Erm, has anyone ever been told by a consultant that waterbirths lead to worse tears?

[wasabipeanut]

I went for my first consultation yesterday with a registrar to discuss my birth options this time round following my em cs last time.

My request to labour in water was met with a flat "no." When I asked why I was told that "some of the worst tears I've ever seen have been in women who have laboured in water." I questioned this because I believed that one of the benefits of a water birth was less liklihood of tearing or at least reduced severity and she said I was wrong. Apparently the water washes off your natural oils and the skin is less flexible - like when you go all wrinkly after being in the bath for ages. I then pointed out that even if that were true surely the risk would apply equally to all women labouring so why does anyone use water? She said I was at greater risk from tearing as I hsven't yet passed a baby through my fanjo - but surely neither has any 1st time mother and they don't get told that waterbirths aren't an option?

I didn't want to get into a fight but I'm a bit pissed off to be told what I can and can't do - especially if the evidence its being based on is wrong. I have a long time to go yet and I dont feel the need to set anything out in stone yet as a lot could happen between here and now. But if the pool is available and I go into spontaneous labour I'd like the chance to use it.

Bit deflated but don't really know what to do?

[flybynight]

Are you having a consultant-led birth? Or will you mostly be seen by midwives? Waterbirths are usually midwife led I think.
When I had my first, some years ago, everyone was assigned a consultant whether they saw you or not. Usually not. One of the team of about 6 consultants refused to have anything to do with waterbirths, so we were told that you had to change to another doctor if you wanted to go down that road. It was very easy to do. What I'm saying, in short, is speak to a midwife who can probably direct you to a doctor who can help you.

I've never heard of the "more likely to tear" hypothesis by the way.

[wasabipeanut]

I have to have a consultant led birth as its a a VBAC. Mind you, by "consultant led" I don't really know what they mean. I was in the CLU last time as I was induced and I didn't see a registrar until I'd been in labour for the best part of 18 hours.

I'm assuming it will still be midwives who are "leading" the proceedings. Might be wrong though.

[wasabipeanut]

BTW she also told me not to make a birth plan as "they always go tits up."

Again, not sure if this is the best logic.

[flybynight]

No, not the best logic.

Found this on the AIMS website:

Using water has also been shown to reduce episiotomy rates. One study reported that of 541 women using a water pool during 1994/96 there were three episiotomies performed on primigravida and two episiotomies on multigravida women (during 1996 there were no episiotomies). Just under half the women had intact perineums, and 53 women had first degree tears, 83 had second degree tears and two women suffered a third degree tear. [5]

[Yorky]

She doesn't sound very helpful or supportive, or well informed.
I have had 2 water births and never torn which doesn't go with the first baby through fanjo theory! She is talking rubbish and looking for excuses by the sounds of it, wonder what her real reason is?

[MrsSantosisafeminist]

Isn't the whole point of being in water that you are more relaxed and therefore less likely to tear?? I never actually got into my pool during labour (can't actually work out why- I just didn't fancy it in the end). It sounds like she may be talking bolleaux. Plenty of people on here have pointed out that consultants never see the straightforward births so assume that things going wrong is the norm. I think you may need to do a bit of research for your own piece of mind. Good luck with whatever you go for and remember human babies have been squeezed out of fanjos for a lot longer than there have been dingbat consultants walking round

[ib]

I would get rid of him to be honest.

Waterbirths and Tearing:

J Perinat Med. 2004;32(4):308-14. Related Articles, Links

Comment in: * J Perinat Med. 2004;32(4):306-7.


Waterbirths compared with landbirths: an observational study of nine years.

Geissbuehler V, Stein S, Eberhard J. Department of Obstetrics and Gynecology, Cantonal Hospital, Frauenfeld, Switzerland. [email protected]

AIMS: This study compares neonatal and maternal morbidity and mortality between waterbirths and landbirths (spontaneous singleton births in cephalic presentation, vacuum extractions are excluded). METHODS: In this observational study covering nine years, standardized questionnaires were used to document 9,518 spontaneous singleton cephalic presentation births, of which 3,617 were waterbirths and 5,901 landbirths. RESULTS: Landbirths show higher rates of episiotomies as well as third and fourth degree perineal lacerations.

Waterbirths show a higher rate of births "without injuries," first and second-degree perineal lacerations, vaginal and labial tears. After a waterbirth, there is an average loss of 5.26 g/l blood; this is significantly less than landbirths where there is an 8.08 g/l blood loss on average. In 69.7% waterbirths required no analgesic, compared to 58.0% for landbirths. Water and landbirths do not differ with respect to maternal and neonatal infections. After landbirths, there was a higher rate of newborn complications with subsequent transfer to an external NICU.

During the study, there were neither maternal nor neonatal deaths related to spontaneous labor.

CONCLUSIONS: Waterbirths are associated with low risks for both mother and child when obstetrical guidelines are followed.

[ib]

I had a waterbirth for my first, by the way, so did two of my sisters, none of us needed stitches.

[Ohmani]

I had a waterbirth with my ds (second dc). This was never mentioned to me, nor do I believe it to be true, however, I did suffer a third degree tear. I believe this was more to do with the force of my pushing rather than the fact I was labouring in water.

