Very recently, ACOG (American College of Obstetrics and Gynecology) declared that water births are potentially dangerous and should not be allowed until a clinical trial has determined whether or not they are really that risky. A local research hospital, OSU (Ohio State University) followed suit by creating a ban on water birth in their facilities (as have most other local hospitals).
Both ACOG and OSU acknowledge that laboring in water may provide some benefit as far as pain relief, but consider delivering in water to be “potentially risky” and recommend against it. Well — OSU has outright banned it.
There are several astronomical problems with this.
First, the statement by ACOG, which came out on March 20th, was based purely on the opinion of a group of OBs. It was not a study. They were not basing this on any data. They just “felt” that water birth “could” be dangerous. Recommending for or against any procedure without actual data is wrong.
Second, they are limiting the options that women have during labor and birth. There’s no informed consent here — they’re simply saying “We don’t like it, so we won’t allow you to do it.” What about a woman having choices about her body and her baby?
Third, their very flimsy logic centers around the idea that there’s no evidence to show that water birth is beneficial. However, ACOG recommends a number of non-evidence-based practices, and many hospitals (including OSU) follow ACOG guidelines or evidence-based-practice only when it suits them. To say that this is about “best practices” is ridiculous, because it’s not.
Fourth, if they’re concerned about the trend of increasing out-of-hospital births, they just contributed to it — it’s likely that more women will seek alternative care, with their options limited in this way.
Fifth, ACOG ignored anecdotal evidence and guidelines issued on water birth from similarly developed countries, like the UK, which allow water birth and consider it harmless until proven otherwise.
…there are more. These are the biggest ones. Let’s break it down.
My Opinion Rules
The statement made by ACOG in March wasn’t based on any real study data. It was based on their opinions only.
The doctors involved looked at the literature available, and noted that there is no actual proof that water birth improved outcomes in moms or babies. (The literature also didn’t show any increase in harm or negative outcomes.) Based on the idea that water birth isn’t clearly “better,” they imagined all sorts of potential, exceedingly rare complications that might occur, and recommended against it.
Ultimately, with a lack of strong evidence, this comes down to “You can’t water birth because I said so.”
There’s enough evidence that doctors and midwives should be explaining the potential risks to women, as well as how rare they are, and helping women figure out if they are good candidates for water birth or not. (Women who are high risk, whose water breaks long before labor, who have low-lying placentas, etc. are not good candidates.) There’s no evidence at all for this draconian ban on all water birth.
As usual, official policy is anti-natural. It’s perfectly fine for them to use interventions that may or may not be dangerous and show little to no benefit, but it’s not okay to leave women alone when the risk/benefit is uncertain…
By the way, there is no evidence that water births are riskier than any other births, according to this study. There are other studies, simple case studies, showing incredibly rare negative outcomes. One such study recommends the use of disposable, single-use filters on birthing tubs to mitigate risk, a move I fully support. That’s evidence-based.
…unlike a lot of ACOG guidelines.
Evidence? Who Needs It?
Obstetrics is the least evidence-based form of medicine.
Unlike other areas, birth isn’t a “problem.” It’s a normal process. It doesn’t require “fixing” or “management” the way a disease would, like cancer or diabetes. As such, it’s really better to leave it alone, until or unless there is an issue that is outside the norm. Unfortunately, that’s not how modern obstetrics approaches birth. At all.
In the U.S., every birth is treated as a potential (likely) emergency. OBs operate under the “more intervention is better” premise most of the time. Granted, no small part of this is because of the litigious culture — OBs are less likely to get sued if they can prove they “did everything they could” than they are if they did not intervene, and something bad happened. That part is not their fault, yet they’re left to deal with it. However, there are plenty of practicing OBs who manage not to succumb to this pressure by jumping the gun on interventions. (I believe that patients are least likely to sue if they feel their doctor is really on their team, regardless of the outcome. That’s a much better approach to take than “MORE INTERVENTIONS!”)
The important thing is, “more interventions” is not an evidence-based practice.
We know that under certain circumstances, certain interventions are needed — maybe even life-saving. If a woman experiences cord prolapse, then protocol demands she has an emergency c-section. This is necessary. Women who are high-risk require more monitoring than those who are not.
Yet, all women are subject to tests and procedures that evidence — and even, sometimes, ACOG — deems unnecessary. For example, ACOG doesn’t think that women need to have a glucose tolerance test if they are under 25, not overweight, have no family history of diabetes, and have no indication of a problem. Yet many practices will kick women out if they refuse the test (even if they meet those criteria). That’s not evidence-based!
Another fact that most women don’t know is that Pitocin, commonly used to induce labor, is not indicated for elective induction. It’s only to be used where medically needed. But how many women have been told they can get induced if they want to…and are given Pitocin? A lot. See the package insert here.
That’s not evidence-based, either.
I could go on with several more examples (the use of Cytotec for induction is also not evidence-based, for one more; that’s an off-label use and has never been studied — and it’s caused deaths).
The point is, so much of current obstetrical care isn’t evidence-based anyway, so how can they claim that they can’t allow water birth because it isn’t evidence-based?! They’re picking and choosing what they feel like allowing — goes back to “because I said so” again.
