Delivery during a water-birth
What is the advice regarding breech or twins labour and delivery in water?
This is controversial. Many units regard both these situations to be high risk and therefore unsuitable for water birth. In fact, virtually all maternity units in the UK and many other countries no longer offer breech vaginal delivery for term singleton babies let alone conducting that in water.
Others take a more liberal view regarding breech labour, where this may be conducted in water. However, in second stage, the woman has to leave the pool. This is mainly for practical reasons, as proper assistance in breech delivery in the pool can be quite problematic, and therefore unsafe for the baby. In any case, breech vaginal delivery is becoming increasingly uncommon even without adding the water-birth dimension.
There are even fewer practitioners happy to allow twins labour in water. Fortunately, mothers requesting this are fewer still.
What is the advice regarding delivery in water?
This remains a difficult question. Many units will allow delivery under water, if the-mother wishes. However, because of the uncertainty regarding the safety of this undertaking, some units will allow labour in water but delivery has to be conducted outside the pool.
Even in those units which allow underwater delivery, some midwives are unwilling to conduct delivery under water and therefore the mother may be unable to have her wish, for this reason. The issue of safety for this kind of delivery is likely to remain unresolved, since a proper scientific study in this area is probably impractical.
If delivery is conducted under water, how long should the baby be left submerged?
If the temperature has been kept constant and as close to the body temperature as possible, the baby is unlikely to start breathing under water. The risk of inhalation of water is therefore minimal. This assertion is borne out by the widespread experience around the world.
However, if the water had been allowed to cool significantly below the body temperature, the baby is likely to gasp in reflex on coming into contact with the relatively cold environment. This is one of the main reasons why strict water temperature control is essential. Experience shows that a baby born in water with appropriate temperature is relaxed and makes no effort to breathe, since the placenta is still supplying him or her with adequate oxygen.
Prolonged submersion may, however, be inadvisable, since the placenta may start to separate, risking hypoxia (oxygen insufficiency) for the baby.
Should suction of the baby's mouth and nose be commenced immediately after delivery?
If the baby is born under water, suction should never be started while the baby is still submerged. If one wants to do this, the head of the baby may be brought above water and suction performed.
What is the advice regarding delivery of the placenta?
Most practitioners advocate that the third stage (i.e. delivery of the placenta) should be conducted outside the pool.
This has three theoretical benefits.
Firstly, it may reduce the risk of heavy postpartum haemorrhage (PPH).
Secondly, it allows for a more accurate estimation of blood loss post-delivery; and
Thirdly, it prevents a potentially serious - even fatal - complication of water embolism (where water finds its way into the bloodstream).
It has to be stressed that no case of water embolism has been reported in relation to water birth. However, all the ingredients for such a complication are there and hence placental delivery outside the pool is regarded to be a worthwhile precaution.