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Waterbirth has become an established practice in parts of the United States where midwifery is strong and natural childbirth is popular. It is also gaining momentum in Canada, Australia, New Zealand, the United Kingdom, and Germany.
Advocates of water birth say that it is safe, offering Mom drug-free pain relief and better oxygenation during labor and a calm, peaceful entrance into the world for baby as the warm water simulates the intrauterine environment. In addition, the umbilical cord pulsates longer after water birth, helping to remove damaged red blood cells from the baby’s circulation which reduces the risk of neonatal jaundice.
I birthed all three of my children naturally in a birth center with only a midwife and a birthing assistant in attendance. I chose to use a birthing tub briefly during labor with my first child. I did experience some pain relief from the experience. I was particularly grateful to have the birthing tub available as an option during the challenging transition phase.
The decision to give birth in a tub is a lot more significant than the decision to labor in one, however.
The Toxic Effects of Water Birth Few Mothers Know About
The decision to labor or give birth in the water should be approached with extreme caution, and it is disturbing that the very real health risks of water birth are not typically discussed in prenatal examination rooms. Not a single one of my prenatal exams over the span of three full-term pregnancies ever covered the risks discussed below nor were they even mentioned in passing.
A concern rarely if ever mentioned about water birth is the significant chlorine exposure that both mother and baby experience during the labor and delivery process. Many mothers who are careful to filter their drinking water during pregnancy to remove chlorine and other toxins seem to give little to no thought about soaking for hours in the very same water or giving birth to their precious newborn in it.
Bathing or showering in tap water is known to expose a person to a significant amount of outgassed chlorine that is absorbed via inhalation and the skin.
For example, taking a seven-minute shower in treated city tap water (pool water would be much worse) exposes a person to more chlorine, disinfection byproducts (DPBs), and volatile organic compounds (VOCs) than by drinking a gallon of tap water (1). This absorption happens in two ways:
- The chlorine that enters your lungs is in the form of chloroform, a carcinogen, and chlorite, a byproduct of chlorine dioxide. These forms of chlorine hit your bloodstream instantly before they have a chance to be removed by your organs of detoxification.
- The DBPs that enter your body through your skin also go directly into your bloodstream. And the warmer the water, the more the absorption of toxins is maximized by the skin.
Chlorinated Water Destroys Beneficial Microbes Crucial to a Healthy Birth
The most insidious result of exposure to treated water during the water birth process is the adverse effect on gut flora. Most water births use chlorinated tap water straight out of the faucet attached to the birthing pool.
According to Dr. Zoltan P. Rona, M.D., chlorinated water destroys most strains of friendly intestinal flora, known as probiotics (2). The compromise to bodily flora comes at a time when the baby’s gut needs to be seeded properly with the beneficial microbes that will guard the health and bolster immunity for a lifetime. Any beneficial microbes present in Mom’s birth canal will be either weakened, destroyed, or severely damaged by exposure to the chlorinated water by the time baby passes through.
While colostrum and breastmilk also contain beneficial bacteria, there is a wider variety of strains in a healthy mother’s gut and birth canal than in breastmilk alone. Babies born via C-section are also not properly seeded with beneficial bacteria from the birth canal, which may explain why they are 5 times as likely to develop allergies by age two as babies born vaginally (3).
Think about it … all that work you have done with your diet for 9 months limiting sugar, consuming fermented foods and taking probiotic supplements to optimally prepare the birth canal for baby’s entrance into the world potentially wiped out by the misguided decision to have a water birth (4).
In addition, exposure of the baby’s skin to the chlorine and other chemicals in the toxic tap water in the birth pool destroys the healthy living biofilm on the baby’s skin called the vernix caseosa which should be ideally loaded with probiotics from passage through Mom’s birth canal. The vernix is protective of the baby’s delicate skin and has anti-infective and antioxidant properties. It should never be exposed to toxic chemicals like chlorine or wiped/washed off until it comes off naturally some days after birth (5).
Moreover, the moist air in the delivery room coming off the warm birthing tub water (filled with tap water) is the first air that baby breathes, and it is contaminated with chloroform, VOCs, and carcinogenic disinfection by-products like trihalomethanes.
Not exactly the optimal air to be filling baby’s lungs with at birth, don’t you think? The picture above shows a mother nursing her baby right in the birth pool. Remaining in the birth pool for some time after birth is very common and exposes the new baby’s fragile lungs to very contaminated water and toxic air off-gassing from the birthing pool.
What About Using Untreated or Filtered Water?
