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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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I’ve had 2 water births with no issues, my oldest daughter was born in hospital was diagnosed with auto immune vitaligo away 2…
As a mother of six, all born at home, half in the water, I must admit that my children who vary in age from twenty to five are all similar in their health and lack of auto-immune disorders. I have no monetary incentive to insist upon this and no ax to grind in any other way. You make interesting points but perhaps rather overstating potential issues.
I am a midwifery student and mother of 7 children born at home. I think you bring up some valid points about chlorine. What you are saying makes a lot of sense for a woman who has decided to prioritize purified water for drinking, bathing and swimming in. Some clients have whole house Reverse Osmosis filters (or something similar) in their home. I’m considering installing one myself. I recall that for my second planned home birth/water birth I was super careful and went to the trouble of purchasing a filter for my shower head and then trying to fill the tub with it because I wanted to do everything perfectly for my baby (alas, it prevented the tub from filling adequately before I pushed the baby out). I’ve made a lot of compromises in my parenting choices since that time, and I’ve excused myself from the pressure to do everything perfect. We currently swim 2-3 times a week in chlorinated public pools and bathe in tap water, so for my family, making a big deal about the birth water wouldn’t make sense unless we decided to go all the way-filtering the whole house and super prioritizing water quality (which you DO have me considering…).
Most clients I see in prenatal appointments live similarly, and avoiding water birth to avoid chlorine makes little sense when they bathe themselves/will bathe their babies in that same water anyhow. If they care enough to have a whole house filter or RO system set up then they will neutralize the problem you are pointing out. I think these decisions are worthy of bringing up in prenatal appointments on the condition that clients are not pressured or made to feel guilty for not doing everything ‘perfectly.’ 50% of clients giving birth in the US qualify for medicaid and have limited financial resources for filtering home water. As midwives, we meet them where they are at without judgement. But I agree that clients could be alerted to the potential dangers to chlorine exposure during prenatal care so that they can make informed choices as they navigate the challenging waters of health decisions within the limits of their financial situation.
Sarah Pope MGA
Thank you! At last a midwife who is for FULL DISCLOSURE to alert the patients so they are 100% informed and can make the decision that works best for them! I’ve gotten so many nasty emails from midwives about this article that it shocked me! I would think that these providers would be eager to fully inform their patients particularly with the ever-growing body of research that indicates that a diversity of beneficial gut flora status at birth is one of the most important determinants for lifelong health and avoidance of chronic disease for the baby. Possibly compromising this for a short term benefit of reduced pain or a trendy birth experience is NOT a good trade-off!
I apologize in advance if this is a dumb question, but if the mother has an untreated foot fungal infection would that make laboring in the tub a bad idea as far as the baby’s health as it passes thru the birth canal? Would the fungal microorganisms from the feet (specifically under the toenails) survive in the water and then colonize the birth canal or is this not a possible issue?
Sarah Pope MGA
It’s a very legitimate question! I haven’t seen any research that fungus from the foot would live in the water, but since it is warm … very possibly so. If it was me, I certainly would not do a water birth just to be on the safe side.
I read your artical expecting to find some real answers about the safety of water births. Fortunately, I live in the UK where our water authorities provide safe clean drinking water. I think the real issue here is with your water provider. Anyone who provides toxic drinking water should be procescuted by some sort of health and safety legislation. Please make it clear that your report relates to your local water authority. I would hope that at least some American water companies provide safe clean drinking water. There are some great charity initiatives trying to provide safe clean water in Africa. If you like I could send you a link as they maybe able to help. Good luck. Louisa
Sarah Pope MGA
It seems you are not fully informed about the concept of safe drinking water. Chlorinated water which creates a multitude of disinfection by-products is considered safe by governmental bodies here in the USA and the UK. While it won’t kill you immediately to drink it, that doesn’t make it safe! The long term safety of consuming chlorinated tap water is dubious at best. This is why many people buy water filters at home and/or drink bottled water even if their municipal water is declared “safe” according to authorities. I suspect many people in the UK filter their tap water as well.
The vast majority of water births occur in tap water … this water is chlorinated which creates secondary (carcinogenic) disinfection by-products such as trihalomethanes. It is NOT safe to birth a baby in this water. If a midwife insists that it is, find another provider.
CAROL GAUTSCHI CPM LM
Greetings! I’m a mother of seven and grandmother of twelve. Almost all born at home. I am also a homebirth midwife of 41yrs. I attend waterbirths almost exclusively. I teach globally and often include a class on the Human Microbiome. Not meaning to offend – but this article has much mis-information in it. I am certainly more concerned about a baby being born in an institution with rampant strep and staff and untold bacteria’s rather than chlorinated water… The probable exposure to most pharmaceuticals are far more detrimental than chlorine. I have assisted at hundreds of waterbirths and have never seen what you are speaking of here. It is unfair and harmful to speak of things you do not fully know about.