The midwives were devastated that I had such an extensive tear as they really did not expect it to happen. It was a fabulous birth and if it's a waterbirth you want I would highly recommend it.

[warthog]

i've spoken to two ob's about this and neither mentioned that as a problem. so i think it's crap.

[warthog]

'this' meaning water births, not tearing specifically.

[MrsBadger]

NB IME registrars (ie junior doctors) often know substantially less, have less experience and are hence more risk-averse than the actual consultants who lead the unit.

I was told a similar pack of panic-inducing tales by a registrar re my high-risk birth, and it conflicted so much with the evidence base and the NICE guidelines (and upset me so much) that I wrote and requested an appt with the Prof who was head of obstetrics.
He turned out to be completely happy with the idea of a waterbirth and as few interventions as possible, and it's my private opinion he kicked the registrar's arse for misinforming and scaring me.

He also wrote and signed on my birthplan 'NO INTERVENTION UNLESS CLINICALLY INDICATED', which was an absolute charm - the midwives actually barred the door against the registrars who just wanted to 'have a look' at a high risk birth .

...and I went on to have a fabulous natural waterbirth with no pain relief and the tiniest of tears. It can be done

Go over their heads and good luck!

[Habbibu]

I had slight shoulder dystocia with dd1, so my consultant asked if I'd be happy to be in the labour suite rather than MLU, I said, ok, but I had wanted to labour in water - he immediately phoned LS, checked that they had the facilities, and wrote Water Labour in Pool on my notes.

He's damn good - stopped the MW from doing a forceps delivery last time, and dd came out with just a wee bit of tearing, which healed really well. Like MrsB, I think he was just that bit more confident in going beyond protocol etc. I'm just hoping this one hangs on in me until he's back from holiday!

Good luck!

[HeadFairy]

Wasabi, she sounds a bit bossy! I've been told I can't have a labour in water, but that's only because the only birth pools they have at my hospital are in the MLU and I can't have my baby in there as they don't do VBACs, I'll be on the normal labour ward.

The only thing I've read in the same vein was on here, someone said something along the lines of midwives can't monitor you so closely during a water birth because you're under water, so if you tear they can't control it. If you're labouring the traditional way, they can spot a tear and either cut it and control the tear or take steps to make you stop pushing for a moment, or something to limit the damage. Now I have no idea if that's total guff because like you I haven't had a VB either.

[happyjules]

Can only speak from personal experience of two perfect water births with no tearing at all. Good luck

[BertieBotts]

My midwife told me that birthing in water was more likely to lead to tears because the midwives can't see what is going on and so can't manage your pushing as effectively it sounds like a load of rubbish to me.

Purely anecdotal of course, but I laboured in water and only ended up with a small 1st degree tear despite DS' hand being up by his face (which usually leads to large tears)

[Karam]

My midwife told me the situation is far from clear, that in some circumstances it can lower the risks, but there is other evidence to suggest that in other circumstances it can heighten the risks... And there's evidence to support both sides (isn't there always??) incidentally, I had a land birth with a 2nd degree tear and a water birth with a 3rd degree tear.

[Habbibu]

Just tried PubMed:

Waterbirths compared with landbirths: an observational study of nine years.
Geissbuehler V, Stein S, Eberhard J.

Department of Obstetrics and Gynecology, Cantonal Hospital, Frauenfeld, Switzerland. [email protected]

AIMS: This study compares neonatal and maternal morbidity and mortality between waterbirths and landbirths (spontaneous singleton births in cephalic presentation, vacuum extractions are excluded). METHODS: In this observational study covering nine years, standardized questionnaires were used to document 9,518 spontaneous singleton cephalic presentation births, of which 3,617 were waterbirths and 5,901 landbirths. RESULTS: Landbirths show higher rates of episiotomies as well as third and fourth degree perineal lacerations. Waterbirths show a higher rate of births "without injuries", first and second-degree perineal lacerations, vaginal and labial tears. After a waterbirth, there is an average loss of 5.26 g/l blood; this is significantly less than landbirths where there is an 8.08 g/l blood loss on average. In 69.7% waterbirths required no analgesic, compared to 58.0% for landbirths. Water and landbirths do not differ with respect to maternal and neonatal infections. After landbirths, there was a higher rate of newborn complications with subsequent transfer to an external NICU. During the study, there were neither maternal nor neonatal deaths related to spontaneous labor. CONCLUSIONS: Waterbirths are associated with low risks for both mother and child when obstetrical guidelines are followed.

[Habbibu]

And this:

Fetal Diagn Ther. 2000 Sep-Oct;15(5):291-300.Click here to read Links
Waterbirths: a comparative study. A prospective study on more than 2,000 waterbirths.
Geissbühler V, Eberhard J.

