Water birth

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Newborn after a water birth

When water birth is located birthing woman in a water basin with warm water . The warm water should give a feeling of security and promote relaxation .

history

Water births are said to have been known in ancient Egypt . It is said that water births were also observed by James Cook in Central America and New Zealand in 1778. The inhabitants of Hawaii and Samoa , the Cumash Indians, Indian tribes in Costa Rica and the Māori in New Zealand are named .

The first known European water birth took place in France in 1803, where warm water baths were used for obstetrics. After that, the water birth issue was quiet for more than a century. This only became current in 1963, when underwater births were propagated again in the Soviet Union. In Western Europe, water birth goes back to Michel Odent , who used an inflatable paddling pool in the 1970s to allow women to relax in warm water during labor. Water births have been taking place in France since 1978, and in Germany and Switzerland since the early 1980s.

technology

Special water basins, such as the hexagonal water birth basin developed by the Active Birth Center in London , have a diameter of 140 cm and a volume of around 700 liters.

In Germany, in addition to normal (corner) bathtubs, special birth bathtubs are sometimes used that have a flap for getting out in an emergency. However, the water then also pours into the room, which must be taken into account structurally. There are now comfortable, transportable, inflatable and inexpensive alternatives for flexible use. Permanently installed birth baths usually have heating to keep the water temperature constant.

There are certain contraindications to water birth (for example breech position and “green” amniotic fluid ). Due to the diving reflex , the newborn usually only takes its first breath when the face is no longer covered with water; so there is neither the risk of drowning nor the risk of ingesting feces for the child.

In hospitals where there is a water birth option, around 30 to 50% of mothers choose this option. In 2002 about 10% of all births were water births. In many cases, doctors advise against water birth (e.g. if there is a risk of shoulder dystocia or complications from a previous delivery).

As a prerequisite for a water birth, Eldering and Geissbühler name:

  • Hospital delivery
  • Low-risk childbirth
  • Wish of the pregnant woman
  • Complete monitoring by a doctor and midwife
  • Bacteriological monitoring of bath water and bath tub
  • Availability of a second person to transport you out of the bathtub if problems arise.

The German AWMF guidelines also require that the pregnant woman must not have any known infection that could lead to exclusion, that the staff must be vaccinated against blood-borne infections (especially HBV), that the sick person should be given a cleansing enema and that only the sick person should stay in the tub may.

Technically and organizationally, it is also required that the tub and all contaminated surfaces after delivery after draining the water and briefly rinsing the tub with a limited virucidal (effectiveness against blood-borne pathogens) disinfectant and that the declared exposure time must be waited for before re-use . Face / eye protection is required for staff and long-sleeved gloves are required for water birth because of the contamination of the bathing water with blood, stool and urine. Infection control is also required in the woman who has recently given birth and in the newborn.

advantages

Water birth as such does not pose any particular risks to the newborn. Investigations of water births by the gynecologist Albin Thöni and others prove:

  • The birth time is shorter than usual.
  • As a rule, childbearing women do not require any pain medication (if pain medication is required, the birth is continued outside the tub).
  • Postpartum bleeding in the puerperium subside faster.
  • Significantly fewer perineal incisions are required for water births .
  • Reduced stress at birth for the child.

The greatest advantage of this mode of delivery is the greater opportunity for women to relax. Labor is also better tolerated. Movements and changes of position are easier and more energy-saving in the water. Women who gave birth in water also leave clinics and birthing centers earlier than women who give birth in the supine position.

Risks

A dam protection is based on the position of women in labor limited in the water possible. An epidural can not be performed. In the event of an emergency that has to be treated outside the bathtub (e.g. cesarean section , shoulder dystocia ), more time elapses than in the delivery bed.

If hygiene requirements are not strictly adhered to, the woman in labor is at risk due to the reduced resistance of the skin to skin infections with Pseudomonas aeruginosa and other germs contained in the water. The newborn is primarily at risk from invasive infections with water pathogens or pathogens from the mother's stool flora. There are case reports which suggest that infections with pathogens from water can lead to serious illnesses in newborns. This applies to both Pseudomonas and Legionella pneumophila infections , the latter also fatal.

In addition, problems with heat regulation, umbilical cord rupture and rupture when taking the newborn out of the water, and shortness of breath due to aspiration of the tub water have been described. Seizures and perinatal asphyxia have also been reported.

literature

Technical article

  • Albin Thöni: The water birth. In: German midwifery magazine. No. 1, 1999, pp. 3-6.
  • A. Thoeni, R. Kalweit: giving birth in water: experience after 2,375 water births with comparative analysis . In: Obstetrics and gynecology. 1, 2008, Thieme Verlag ( conference contribution )

Web links

Wiktionary: water birth  - explanations of meanings, word origins, synonyms, translations

Individual evidence

  1. ↑ a b c G. Eldering, V. Geissbühler: Wassergeburt. In: Henning Schneider, Peter-Wolf Husslein, K.-TM Schneider: Die obstetrics. 4., rework. and act. Edition. Springer Verlag, 2011, ISBN 978-3-642-12973-5 , pp. 714f.
  2. ↑ a b c S1 guideline infection prevention under the delivery of the "Hospital & Practice Hygiene" working group of the AWMF. In: AWMF online (as of 2012)
  3. ↑ A. Thoeni, R. Kalweit: Birth in water: experience after 2,375 water births with comparative analysis . In: Obstetrics and gynecology. 1, 2008, Thieme Verlag
  4. ↑ M. Vochem, M. Vogt, G. Döring: Sepsis in a newborn due to Pseudomonas aeruginosa from a contaminated tub bath. In: N Engl J Med. 345, 2001, pp. 378-379.
  5. ^ A. Kingsley, S. Hutter, N. Green, G. Speirs: Waterbirths: regional audit of infection control practices. In: J Hosp Infect. 41 (2), 1999, pp. 155-157.
  6. ↑ T. Nagai, H. Sobajima, M. Iwasa, T. Tsuzuki, F. Kura, J. Amemura-Maekawa, H. Watanabe: Neonatal Sudden Death Due to Legionella Pneumonia Associated with Water Birth in a Domestic Spa Bath. In: J. Clin. Microbiol. 2003, pp. 2227-2229.
  7. ↑ Lu-Ann Papile, Jill E. Baley, William Benitz, Waldemar A. Carlo, James Cummings, Praveen Kumar, Richard A. Polin, Rosemarie C. Tan, Kristi L. Watterberg (American Academy of Pediatrics): Immersion in Water During Labor and Delivery. In: Pediatrics. 133, 2014, pp. 758-761, doi: 10.1542 / peds.2013-3794