It’s far, far more dangerous to induce with Cytotec than it is to allow water birth, and yet doctors use Cytotec for inductions somewhat commonly. I don’t see any recommending that we halt the use of Cytotec until the appropriate studies can be done (even though it has caused several deaths), but they are calling for water birth to stop. This is so very messed up.
Out of Hospital Birth Increases
A lot of OBs claim to be concerned about the increasing trend of out-of-hospital births, especially those which occur at home. (Many OBs work with official birthing centers that are near or a part of hospitals — these are more accepted, although not entirely.) Most OBs are worried about the growing trend of homebirthing, though.
Yet, they don’t see their role in it!
The more restrictions that doctors place on women — whether it’s demanding an IV, continuous monitoring, automatic induction at 40 weeks, VBAC bans, water birth bans, etc. — the more women will simply opt out of the system altogether. Women aren’t going to put up with doctors “allowing” them to give birth the way they want to. Remember that most births aren’t emergencies, and low-risk women don’t want to be treated as if they were.
(Plus, since when did it become okay for doctors to basically “own” a woman’s body by telling what she can and can’t do during birth? Why is it when a woman asks a question, the answer is “I’ll have to see if policy allows that” instead of “unless a medical emergency prevents it, yes?” WHY? It’s absolutely maddening.)
Of course, this very maddening trend of treating women like they don’t and shouldn’t have control over their own bodies, nor the right to make medical decisions for themselves and their babies is the very thing driving the out-of-hospital birth movement.
By eliminating water birth, women who were considering a natural hospital birth may be driven to look elsewhere.
Somehow, doctors do not understand how they are contributing to this trend. All the articles I’ve read basically say that doctors are concerned about the trend, but that they’re continuing to place restrictions on women, and they expect women to listen to their professional advice and opt back in again. There’s just no respect or understanding here!
So, OBs like that, get a clue! Your draconian, one-size-fits-all policies are causing women to seek alternative care. OBs who are understanding, who practice in partnership with their patients, who believe that women can make (most) decisions about their bodies and babies with input that comes in the form of advice (not a ruling from on high) have more patients than they can handle, including women who would not consider hospital birth otherwise. You’ll keep your patients by treating them as respectable human beings, not by trying to force your will on them, because you went to medical school and they didn’t.
(Sidebar: I can’t stand that line. “I went to medical school.” Congratulations! I don’t care. You are human. You make mistakes. You don’t know everything there is to know about medicine. If you can admit that you are in partnership with your patients and that you offer advice and informed consent, and you’re willing to admit your shortcomings and want to learn more or refer patients to doctors with more knowledge in certain areas, I respect you. If you expect patients to bow to your superiority because you went to medical school and they didn’t, and therefore you clearly know everything, I have no respect for you whatsoever.)
I don’t personally have a problem with out-of-hospital birth increasing, of course — three of my babies were born at home (read their birth stories: Daniel, Jacob, Nathan) — but doctors need to understand the role that their decision-making plays in this trend. I’m all for women choosing to birth where and how they want.
U.S. Doctors Don’t Look to European Examples
As in most things, U.S. doctors don’t look at Europe for another example on how to handle things.
In Europe (at least in the UK), their doctors also acknowledged that there really wasn’t a whole lot of evidence that water birth was specifically beneficial. But unlike the U.S., they also acknowledged that there was really no evidence that water birth was any more dangerous than “land” birth, either. Therefore, they are still allowing water birth (until or unless new evidence shows a significant risk of harm).
That’s the way to do it.
With something that’s as common as water birth, and which has been done for a long time, and from which few reports of harm have come, it’s better to err on the side of allowing, rather than disallowing. Only if there’s mounting evidence that something may be harmful is it worth stopping.
(And even then, if there’s not much evidence or the evidence isn’t very strong, I think it should be allowed, with the caveat that patients should be fully informed of the potential risks — what they are, how often they have occurred — and allowed to choose for themselves. As usual, what’s the least risky situation for one won’t be for another.)
Even though this is the way it should be, I’m not at all surprised that the ACOG has gone the way they have. Most of the U.S. medical system is strongly anti-natural. They don’t welcome complementary and alternative medicine (CAM) very much. They ignore scientific evidence in favor of herbs or the role that nutrition plays. They even go as far as to engage in name-calling, referring to such alternative or natural treatments or procedures as “quackery,” “woo,” or “magic.” (Despite preaching tolerance, most people in the U.S. are actually pretty intolerant of those who hold deep beliefs that oppose theirs.)
This is entirely unacceptable.
I won’t bother to rant, here, about what I think about professionals who would talk this way towards women, openly mocking their choices, but we’ll say I have extreme disdain for them.
Bring Back Water Birth!
Given that water birth shows no evidence of being harmful, that OBs rarely practice evidence-based medicine anyway, and that similar practices in Europe allow it, doctors in the U.S. need to bring water birth back, for those who want it.
If you live in an area where water birth has recently been banned, write to the hospital and let them know you’re disappointed and would like them to change the policy. Cite the reasons above. Cite your rights as a woman to choose where and how your baby is born. Let them know this is important to you. If you don’t say something, then they won’t understand it.
I’m officially asking: OSU and other Columbus area hospitals, please bring back water birth. Your clients want the option. There’s no scientific reason to disallow it. The local statistics show that water birth is safe. Women should have a choice on how their babies are born. We want water birth.
How do you feel about this ban on water birth?
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