Clinic for Obstetrics and Gynecology, Thurgauisches Kantonsspital, Frauenfeld, Switzerland. [email protected]

BACKGROUND: Waterbirths were introduced in 1991 as part of a new birth concept which consisted of careful monitoring and birth management, restrictive use of invasive methods and free choice of different birth methods. METHODS: After the introduction of this new birth concept a prospective observational study was initiated. All parturients of the region give birth in our clinic without preselection, ours being the only birth clinic of the region. 2% of the parturients will be referred to a larger birth clinic (university clinic) mainly because of preterm births before the end of the 33rd week of pregnancy. Every one of the 7,508 births between November 1991, and May 21, 1997, was analyzed. In this article the birth parameters of mother and child in the most often chosen spontaneous birth methods will be compared to assess the safety of alternative birth methods in general and of waterbirths in particular. 2,014 of these 5,953 spontaneous births were waterbirths, 1,108 were Maia-birthing stool births and 2,362 bedbirths (vacuum extractions not included). RESULTS: The parity and age of the mother as well as the newborn's birth weight are comparable in all 3 groups: waterbirth, Maia-birthing stool, and bedbirths. An episiotomy was performed in only 12.8% of the births in water, in 27. 7% of the births on the Maia-birthing stool and in 35.4% of the bedbirths. These differences are statistically significant. In spite of the highest episiotomy rates, the bedbirths also show the highest 3rd- and 4th-degree laceration rates (4.1%), thus the difference between the rates for bedbirths and alternative births methods for severe lacerations is significant. The mothers' blood loss is the lowest in waterbirths. Fewer painkillers are used in waterbirths and the experience of birth itself is more satisfying after a birth in water. The average arterial blood pH of the umbilical cord as well as the Apgar scoring at 5 and 10 min are significantly higher after waterbirths. Infections of the neonate do not occur more often after waterbirths. No case of water aspiration or any other perinatal complication of the mother or child which might be water-related was reported. CONCLUSION: Waterbirths and other alternative forms of birthing such as Maia-birthing stool do not demonstrate higher birth risks for the mother or the child than bedbirths if the same medical criteria are used in the monitoring as well as in the management of birth. Copyright 2000 S. Karger AG, Basel.

[Habbibu]

Though the lead author is the same in both.

[Habbibu]

And here is a recent Cochrane review:

Immersion in water in labour and birth.
Cluett ER, Burns E.

School of Health Sciences , University of Southampton, Nightingale Building (67), Highfield, Southampton, Hants, UK, SO17 1BJ. [email protected]

BACKGROUND: Enthusiasts suggest that labouring in water and waterbirth increase maternal relaxation, reduce analgesia requirements and promote a midwifery model of care. Sceptics cite the possibility of neonatal water inhalation and maternal/neonatal infection. OBJECTIVES: To assess the evidence from randomised controlled trials about immersion in water during labour and waterbirth on maternal, fetal, neonatal and caregiver outcomes. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (October 2008). SELECTION CRITERIA: Randomised controlled trials comparing any bath tub/pool with no immersion during labour and/or birth. DATA COLLECTION AND ANALYSIS: We assessed trial eligibility and quality and extracted data independently. One review author entered data and another checked for accuracy. MAIN RESULTS: This review includes 11 trials (3146 women); eight related to the first stage of labour, one to the first and second stages, one to early versus late immersion in the first stage of labour, and another to the second stage. We identified no trials evaluating different baths/pools, or the management of third stage of labour.Results for the first stage of labour showed there was a significant reduction in the epidural/spinal/paracervical analgesia/anaesthesia rate amongst women allocated to water immersion compared to controls (478/1254 versus 529/1245; odds ratio (OR) 0.82, 95% confidence interval (CI) 0.70 to 0.98, six trials). There was no difference in assisted vaginal deliveries (OR 0.84, 95% CI 0.66 to 1.06, seven trials), caesarean sections (OR 1.23, 95% CI 0.86 to 1.75, eight trials), perineal trauma or maternal infection. There were no differences for Apgar score less than seven at five minutes (OR 1.59, 95% CI 0.63 to 4.01, five trials), neonatal unit admissions (OR 1.06, 95% CI 0.70 to 1.62, three trials), or neonatal infection rates (OR 2.01, 95% CI 0.50 to 8.07, five trials).A lack of data for some comparisons prevented robust conclusions. Further research is needed. AUTHORS' CONCLUSIONS: Evidence suggests that water immersion during the first stage of labour reduces the use of epidural/spinal analgesia. There is limited information for other outcomes related to water use during the first and second stages of labour, due to intervention and outcome variability. There is no evidence of increased adverse effects to the fetus/neonate or woman from labouring in water or waterbirth. The fact that use of water immersion in labour and birth is now a widely available care option for women threatens the feasibility of a large, multicentre randomised controlled trial.

[Habbibu]

Just realised I've duplicated one of ib's posts - sorry!

[CarmenSanDiego]

I had a 6lb 11oz baby on land with second degree tear. 8lb 5oz baby in water with a tiny graze. But I realise that's anecdotal.

My understanding was that water and heat could soften the perineum and reduce tears - this is why in the old days, midwives used to call for warm towels and boiling water.

[CarmenSanDiego]

But.. more importantly, your consultant shouldn't just be saying no to a reasonable request. She could offer her opinion but it's still your choice. You need a consultant who understands and supports informed choice.