Waterbirth: A Social Phenonemon

Posted on 25 October, 2013 by Judith Halek

By Judith Elaine Halek

Photos and Article Copyright @ 1987
Judith Elaine Halek

Twelve years ago, if I was to mention waterbirth to someone on the street, or a pregnant couple I was working with, most would not know what I was talking about. Now, in 1997, after two International Waterbirth Conferences, media exposure from two segments of 20-20, 60 Minutes, two programs of the Phil Donahue Show, an accidental water birth in a bathtub mentioned on the Oprah Winfrey Show, a Good Morning America segment, America’s Talking; Alive and Wellness highlight, numerous articles and countless parents choosing this alternative approach to childbirth, water birth has become a household term.

In 1985 you could count on one hand the number of books and video tapes available on the topic. Now, you’ll need your other hand, both feet, a friend’s set of limbs and possibly another set of limbs from the community of people, to count the information available. Bibliographies, medical protocols, world wide web are overflowing with information. As with everything that’s alternative and unfamiliar, it takes time for the studies to be calculated and presented in the medical journals.

The Society of Obstetricans and Gynecologists of Canada is preparing to release what may be the most comprehensive guidelines for the management of normal pregnancy and delivery in North America. The 78 page guidelines, to be distributed to all Canadian physicians practising obstetrics, represent an update of SOGC’s existing antenatal guidelines. 1 The SOGC guidelines endorse waterbirths with instructions for safe practice, which primarily involves lifting the baby’s head out of water as soon as it is born.

Sheila Kitzinger’s “Letter from England: Is Water Birth Dangerous?” in the Birth Journal 22:3 September 1995 is an excellent review of the first International Conference on Waterbirth, Exploring the Issues, which took place in London, April 1-2, 1995. This conference attracted over 1,500 participants from 36 countries and reported on at least 19,000 births. Janet Balakas of the Active Birth Movement, Beverly Lawrence Beech of the Association for Improvements in Maternity Services, Jay Ingrey of Splashdown Waterbirth Services and Sheila Kitzinger organized the conference.

The second International Conference; First North American Conference on Nurturing Women: Integrating Water into Maternity Care, held in Greensboro, North Carolina on April 12-14, 1996 was organized by Joanne Zaleski with Wake Area Health Education Center, Barbara Harper with Global Maternal/Child Health Association, Inc, (GMCHA), North Carolina’s ACNM, the University of North Carolina School of Medicine, North Carolina Department of Environment, Health and Natural Resources and Maternal Child Health Division. There were 403 participants, and eight countries represented.

There is a projection date for a third International Conference scheduled for Spring of 1997 in the United States and a fourth Conference in 1998 back in London.

Dr. Michael Rosenthal, formerly the obstetrician at the Family Birthing Center in Upland, Southern California reported at both conferences on his 10 years experience and 948 water births. Dr. Rosenthal brought the concept of waterbirth into a medical setting in the United States in 1985. “Only nine percent of women had drugs for pain relief, compared with approximately 80 percent in hospitals with a similar patient population in the area. The cesarean section rate was under 10 percent but 34 percent at the adjacent community hospital and 86 percent of women with previous cesarean sections gave birth vaginally.” 2

Studies presented at the Conferences revealed that fewer babies needed resuscitation, fewer went to the intensive care nursery, fetal heart rates were significantly more likely to be abnormal on land than in water, women needed fewer pain-relieving drugs when in water, and episiotomy rates were reduced from 38 to 19 percent. 3

Dr. Faith Haddad, a consultant obstetrician at the Hospital of St. John and St. Elizabeth, London, discussed water births that had occurred since 1987. Data gathered in 1993 and 1994 contained vital information confirming that water reduces the use of analgesia, helps to keep perineum’s intact yields healthier babies and can accelerate the second stage of labor. Dr. Haddad stated that 76 percent of the women studied, used water during labor and birth.

Water labor and birth has been known to help lower blood pressure, reduce edema, help reduce asthmatic responses. The water also enables a women to organically discover her birth position.

