Hydrotherapy-Student Article

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The following is a student blog post by Lisa Oberstadt

Hydrotherapy by Lisa Oberstadt

Hydrotherapy is the use of water to relieve discomfort and promote well-being.  Doctors realize the benefits that water can bring, especially when used with exercise.  The Centers for Disease Control (CDC, 2013) recognizes these benefits.  In an article titled “Health Benefits of Water-based Exercise,” the CDC states, “People report enjoying water-based exercise more than exercising on land.  They can also exercise longer in water than on land without increased effort or joint or muscle pain. . . . Exercising in water offers many physical and mental health benefits and is a good choice for people who want to be more active.”  Many people compare childbirth to a marathon, and few would disagree.  It makes sense, then, that using water in labor would have similar benefits.  There are three main ways that water is used during childbirth to gain these benefits: laboring in a shower, laboring in a tub, and waterbirth.

Hydrotherapy
Hydrotherapy

Even doctors in hospitals recognize the benefits of laboring in the shower.  The water is soothing, relaxing, and helps to relieve pain, which leads to greater progress in labor.  Many women experiencing back pain find at least some relief in the shower.  The shower is also a good alternative to the tub when infection due to ruptured membranes is a concern.  Baby may be monitored while mom is in the shower using telemetry equipment.  Most hospitals now provide laboring suites that include a shower.

While not as accepted among physicians, laboring in a tub has become more popular in the last two decades.  Water labor includes submerging past the belly during active labor in water that is about 98 degrees Fahrenheit.  Physicians and nurses are sometimes less friendly toward water labor, because they have less control, restricted access, and difficulty monitoring.  Some hospitals allow a tub during labor but usually require that the mother leave the tub before beginning third stage labor.  The best places for laboring in water are in a birth center or at home.  Laboring in the water provides all the benefits of laboring in the shower, plus many more.  The mother has more control and freedom of movement.  Being submerged in the water relieves pressure, which provides greater pain relief; in fact, water labor is often seen as a natural alternative to an epidural or other anesthesia.  The water is so calming that there is almost an immediate drop in blood pressure and a heightened intuitive awareness.  Women laboring in water are more in tune with their bodies.

Waterbirth takes these benefits further by actually delivering the baby in the water.  The mother may then get out of the water or stay to deliver the placenta in the water.  Waterbirth in the United States is virtually unheard of; physicians and midwives who have participated in a waterbirth and witnessed the benefits criticize the resistance from opponents of waterbirth as being primarily about control and money.  In the U.S., if a woman wishes to deliver her baby in the water, she will most likely need to find a midwife willing to attend the birth at a birth center or at home.  Further benefits of waterbirth to mom include elasticity of the perineum, which means that tearing occurs less often and with less severity.  Also, the laboring woman does not have to leave the tub during the most strenuous time of labor, and the water sometimes helps speed delivery.

There are also great benefits to the baby born in water.  The warm water helps with heat regulation and provides a gentle introduction into the world.  The water is similar to the environment the baby has been in for nine months and is gentler to its sensitive skin. The baby also has an opportunity to unbend and unwind after the stress of birth before being exposed to air.  Such a gentle introduction aids in the bonding process between the parents and baby.

The two main risks that opponents of waterbirth cite are drowning and infection.  When a baby’s face comes into the air, he takes his first breath, his lungs open and begin to work, and the vessels between the lungs and heart open as well.  Drowning is impossible until that contact with air and the first breath.  It is actually asphyxia that is the risk. However, until the placenta detaches from the uterine wall or the cord is clamped, a baby is still getting oxygen from his mother.  There was a case of a baby “drowning” – or asphyxia —  after a waterbirth in California in the 1990’s, but this happened because his parents kept him in the water for an hour.  When proper care is taken to bring the baby out within fifteen to twenty minutes, the baby is fine.  And most midwives will bring the baby out of the water within two minutes of the birth, long enough for the baby to calm down after delivery but short enough to be well on the safe side.

It might seem that worry about infections would be a valid concern, but the experience of physicians and midwives who deliver babies in water shows evidence to the contrary.  Susanna Napierala (1994) states in her book Water Birth that in all their cases of waterbirth combined, she, Igor Charkowsky (a prominent Russian midwife and swimming instructor), and Michel Odent (a French obstetrician) have had no complications of infection in any of their waterbirths (pg. 68).  In fact, Napierala would argue that the risk of infection is higher in hospitals: “Hospitals have become acute care centers where those with highly infectious and terminal diseases are in abundance. Mothers are expected to give birth and subject their newborns to this bacteria (which is supposedly contained on certain units and certain floors), whereas most of the ‘germs’ in our homes are with us everyday, forming part of our environment” (pg. 68).  Barbara Harper (2005), midwife and author of Gentle Birth Choices, believes that “it is important for the baby to become colonized with the mother’s bacteria, which offers some protection to the baby, helping develop its immune system” (pg. 174).

There are other complications that might arise during waterbirth.  Some of these, like shoulder dystocia and breech babies, might actually be easier to handle in the water environment, where babies are easier to turn and manipulate.  Harper (2005) states, “The use of water often transforms what could be considered an emergency and possibly require a cesarean into an experience that is handled efficiently because of the water” (Gentle Birth Choices, pg. 181).  Water might slow down labor, especially before contractions are thoroughly established, or drain the energy of a mother who spends too much time in the tub.  Such complications as these can be avoided if the mother stays out of the water until she is in active labor and if she changes position regularly, getting in and out of the tub.

There are some contraindications for waterbirth.  In her list of conditions that would exclude a woman from a waterbirth, Napierala (1994) includes being a diabetic or having cardiac problems, an “unwillingness or inability” to follow directions from the midwife, “inadequate home environment,” living too far from an emergency facility, eclampsia, herpes, placenta previa, infectious diseases, and a few others (pg. 107-8).  In Choosing Waterbirth, Lakshmi Bertram (2000) also lists prematurity, footling presentation, and “disease or illness . . . which require careful medical supervision” as contraindications for waterbirth.

The benefits of using water in childbirth are virtually indisputable, despite physicians’ claims that it is not safe.  In her article, “Doctors Say Don’t Give Birth To Baby In A Tub, But Midwives Disagree,” Nancy Shute (2014) declares that midwives “have been helping women deliver in water for decades in order to ease pain and speed delivery.”  Terri LaPoint (2014) of the Inquisitr shares the experience of a midwife who says that “babies born in water . . . are the most peaceful of all the babies that she has witnessed being born.”  While hydrotherapy is not for everyone, laboring women should have the freedom to choose how they wish to labor and deliver their babies.

 

References

Bertram, Lakshmi. (2000). Choosing waterbirth: Reclaiming the sacred power of birth. Hampton Roads: Charlottesville, VA.

CDC. (2013). “Health benefits of water-based exercise.” Centers for Disease Control and Prevention, cdc.gov:      http://www.cdc.gov/healthywater/swimming/ health_benefits_water_exercise.html

Harper, Barbara. (2005). Gentle birth choices. Healing Arts Press: Rochester, VT.

LaPoint, Terri. (2014). “Water birth has no proven benefits? Moms and experts disagree.” Inquisitr.com: http://www.inquisitr.com/1182455/water-birth-has-no-proven-benefits-moms-and-experts-disagree/

Napierala, Susanna. (1994). Water birth: A midwife’s perspective. Bergin & Garvey: Westport, CT.

Shute, Nancy. (2014). “Doctors say don’t give birth to baby in a tub, but midwives disagree.” NPR.org: http://www.npr.org/blogs/health/2014/03/21/292381478/dont-birth-that-baby-in-a-tub-doctors-say-but-midwives-disagree

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