Sarah Pope MGA
If you are earning your living with waterbirths, you are not an objective source of information on the subject. There is NO misinformation here … just VALID concerns that any mother-to-be needs to seriously consider before consenting to a trendy but dangerous water birth. People are not dolphins … and waterbirth (much like a C-section) poses a serious threat to the proper development of a baby’s flora both on the skin and inside the body. Actually, I doubt you even read the article as there is plenty of science cited.
As for you “never” seeing any of the problems discussed in this article, with all due respect … you are either flat out lying or misinformed because you don’t document the health of the babies you waterbirth after they leave your practice. I am sure the MAJORITY of babies you’ve birthed via waterbirth have autoimmune problems perhaps not immediately after birth when you would be seeing them, but certainly months/years down the road when you no longer even know what is going on with them (and hence, make the mistake of “assuming” they are just fine). Waterbirth would undoubtedly contribute to the development of those conditions as improper flora development in infancy is a major reason why these chronic illnesses occur. There are BOOKS written on the importance of diverse flora to health by highly qualified MDs and others in the field. I suggest you get your head out of the sand and start reading.
I am the mother of three … all birthed naturally WITHOUT water birth … NONE have autoimmune illness of any kind. Skipping the waterbirth was one important reason for this. MOST babies I know birthed via water have autoimmune illness … starting with eczema and it dominoes from there as they get older. Yes, we need definitive, double blind studies on this, but as a parent, we need answers NOW not years down the road after the damage has been done. The preliminary science about waterbirth give caution already; it is the safest bet to NOT birth in the water if you are smart and research both sides.
I work in a hospital and every baby that comes out is absolutly cleaned and bathed right after birth. Even in a vaginal birth they still pat the baby down and rub the vernix off with the towel. This would seem like the same exposure and lack of microbials as a water birth. It makes perfect sense to leave the vernix on in my option but this is not the case with any of the babies born where I work. Also, it is the pediatricians that are so particular on having them sparking clean!
Most babies come out facing the rectum regardless of maternal position. Perhaps the idea of hands and knees may cause poop to move toward the vaginal
canal, whereas sideways positions, back lying, or standing or sitting will assist in poop moving potentially not towardthe birth canal.
But you would have to be familiar with when women poop during labor (usually comes out before baby) and what it looks and acts like. Birth attendants usually catch the poop and clean the rear end up right away, they don’t let poop just poured down the lady’s bottom and crotch and remain there.
So I guess it’s a moot point. It’s just not something that typically causes a problem, and one doesn’t see poop face babies (unless in their own meconium perhaps).
The hospital I am looking at has waterbirth as an option. I have not given birth before but reading your article left me to pose one thought. Every baby I have visited in the hospital is cleaned. I am no expert but I guess I just assumed it was with water? and nowadays I have seen many new mothers leave the hospital within the day. So if this special skin should be left to naturally peel off why does everyone wash there babies? And washing involves water I mean you could argue that water births the baby would be soaked instead of rinsed but that doesn’t seem realistic and would the hospital use the same water to wash my baby as they put in the birthing pool? What is your stance on distilled water? The whole pregnancy I’ve showered in tap that gets in my blood stream is it wrong later on to bath your baby in tap? I feel like my on thought led to a lot of questions but it seems even having a conventional birth your baby would still be harmed inevitably. I mean and if they don’t wash it don’t they at least towel it off? Which also sounded like a nono in this article.
Um, no. Babies aren’t cleaned or washed after birth anymore! That is a relic of the last century. Not one of my three children was cleaned! Just wrapped in a blanket by a midwife to preserve that precious vernix! They aren’t “dirty” anyway after birth. The vervix keeps them clean and preserves and protects their skin.
“Toxic Tap water” seriously!? Do you have any evidence at all to show that toxic levels of chlorine are absorbed via the lungs and skin during a water birth? Or is this just conjecture on your part? You’ve used the word carcinogen – again – any evidence to back this up at all? One minute you are saying that the water in a birth pool doesn’t have pathogens in due to chlorine killing them the next you are saying that there could be dangerous pathogens in the water!? Frankly I think this is ridiculous scaremongering, a completed unbalanced and biased view that will potentially prevent mothers from choosing an option that could make birth significantly less painful and traumatic – which can only be a good thing. Many mums who have a water birth would otherwise use other drugs.
Not conjecture at all … scientific references with links are provided in the article if you take a look 🙂 Having birthed 3 children naturally myself, I know what its like to make difficult choices when making a birth plan. This article is for those women who want to know the entire story about water birth to make a fully informed decision. I’ve had MANY emails from women thanking me for this article as they had never considered this angle before.