Paul Johnson, a physiologist and specialist in fetal breathing riveted attention as he spoke at the first Conference about what happens before and immediately after birth. In his research, the main factor involved with the first breath is the chemoreceptors in the larynx.  During pregnancy, the lungs, of the fetus, “breathe” off and on (fluid moves through them). About 48 hours before labor, the prostaglandins in the fetus increase and “fetal” breathing stops. The baby continues to receive oxygen only through the placenta until specific chemical changes trigger the breathing after birth.

When the baby is born into water, water goes into the larynx, the chemoreceptors are stimulated and this in turn triggers the dive reflex, inhibiting breathing, slowing heart rate, and reducing the need for oxygen. The glottis is closed, swallowing occurs instead of aspiration and the baby continues to receive oxygen from the placenta. In other words when the newborn is born into water, it continues to experience fetal circulation. The baby does not attempt to breathe under water.

As the baby emerges from the water and experiences the change in air pressure, the chemoreceptors in the larynx are stimulated, there is a change in the PH of the cerebrospinal fluid, and the respiratory center in the brain is commands the baby to breathe. The placenta continues to supplies oxygen through the cord for a number of minutes while this transition takes place. Other factors, such as changes in light, sound, temperature and gravity affect the breathing as well.

In all the studies presented at both conferences, there was never a report of fetal or maternal death or infection due to the water labor or birth. Some medical caregivers believe the water dissipates the bacteria. The key is to make sure the tubs are cleaned with a strong bacterial agent and a chlorine bleach rinse. Bensilkonium spray (diluted 4%) is used after the scrub. Bacterial cultures should be taken monthly and any debris that accumulates while the mother is in the water must be strained out as quickly as possible with a disposable fish net.

Contraindications for the use of water for labor or birth include anticipated birth complications anticipated, thick meconium in amniotic fluid (as there would be a need for perineal oronasal suctioning,) any obstetrical risk that would be cause for transfer to “high risk” unit, fetal distress, membranes ruptured and the amniotic fluid consistency and color not known, prolonged rupture of membranes (selectively greater than 24 hours with a maternal temp). 4

The use of water is not just another technique. It provides direct phisological benefits to mother and baby by increasing comfort and reducing medical interventions. And babies like it. A father of five who’s last two babies were born under water, swears his waterbabies looked happier and calmer at birth than his “airborn” babies.

FOOTNOTES
1. Medical Post, Vol 32 (5), 1996, page 1. “Healthy Beginnings…Guidelines for care during pregnancy and childbirth.”

2. Birth Journal 22:3 September 1995, Sheila Kitzinger’s Letter from England: Is Water Birth Dangerous?

3. Analysis of first 501 water births a t hospital in Bensburg, Germany. First International WaterBirth Conference, London, April 1-3, 1995.

4. Prodedures and Protocols for Hydrotherapy for Labor and Birth for use @ Harris Regional Hospital, Sylva, NC, July 1995.

My Reflections On Labor And Birth

Posted on 25 October, 2013 by Judith Halek

By Judith Elaine Halek

Photos and Article Copyright @ 2000 Judith Elaine Halek

I was sitting at a dinner table with a group of women in their late thirties and forties. I, myself, am in my early forty’s, not married, been working in the birth modalities for the past twelve years and at present, am not seeing anyone in particular. I commented, “I don’t think it’s in the cards for me to have a baby this lifetime.””Really!” exclaimed a couple of the women. “How old are you?” inquired one woman. “Close to my mid forties.” I responded. “Oh, that won’t be a problem,” she said matter of factly, “You can always do invitro, or donor insemination.” I looked at her and then to other women around the table as all eyes were set on my response. I was surprised and disappointed that conception has become a casual ‘technocratic procedure’ in the minds of the public. I began to explain IVF and donor insemination requires massive douses of antibiotics, a large bank account, arranging one’s work schedule around clinic visits, undergoing countless invasive, often painful, always emotionally charged procedures, all for the chance that I might be the one of ten to be blessed with the news of a cyborg conception. Please understand, I am not judging anyone who chooses this path of conception. It is not my preference of choice and thank goodness, we still have a choice.

Or do we? When I reflect back on my experiences the past twelve years as a labor support specialist, childbirth educator, birth counselor, massage therapist, yoga instructor I’ve found far too many women who did not exercise their options of choice and gave their power away to the medical caregivers, especially in hospitals. After attending over 100 births in hospitals, birth centers and homes, I have had the opportunity to experience a variety of possibilities. It is my vision, that all labor and delivery nurses and obstetricians witness 30 home births or birth center births as part of their medical training.

