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Study
Looks at Benefits
of Underwater Birth
BERLIN (Reuters Health) -
Giving birth in water is safe for women with an uncomplicated
delivery, and may shorten the first stage of labor, according
to Italian scientists who studied more than 1,500 births.
However, some US-based experts
caution that the jury is still out on the safety of such births.
Drs. Albin Thoni and Konrad Mussner,
from the regional hospital in Sterzing in the South Tyrol region
of northern Italy, compared data from 969 water births, 515 births
in bed and 172 using a birthing stool.
After excluding complicated births
that required vacuum extraction, other manual help or epidural
anaesthetic, the results showed some advantages for water births,
they report in the December issue of the German-language journal
Geburtshilfe und Frauenheilkunde (Obstetrics and Gynaecology).
The average duration of first-stage
labor, which finishes when the cervix is fully dilated, was 381
minutes for women in water compared with 473 minutes for those
using other positions. There was no difference in the duration
of the second stage of labor, when the baby moves through the
birth canal.
"Our results suggest that water
birth is associated with a significantly shorter first stage of
labor, a lower episiotomy rate, fewer perineal lacerations and
reduced analgesic requirements compared with other delivery positions.
Water birth appears to be safe for the mother and the fetus-neonate
if candidates are selected appropriately," they write.
Yet, the Italian team's views are
not universally supported in the medical community. Other experts
believe that underwater births need more study or are potentially
dangerous. In August last year, New Zealand researchers described
four instances within 18 months where infants inhaled water after
underwater delivery.
In those cases, the four infants
began to experience respiratory distress and a need for oxygen
anywhere from five minutes to six hours after birth, study findings
indicate. They were treated with antibiotics and/or oxygen, and
all were discharged from the hospital a few days after birth.
Part of the problem is that there
are not enough studies of the practice, said Dr. Bruce Shephard,
affiliate associate professor of obstetrics and gynecology at
the University of South Florida College of Medicine in Tampa,
Florida, and author of the book, "The Complete Guide to Women's
Health."
"There have been thousands of articles
on all these things, but the problem is, it's the same thing we
have with hormone replacement therapy," he said. "Most of the
studies are observational studies that don't have statistically
significant data from which general conclusions about clinical
decision making can be made, they're just snap shots."
"Unless this was a large study,
with randomized controls, it makes it hard to draw conclusions
from it. Most of these studies have qualitative aspects as well
as quantifiable aspects which are also hard to measure."
Most obstetricians would probably
not recommend an underwater birth, said Dr. Bruce Flamm, an obstetrician-gynecologist
at Kaiser Permanente Medical Center in Riverside, California.
He said there are several issues,
including sanitation, as well as the fact that babies are not
normally born underwater.
"It's an interesting theory that
the baby kind of likes being in its water-filled world for the
first few minutes after birth, and it will in some way be less
traumatic, but there's no evidence to support that," he said.
Many midwives and some doctors
believe that being in a tub in the early phase of labor is helpful,
he said.
"That probably is reasonable, and
I think many obstetricians will probably say that's quite reasonable,
as long as it's a low risk patient, but the actual concept of
giving birth underwater--that's a much more difficult question
to answer, and I think most obstetricians would say it's not a
good idea."
SOURCE: Geburtshilfe und Frauenheilkunde
2002;62:977.
Reference
Source 89
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