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Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA

Minnesota women embrace the gentle option of water birth

by Darlene Pfister, Star Tribune
Published Oct 1, 2002

Red and blue fishes greeted tiny Ani Madson as she plunged into the world in the early hours of Sept. 17. The strong contractions that thrust her through her mother's birth canal splashed her gently into a kiddie pool full of warm water. Seconds later, she was at mother's breast, lifted there by loving arms.

Ani's purple body quickly turned pretty pink as oxygen pumped through her young lungs. For mother Amy Madson, the lingering trauma of labor and delivery seemed to dissolve into the water, where she remained to admire her third child. Husband Pete knelt behind her, his arms enveloping them. Gazing into her daughter's alert eyes, Amy barely noticed midwife Kerry Dixon checking vital signs, or the delivery of the placenta a few minutes later.

About 20 minutes after Ani's birth, Amy stepped from the birthing pool to her bed. Dixon checked mother and child, then left the parents to sleep, their new daughter cradled between them. It would be daybreak before Tyler, 4, and Juul, 1, padded across the hall in their Minneapolis home to discover their new sister.

Madson is one of a growing number of Minnesota women choosing water birth to deliver their babies. Like her, some give birth at home, but more hospitals are offering it as an option.

Advocates of water births cite many advantages over bed births: Mothers who immerse themselves in warm water are more relaxed during labor and delivery. The water's buoyancy takes the weight off their bones and body, allowing them to move more easily and comfortably during labor. As a result, they have shorter, easier labors and use fewer, if any, painkillers.

The warm water stretches and softens the skin of the perineal area, so episiotomies are rare, advocates say. Water birth babies also seem calmer, they say, because of the gentle transition from warm womb to warm water.

Research limited

Little research has been done to prove or disprove those claims.

For that reason, the American College of Obstetrics and Gynecology takes no position on the practice. In Britain, where it has been common for decades, a 1999 study of 4,032 births found the perinatal death rate for babies born in water comparable to the death rate for other low-risk deliveries -- about 1.2 per 1,000 births.

Many mothers with low-risk pregnancies are choosing water birth as a safe, gentle option. In the Twin Cities area, home-birth providers such as Dixon, a certified professional midwife, have been assisting home water births for nearly a decade. Metro hospitals have recently begun to offer the option, although hospitals elsewhere in the state embraced it several years ago.

"I think they're wonderful," said Sharon Riester, a certified nurse midwife and family nurse practitioner at St. Elizabeth Hospital in Wabasha, Minn., where 80 percent of mothers-to-be choose water births.

"They need much less medication. There's much less perineal trauma. Babies are calm," she said. "Second-time moms definitely call it a wonderful experience compared with traditional bed birth."

 The midwife model of care regards birth as a mother-centered event -- not a medical procedure. Midwives have encouraged hospitals to offer water birth.

"It's a cultural thing that physicians are cautious to grasp," said Jeanette Schwartz, manager of maternity care center at Woodwinds Health Campus in Woodbury, one of the few Twin Cities-area hospitals that offer water births.

"There's not much research on water births, either good or bad," she said. "And for physicians, there's not much for them to do." [Ed. - Research]

Midwives worked with physicians to bring water birth to Woodwinds and St. Joseph's Hospital in St. Paul, both owned by the HealthEast Care System. The planning took nearly a year.

"You never had a physicians' meeting so crowded as when water birth was on the agenda," Schwartz said. "They [physicians] were very involved with the decision. They wanted to know the research, and they helped develop the policies and procedures."

Since July 2001, about 50 women have given birth in portable birthing tubs at Woodwinds and St. Joseph's. Hennepin County Medical Center in Minneapolis has offered water birth for about four years, said Claire Nelson, co-director of the nurse midwife service there. They do about one per month, she said.

At Woodwinds, which stresses holistic care, Schwartz believes more pregnant women will embrace the practice once they learn about it.

"This is something I've wanted forever," she said. "It brings back that spirituality to the birth process. Water birth gives the mother the power over her process; we just stand by and watch it."

Midwives lead

Smaller, nonmetro hospitals have led the way in the water birth movement in Minnesota.

At Douglas County Hospital in Alexandria, certified nurse midwife Jeanne Howell estimates that she's attended 80 water births since the hospital began offering them in 1997. About one-third of mothers now give birth to their babies in the hospital's aquapool.

In Olivia, 75 percent of expectant women at Renville County Hospital deliver their babies in one of the hospital's two new whirlpool-equipped birth rooms.

"They get into water to deal with labor pain and then don't want to go out," said certified nurse midwife Edie Weiss-Holzbauer. "Labor and pushing time seems much shorter."

In the second year that water birth has been offered at Long Prairie Memorial Hospital, half of expectant moms requested it, said certified nurse midwife Ruth Wingeier. The hospital recently installed two birthing tubs.

"The word gets out and people feel more comfortable with it," she said. Mothers from as far away as St. Cloud, Brainerd, Pine River and the Twin Cities have come to Long Prairie to deliver in water, Wingeier said.

Although hospital options for water births are limited in the metro area, many hospitals offer deep bathtubs for labor relief.

At Methodist Hospital in St. Louis Park, Madson went into the water for labor relief during her second son's birth. She had barely gotten in the tub when she was ordered out after her first strong contraction. After 90 minutes of labor, Juul was born without complication, but Madson felt rushed. Her history of easy birth and her desire to have greater control over the process were factors in choosing a home water birth for her third baby.

She has no regrets.

"I've always been comforted and soothed by warm water," said Madson, who is a second-year nursing student. "It was still as painful, but I was much more in touch with what was happening. I wasn't panicking with Ani; I knew that I could do it. I never thought I wanted to die. I just wanted it to be over."

"The water took the weight off my body," she said, gazing at her dozing newborn daughter.

"All I felt was the birth."

 

Q&A: Water birth

What are the benefits? Several European studies suggest that mothers using water birth have shorter labors, require less pain relief and have less perineal tearing. Minnesota midwives say they have seen those benefits, but no large studies have been done in the United States to assess the benefits or risks of births in water.

Is it safe? A study in the British Medical Journal of 4,032 water births found an infant death rate of 1.4 per 1,000 births, about the same as for all births following low-risk pregnancies.

Why doesn't the baby drown? An inborn mechanism called the dive reflex prevents babies from breathing underwater for the first six months of their lives, according to Barbara Harper, a nurse who founded Waterbirth International.

Who can consider water birth? HealthEast Care System policies state that a healthy woman with a normal, low-risk pregnancy of at least 37 weeks is a candidate, with caregiver approval. She should not have had a Caesarean birth previously.

Online resources: Global Maternal/Child Health Association and Waterbirth International at http: Minnesota Birth Network at http: HealthEast Care System at http: and Woodwinds Health Campus at http:

-- Darlene Pfister is at dpfister@startribune.com.