I remember at one hospital, a nurse commented, “Having a baby at home is one of the most dangerous experiences a mother could put her baby and herself through.” I asked if she had ever attended a home birth, or studied the statistics of home birth practices. She admitted she had not attended a one or knew anything about recent studies on home birthwith midwife practices. I asked her, as I’ve asked many people who make blanket statements without any information to back up their claims, “How can you make such a definitive comment when you’ve not any experience with what you are judging?”

It’s rather ironic that we in our intellectual aspects, read, watch videos, attend classes, surf the internet, express our gathering feminine nature, becoming an ‘informed consumer’, yet when it all comes down to the real deal, one of my favorite mentors, Dr. Michel Odent states, “Forget the books, tapes, videos. Go to a quiet, dark place, private and safe, trust the process, surrender to your bodies and have your babies.”

I believe women have forgotten how to birth, trust, listen, go deep inside and communicate with their bodies and their babies. I also believe women can remember.

What are the choices, options, for non-technocratic pregnancies, labors and births? I have treeoflife been an advocate of midwifery for the past 12 years. After researching international statistical outcomes regarding midwifery vs. obstetrical care, midwives have far exceeded the lower infant mortality rates, fewer medical interventions and higher results in more empowering births.

Having a baby with an obstetrition in a hospital? Create a birth plan, a “guide line,” toward the ideal birth you would like to create. Birth plans are generally discussed in your childbirth classes. Look in various childbirth books early on in your pregnancy and begin to educated yourself. A few favorites are, “The Birth Book” by Sears and Sears, MD, “The Complete Book for Pregnancy and Childbirth,” by Sheila Kitzinger and “New Active Birth, a Complete Guide to Natural Childbirth,” by Janet Balaskas. To find out about midwifery based practices in your area, call American College of Nurse Midwives, (ACNM,): 202-728-9860 (general number), 1-888-643-9433, (toll free locator number). Or contact Midwives Alliance of North America, (MANA): 1-888-923-6262.

Bring questions to your medical caregivers, be attentive how they respond. If you experience not being heard or rushed through prenatal visits, go over in your mind and with your partner why you don’t feel supported. If you do your work early on, talking further or switching medical caregivers will not be as problematic.

Over and over I have encouraged women to trust your highly sensitized instincts, do research and own this birth. This labor and birth will only happen once and it’s vital to be with people you feel safe, listened to and trust. I believe, the only way change will take place among the obstetrical practices is through the public. By asking for what you deserve, you educate and introduce the medical profession to another possibility.

Another alternative is a labor support doula. A ‘doula’ is a Greek word for ‘woman assistant.’ She meets with a couple and gathers information prentally. She’s on call before and after the due date, attending to the parents needs during early and later stages of labor and birth, following up with a post-natal visit after the birth. Doulas have statistically proven to lower cesarean sections by 50%, length of labor down 25%, oxytocin use, down 40%, pain medications (narcotics) down 30%, forceps down 30%, and epidurals down 60%. A labor doula is by no means to replace the partner of the mother. No one can replace the relationship or connection of a woman’s partner. The doula helps to relieve the pressure and enhance the experience.

Since 1993, when Doulas of North America, (DONA,) began a certification program there are now over 8,000 certified. For referrals call, 206-324-5440. Book referrals for becoming a doula: “The Birth Partner,” by Penny Simkin, PT, “Mothering The Mother,” by M. Klaus, MD , J. Kennel, MD and Phyllis Klaus, M.Ed., CSW. If someone would be interested in setting up a doula program read, “Doula Programs: How to Start and Run Private or Hospital-Based Programs with Success!,” by Paulina Perez and Deaun Thelen.

