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Bridging the divide on water births

Bridging the divide on water births - Featured Image

The water birth debate is back in the spotlight, as experts call for doctors and midwives to come to an agreement so that women can better make informed decisions

This comes after research found that most Australian midwives support the use of water immersion for labour and birth.

Lead author of the research and midwifery lecturer at the University of South Australia, Dr Megan Cooper, told doctorportal that “women need to be empowered to exercise choice and this requires full disclosure of all available options.”

She said there is mounting observational evidence on the safety and benefits of water births, but this is largely overlooked.

“Subsequently, midwives are finding it difficult to facilitate the option and women are unable to exercise choice around the option.”

The web based survey was completed by 234 Australian midwives. The results showed that not only do most midwives support the practice, but they reiterated its documented benefits.

This stands in contrast to the position statement of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), which highlights safety concerns and the need for more research.

University of Queensland Associate Professor Ted Weaver, an obstetrician and former president of RANZCOG, told doctorportal that given the limited evidence base, water birthing remains an issue of contention.

“The evidence so far such suggests that warm water immersion as a comfort measure during labour is useful. It helps women relax, reduces the number of epidurals, and reduces pharmacological pain relief.”

“Water birthing, where the baby is born in water, has its own potential risks – inhalation of water and the baby drowning, mothers collapsing in the bath, and post-partum haemorrhaging.”

Professor Weaver says that many doctors are not exposed to water births, because midwives largely perform them, and the women opting in are at low risk of complications.

“Certainly, in my institution, where there’s a bath in every room, we haven’t had any problems.”

Professor Weaver acknowledged there are obviously opposing views which complicate the discussion. “There are women who come and request water births, and there’s a lot of obstetricians who would say ‘absolutely not’. Midwives have an opposite view, feeling this is something women should be able to choose to do.”

Professor Weaver says that to resolve the disagreement and help women make more informed choices, professional bodies must cooperate.

“How policies are arrived at should be an exercise in collaboration. Doctors and midwives have to sit down and come to an agreement.”

He said that any policy must outline what criteria preclude women from having water births, and what to do when emergencies occur.

Dr Cooper said that women should be active in having conversations about their care.

“It is important for women to ask about the risks of conventional options of pain relief such as epidural. They can then weigh up the benefits and risks, and choose what is right for them.”