Unfortunately, using untreated well water for a water birth isn’t much better. Below is a list of some of the toxins commonly found in natural well water from contaminated runoff due to dumping by the millions of pounds into soils every single year (6):
- Herbicides (like Roundup, proven to damage beneficial flora)
- estrogen-mimicking hormones
- drug residues
- heavy metals
Filtering the water would be a much better alternative, but the risk of infection is increased due to the lack of chlorine as a disinfectant to maintain water hygiene. A study in 2004 of the water in a birth pool that had been filtered and thoroughly cleaned found high concentrations of the pathogens E. coli, coliform, staph, and P. aeruginosa (7)
Just recently, a baby in Texas died from contracting Legionnaires’ Disease from a contaminated birthing pool. The infant was born in a tub full of well water that hadn’t been chemically disinfected and died after 19 days in the hospital (8).
One final note on using filtered or untreated well water for water birth: this will still at least partially remove the baby’s beneficial, protective biofilm called the vernix caseosa from patting the wet baby down with a towel. The vernix should never be compromised in any manner until it flakes away itself in the days following birth. The vernix protects the baby from infection and has antioxidant properties affecting immunity that science does not yet fully understand (9).
In contrast, babies born “on land” do not need to be patted down with a towel because they aren’t wet at birth except in the very rare case of a baby born in the caul, which isn’t an ideal scenario as baby doesn’t get exposure to Mom’s flora in the birth canal when born in the bag of waters.
Other Water Birth Dangers
Waterbirth supporter and midwife Annie Sprague, author of the book Water Labor, Water Birth, refutes the 2005 warning by the American Academy of Pediatrics on water births which states,
The safety and efficacy of underwater birth for the newborn has not been established. There is no convincing evidence of benefit to the neonate but some concern for serious harm.
Ms. Sprague asserts that current research has shown that babies do not breathe underwater at the time of birth so concerns for water inhalation are unfounded.
While some studies have shown benefits to water birth, a 2003 retrospective study found little to no benefit to the infant and no clear evidence of reduced labor duration or risk of tears (10). In addition, a 2004 review of the medical literature found 74 articles and 16 citations of infants who experienced serious complications from water birthing. These included death, drowning, near-drowning, waterborne bacterial infections, cord rupture and fever (11).
Water Birth Contraindications
Even under the best of circumstances, water birth is not an option for some pregnant women. Waterbirth contraindications include (12):
- Women who do not want to be in the water when laboring or giving birth.
- Women who have a fear of the water.
- Women who are less than 37 weeks gestation.
- Women who show increased maternal pulse rate.
- Situations where maternal fever or infection (including herpes) is present.
- Decreased fetal heart rate during labor.
- Any concerns regarding the health of the fetus.
- Maternal preeclampsia.
- Complicated or overly lengthy labor.
- Less than ideal fetal presentation.
- Women who have used a narcotic analgesic within the previous three hours.
Best to Pass on the Water Birth
It is surely a pleasant experience to labor and birth in water. Pleasant should not be confused with safe, however. I had a very positive experience with water labor as it eased my discomfort during the transition, and I felt much more relaxed which obviously improved blood flow to my baby. However, pregnant women need to be fully apprised of the risks to their babies’ health and their own if water birth is attempted, and as of this writing, this is occurring in few prenatal examination rooms.
The biggest risk of water birth, it seems, is the very real potential of the decimation of beneficial microbial populations in the birth canal from exposure to toxic chlorinated tap water such that the baby’s gut (via mouth contact with the birth canal) is not properly seeded at birth. Lack of beneficial flora in Mom’s birth canal means that the vernix caseosa, which is ideally supposed to be a living biofilm, will not be exposed to probiotics either.
Why so many in the natural health community are flippant about the risks to baby’s microbiota from water birthing is concerning! This is especially true given the almost daily research coming out about how CRUCIAL good gut flora is to lifelong health.
Even if filtered water is used, there is the risk of infection from contaminated water (e.g., many women defecate when pushing). The protective biofilm called the vernix caseosa on the baby’s skin would be exposed to these contaminants and then partially washed/wiped away. This protective coating has anti-infective and antioxidant properties that science believes may affect innate immunity. It should never be exposed to contamination or inadvertently tampered with via towel drying.
The second biggest risk is the absorption of dangerous and carcinogenic toxins from skin contact and breathing outgassed chlorine and other chemicals present in treated water. And what about the toxic chemical cleaners used to disinfect the tub itself by hospital or birthing center personnel? Obviously, this can be controlled in home birth, but not elsewhere. And, finally, the risks of other complications including death from drowning, while small, are very real.
If you absolutely must have a water birth because the pain management and relaxation benefits really work for you, here’s a good compromise: Labor in the water (make sure the water is filtered [this one is a good model to consider] and the tub was cleaned with non-toxic, green cleaners) and then get out when it is time to push. This is a very good compromise that won’t negatively affect your flora, and you won’t expose your baby to pathogens in the filtered water that has no chemicals in it as disinfectant nor will there be any risk to the integrity of the vernix caseosa.
Author Sally Fallon Morell, author of The Nourishing Traditions Book of Baby and Child Care, summarizes it well:
“So, despite glowing reviews, water birth should be embraced with caution.”
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