An aquatic analgesic alternative to medical pain medication or an epidural is water labor or water birth. As the east coast resource center for water birth, my organization, Birth Balance, has educated countless couples on this unique and growing approach. A shower is great during labor, yet, it can’t compare to submerging half to three quarters of your body in a tub of water. Advantages to water birth for the mother are: easier coping during dilatation of the cervix and the pushing stage, softening of the perennial tissues, bones, muscles so lacerations are minimal, ability to move in whatever position her body organically discovers, less interventions, faster labors and births. Advantages to the baby: a medium which softens the baby’s bones and tissues thus creating a softer birth experience, babies appear to be less traumatized, a drug free beginning and more immediate bonding with mother.

wavecave A concern regarding water labor or birth is infection. When in the water, bacteria is diluted. Unless someone enters the water with an infection of some sort offering foreign bacteria, there wouldn’t be problems with the mothers infecting herself or the baby. A study in 1996 of 1385 women with prelabor rupture of the membranes after 34 weeks gestation concluded a tub bath did not increase the risk of maternal or neonatal infection after premature rupture of the membranes and prolonged latency. (1)

Another randomized, controlled trial was with 785 women. The results were as follows: tub group required fewer pharmacological agents, fewer deliveries by forceps and vacuum, more likely to have intact perineum and an overall positive effect on analgesic requirements, instrumentation rates, condition of the perineum and personal satisfaction. (2)

Another concern people have is the drowning of the baby at birth. The baby is in a womb of water from conception and is born into an extended womb of water later. The baby receives oxygen from the umbilical cord which is attached to the placenta. As the baby is born, the placenta is detaching from the mother, thus the supply of oxygen becomes depleted and bringing the baby up to the surface as soon as possible is imperative. Another atmospheric pressure, such as air or gravity is what stimulates the babies chemoreceptors to take a breath. That is why, in water, the baby will not take a breath.

Water birth has been around for centuries. In the contemporary times the concept began in Russia in the 60’s,, spread to France, England in the 70’s and come to the United States in the 80’s. For further reading on the subject check out: (book and video) “Gentle Birth Choices,” by Barbara Harper, RN, “Water Birth, A Midwife’s Perspective,” by Susanna Napierala and “The Waterbirth Handbook, ” by Dr. Roger Lichy and Eileen Herzberg.

No matter what choices you make for this birth or future, each pregnancy, labor and birth will teach you what to do differently or the same the next time. Remember, everything is an opportunity for learning. Keep an open mind and heart and learn.

(1), (2): MIDIRS Midwifery Digest, (Mar 1997) 7:1.

Aquadurals and Douladurals Replace the Epidurals

Posted on 25 October, 2013 by Judith Halek

Printed in 2000 by Midwifery Today

In an ancient tradition of “woman supporting woman,” my friend asked me to do something I’d never done before attend the birth of a child. “Just be there and support me, massage me, talk to me,” she said, then added matter-of-factly: “Oh, by the way, we’re going to have the baby underwater.” It was a cold, blustery evening in November 1987 when baby Maxx appeared, landmarking the first home underwater birth in New York City accompanied by a midwife. Thus was conceived my passion for birth. Without much information available to us at that time, we were all virgins finding our way as comfortably as possible to fulfill the mother’s wishes. We had three resources: books by Erik Sidenbladh1, Timothy Wyllie2 and Dr. Michel Odent.3 In 1987 very few if any hospitals in the United States had birthing tubs. In 1996 a handful of U.S. hospitals offered birthing tubs; today hundreds do. Waterbirth, which started in Russia during the 1950s and 1960s, moved to France and England in the 1970s and to America in the mid-1980s, was once considered a fad. Today it has become the “aquadural,” replacing for many women the epidural. Innovative and controversial, the aquadural involves laboring and/or birthing under water. After my initiation in 1987, I became one of the first of a handful of doulas in New York City. The doula, a specialist in labor, has become another significant element in late twentieth and early twenty-first century birth, one that decreases the need for drugs, interventions and surgical procedures up to 50 percent. 4 A “douladural” is a non-medical person who has certification training or life experience in the birth field. She acts as a liaison between medical caregivers and parents by offering physical, mental, emotional and spiritual support. She does not perform medical procedures or make medical decisions, yet she does advise the parents on these matters.

Safety Reports and Stipulations

During the early 1980s, Estelle Myers, at the Rainbow Dolphin Centre in New Zealand, led the first two waterbirth conferences.5 International waterbirth conferences were held in London, England in 1995 and Greensboro, North Carolina in 1996. Thousands of births reported at these conferences confirmed no increase of infection to baby or mother or fetal or maternal deaths due to the water. 6 The next international waterbirth conference will be held in Portland, Oregon in September 2000 and is co-sponsored by Midwifery Today.

