just holding their breath after 40 weeks, that is why it is so dangerous to go over the estimated due date?! I guess my 42 weeker is double drowned, born en caul AND in the birthtub!
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