©Pregnancy bliss 2008
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Breech or twins labor and delivery in water
The issue of breech or twins and water birth is controversial. Many units regard both these situations to be high risk and therefore unsuitable for water birth.
A lot of obstetric units, probably most, have abandoned breech vaginal deliveries altogether, let alone laboring in water for such. Others, decidedly a minority, take a more liberal view regarding breech labor, where this may be supported and even conducted in water. However, in the 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.
You will be hard pressed to find a practitioner happy to allow twins labor in water. Fortunately, mothers requesting this are fewer still.
Actual birth in water
This remains a difficult question. Many units will allow delivery in water, if the mother so wishes. However, because of the uncertainty regarding the safety of this undertaking, some units will allow labor 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, there is the question of how long the baby can stay safely submerged. The fact is, 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.