In the late 1980s to mid-1990s, a series of articles in the medical journals noted the death of a baby in Sweden, one death and one brain-damaged baby in Britain and one death in France due to water labor or birth. After further investigations, it was shown that the water was not the cause of these babies’ deaths and brain damage; rather, other mitigating circumstances were evident. 7 As a result of these incidents the following stipulations occurred and were administered: 1) decrease the temperature of the water to body temperature‹ 97 to 99 degrees Fahrenheit or 34 to 38 Celsius; 2) encourage the mother to get in the water no earlier than five centimeters dilated; 3) shorten the labor time a mother is in the tub; 4) shorten the amount of time the baby is submerged. The Royal Society of Medicine delivered an abstract on a comparison of 602 maternal and neonatal outcomes in waterbirths and conventional vaginal deliveries from 1989 to 1994 (301 women electing for waterbirths compared with the same number of age- and parity-matched low-risk women having conventional vaginal deliveries). The Society¹s conclusion: waterbirths in low-risk women delivered by experienced professionals are as safe as normal deliveries. Laboring and delivering in water is associated with a reduction in length of labor and perineal trauma for primigravidae and a reduction in analgesia requirements for all women. If a mother is in a prodromal labor pattern early on, having intense back-to-back contractions with a two to three centimeter dilation, she can become extremely tired. I suggest she sit in the tub for therapeutic rest and encouragement. If the temperature exceeds 99º F or 38º C, it can lead to hyperthermia and dehydration in the mother and baby. It is also imperative that the mother as well as the assistants in the room drink fluids with glucose. If the mother is not well hydrated, it leads to low blood volume and could possibly result in orthostatic hypertension, passing out when standing up to get out of the pool.9 Janet Balaskas states in her book, Water Birth: Maintaining the correct water temperature is very important. If the water temperature is too low the mother’s body temperature particularly if she spends a long time in the pool, will drop. The sweating mechanism for heat loss does not work in water, so if the water is too warm the mother’s body temperature will rise and her energy may be sapped. Doula Linda Cohen in Long Island, New York devised a rather simple recipe for situations in the hospital where the mother is not allowed anything but ice chips and water. She calls this “The Drizzle.” In a cup add: a bit of infused (very strong) hot red raspberry leaf tea and a teaspoon of honey; mix thoroughly and add ice chips. Feed to mother with a spoon while in the tub, on the birth throne (toilet), on a bed, kneeling over a physioball, walking down the hall or up and down stairwells. Once I was fortunate enough to be invited to a home birth with a small group of Russians from Moscow. I saw a small bowl of fresh cranberries on the side of the tub. Periodically the mother would suck on one, put it back in the bowl and go through the contraction. Sucking the cranberries, the mother claimed, helped stimulate her thirst. As an assistant, I periodically ask the mother if the water feels too cool or too warm. Placing a small thermometer in the tub helps monitor the temperature. If the water is too hot and the mother desires it to be even warmer, I suggest she get out of the water and walk. If the water became too cold I would add hot water away from the mother if she remains in the tub or get her out of the tub and add the water. Another trick the Russians taught me is, if the mother is feeling too warm in the tub yet doesn’t want to get out, she can hold onto pieces of ice to cool down, or sit along the edge of the tub with her feet still in the water. Barbara Harper explains: “The greatest benefit to immersion will be experienced in the first hour to two hours. Twenty minutes in the bath is not enough for the physiologic responses to work effectively. That is why some women, both primips and multips, get into the water at 7 cm or 8 cm dilation and begin to experience pushing urges within the first hour of immersion.”11 Keeping a woman in the water for hours is unsafe and unnecessary. I just received a call from a mother who labored in a rented tub at home but didn’t birth there. I asked her why not. She responded: “The water was filthy after being in it for six hours and by the time we had drained it and started to fill it again, the baby was born.” In Bristol, two women who had adverse perinatal outcomes had labored for more than seven hours in the birthing pool. There was one stillborn child with evidence of asphyxia and one baby with severe hypoxic-ischaemic encephalopathy. These women had labored, not birthed in the water. In neither case was any specific cause evident. 12 When helping the woman out of the water, one must be aware of the “fetus ejection reflex,” a term coined by Dr. Michel Odent. 13 This means there is a possibility of the baby slipping through the birth canal unexpectedly because of the change of atmospheric pressure and movement. I focus on the laboring mother¹s pelvic area and keep in touch with the physical sensations she is feeling when assisting her out of the tub. I also make sure if in a birth center or hospital, to wrap the mother in the kind of warm large white thin blanket supplied by the hospital or birth center. I use the small towels to wipe the legs and feet of the shivering woman stepping out of the water. I also make sure the room temperature is as warm as possible so the mother does not chill from water to air. In some facilities, especially hospitals, we have no direct control of the temperature. Most facilities are quite cold. In one hospital we fooled the thermostat by taking a rubber glove, filling it with ice chips, slipping a knot at the opening of the wrist and placing the dangling fingers of ice on the thermostat box. Worked like a charm. It is also important the mother does not slip when exiting the tub. I think it’s a good idea to put a large tarp underneath the portable tub. Towels placed on the floor beside the entrance to the tub help create an absorbent, non-slip surface. If there is full access around the tub, I place towels around the whole area. When a baby completely emerges from the womb it is logical to get the child directly into the mother¹s arms, or better, to assist the mother as she brings the baby to her belly or chest. Oxygen flows to the baby through the umbilical cord attached to the placenta. When the placenta detaches completely or partially from the mother, the baby¹s supply of oxygen is compromised. Thus emergence within a short time is of essence. There was a case during the early 1980s in the United States where a couple, unattended by medical caregivers, left their child under the water after the placenta was birthed. The baby died due to lack of oxygen. 14 When pulling the baby out of the water and onto the mother’s belly or chest, it is important to become aware of the length of the umbilical cord. It’s easy to snap a short cord if one pulls the baby up abruptly. In regard to the physiology of birth, each woman responds differently to pain, yet when mothers get into the water, there is a universal, “AhhhhŠoh my god, why did I wait so long!” After the tenth person responded with the exact words, I wondered if I was experiencing the “hundredth monkey” concept. Barbara Harper, director of Global Maternal Child/Health Association, reports on her survey of close to 2,000 women, when asked the question, “What feelings do you recall?”‹almost 100 percent of women stated in one form or another they were relaxed, calm, at peace in the water. 15 I can say that for every birth I’ve attended where there was a tub of water and a challenging labor or birth, that without the water, the woman would have received an epidural. During one of my interviews for my local cable program, Birth Balance Presents: Waterbirth, I was interviewing a mother who labored in water and birthed her baby in air due to meconium and late due date. When I commented to her, “From my observations of you during the labor, if you had not had the tub available, I believe there was an 80 percent chance you would have gotten an epidural.” “Eighty!” she exclaimed, “200 percent I would have gotten the epidural! The water saved me.” When sticking my hands in the water to massage or support I do not wear gloves. I wash thoroughly with antiseptic soap and make sure I do not have any staph infections on my body. In one case an infection was passed to the baby during a water labor because the father had a staph infection on his foot and was in the water when the baby was born. When I am pressing points on the mother’s back during a contraction or massaging her shoulders, legs or belly in between contractions, the warm water soothes my tired hands and arms. I am also given more breaks from actual hands on at a water labor because the women spend time rocking back and forth on their hands and knees moaning and breathing. This gives me time to talk gently to a birthing mother or massage the father. During my prenatal visits with parents to discuss their birth plans and choices for childbirth, I encourage them to stay open and unattached to birthing in the water. Waterbirth should not be the goal. Often times when a woman becomes fixated on any particular outcome of birth, there potentially are more difficulties because of inflexibility. Dr. Michel Odent speaks often of women getting out of the tubs right when they are to push their babies out, so that they then present right alongside the tub. Or when the water is running into the tub, the woman may grab alongside the tub and begin to scream as her contractions become stronger. In some cases, women actually birth their babies just by the sound of the water running. Listening to one’s body, trusting the process and going with the flow are vital. A question I am commonly asked is: “Is it a good idea to hire a doula who has little or no experience with water labor or birth?” In this day and age, there is so much information about this alternative method of labor and birth. If the doula is more inexperienced it would be worth her time to research through the Internet, read books, watch and listen to video and audiotapes. Anyone can read up, ask questions, talk to parents who’ve had a water labor or birth, and attend lectures or private consultations with a waterbirth consultant. It is more important that parents have a strong connection with the doula they have interviewed. Educating and participating is a moment to moment experience.

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Judith Elaine Halek is the founder and director of Birth Balance, an East Coast resource center for underwater birth that she started in 1987. One of the original labor support doulas in New York City, she has pioneered alternative choices in childbirth throughout the tri-state area. A birth consultant and counselor, massage and fitness therapist, writer, educator, speaker, photographer, videographer and producer of Birth Balance Presents: Water Birth, a Manhattan Educational Cable Station, Judith is airing her third thirteen-part weekly series on underwater birth and midwifery related issues. If you would like to contact Judith directly by email she’s at: Judith@BirthBalance.com.

Footnotes

1. Sidenbladh, E. (1982). Water Babies, A Book about Igor Tjarkovsky and His Method for Delivering and Training Children in Water. New York City: St. Martin’s Press. 2. Wyllie, T. (1984). Dolphins, Extraterrestrials, Angels, Adventures among Spiritual Intelligences. Boston Enterprises (distributed by Knoll Publishing Company, IN). 3. Odent, M. (1983). Birth under water. Lancet 2:1776-1477. 4. Klaus, M.H. & Kennell, J.H. & Klaus, P.H. (1993). Mothering the Mother, How a Doula Can Help You Have a Shorter, Easier, and Healthier Birth. New York City: Addison-Wesley. 5. Myers, E. (1976, 1999). Cross Your Bridges When You Come to Them. New Zealand: Rainbow Dolphin Centre. 6. Beech, B.L. (1996). Water Birth Unplugged, Proceedings of the First International Water Birth Conference. England: Books For Midwives Press. 7. Ingrey, J. (1993). Water birth press release. Midwifery Matters, Issue 59, Winter. 8. Royal Society of Medicine. A Comparison of Maternal and Neonatal Outcome in Water Births and Conventional Vaginal Deliveries. C171-29C-2986, p.10. 9. Harper, B. (1999). Water birth report. OBC News. 10. Balaskas, J. & Gordon Y. (1990). Water Birth, The Concise Guide to Using Water during Pregnancy Birth and Infancy. Great Britain: Unwin Hyman LTD. 11. Harper, B. (1999). Ibid. 12. Gilbert, R.E. & Tookey, P.A. (1999, Aug. 21). Perinatal mortality and morbidity among babies delivered in water: surveillance study and postal survey. BMJ 319-483. 13. Odent, M. (1987). The fetus ejection reflex. Birth 12(2). 14. Ingrey, J. (1993). Ibid. 15. Harper, B. (1999). Ibid. 16. Napierala, S. (1994). Waterbirth, A Midwives Perspective. Connecticut: Bergin & Garvey (a branch of Greenwood Pub. Inc.). 17. Lichy, R. & Herzberg, E. (1993). The Waterbirth Handbook, The Gentle Art of Waterbirthing. United Kingdom: Gateway Books. 18. Balaskas, J. & Gordon Y. (1990). Water Birth, The Concise Guide to Using Water during Pregnancy Birth and Infancy. Great Britain: Unwin Hyman LTD.

Additional Resources

Gilbert, R.E. & Tookey, P.A. (1999, Aug. 21). Perinatal mortality and morbidity among babies delivered in water: Surveillance study and postal survey. British Medical Journal. 319:483-487.www.bmj.com/cgi/content/abstract/319/7208/483 under Obstetrics and Gynecology: Pregnancy. The conclusions from this paper: “Perinatal mortality is not substantially higher among babies delivered in water than among those born to low risk women who delivered conventionally. The data are compatible with a small increase or decrease in perinatal mortality for babies in water.” I have also found the waterbirth egroups, a group of like-minded people who share and question and learn more about waterbirth, to be informative and educational. To register: www.egroups.com/subscribe/waterbirth An online electronic Waterbirth Newsletter is debuting in April 2000. To subscribe: www.egroups.com/subscribe/WaterbirthNews