Ob-Gyns Weigh In: Laboring in Water is OK, but Deliver Baby on Land

Washington, DC—Undergoing the early stages of labor in a birthing pool may offer some advantages to pregnant women. However, in water delivery has no proven benefit to women or babies and may even pose a risk of serious health problems for the newborn. These recommendations on laboring and delivering in water were released today by the American College of Obstetricians and Gynecologists (ACOG) in a revised Committee Opinion.

"Immersion in water during the first stage of labor may offer some benefits: It may shorten labor and is associated with a decreased use of epidurals,” said Joseph R. Wax, chair of the ACOG Committee on Obstetric Practice that developed the Committee Opinion. “However, it is important to differentiate between laboring in water and delivering in water. There is no evidence to support delivering a baby in water has benefits to the baby.”

To protect the health and safety of the mother and the baby during labor, ACOG provides recommendations for hospitals or birth centers that plan to offer water immersion in the first stage of labor.

These include:

• Developing rigorous processes for candidate selection;
• Maintaining and cleaning tubs and immersion pools;
• Following infection control procedures;
• Monitoring pregnant women at appropriate intervals while immersed; and
• Moving women out of the tubs if maternal or fetal concerns develop.

The Committee Opinion stresses that the safety and efficacy of immersion in water during the second stage of labor (delivery) have not been established, nor has there been any benefit shown to women or newborns. Additionally, rare but serious health problems in the newborn have been reported. Potential risks of in water delivery include a higher risk of maternal and neonatal infections; difficulty in the regulation of the baby’s body temperature; increased chance of umbilical cord damage; respiratory distress resulting from the baby inhaling tub water; and potential for asphyxia and seizures. Until sufficient is available, it is the recommendation of ACOG that birth occur on land, not it water.

The American Academy of Pediatrics reviewed and endorsed this Committee Opinion.

The Committee Opinion #679 “Immersion in Water During Labor and Delivery” will be published in the November issue of Obstetrics & Gynecology.

Other recommendations issued in the November Obstetrics & Gynecology:

Committee Opinion #678, Comprehensive Sexual Education

Current sexuality education programs vary widely in the accuracy of content, emphasis, and effectiveness. Data have shown that not all programs are equally effective for all ages, races and ethnicities, socioeconomic groups, and geographic areas. Studies have demonstrated that comprehensive sexuality education programs reduce the rates of sexual activity, sexual risk behaviors (eg, number of partners and unprotected intercourse), sexually transmitted infections, and adolescent pregnancy. One key component of an effective program is encouraging community-centered efforts. In addition to counseling and service provision to individual adolescent patients, obstetrician–gynecologists can serve parents and communities by supporting and assisting sexuality education. Because of their knowledge, experience, and awareness of a community’s unique challenges, obstetrician–gynecologists can be an important resource for sexuality education programs.

Committee Opinion #680, The Use and Development of Checklists in Obstetrics and Gynecology

Checklists are used in medical and nonmedical settings as cognitive aids to ensure that userscomplete all the items associated with a particular task. They are ideal for tasks with many steps, for tasks performed under stressful circumstances, or for reminding people to perform tasks that they are not routinely accustomed to doing. In medicine, they are ideal for promoting standardized processes of care in situations in which variation in practice may increase patient risk and the chance of medical errors. Checklists also can be used to enhance teamwork and communication. It is a good idea to include frontline individuals who are involved in completing the procedure in the selection and development of the checklist. To be optimally effective, those who create checklists need to carefully plan for their design, implementation, evaluation, and revision. Checklists are valuable cognitive aids to help health care teams provide complete and timely care to patients, but checklists should be only one tool in the armamentarium to ensure that practitioners do the right thing for the right patient at the right time.

Practice Bulletin #173, Fetal Macrosomia

Suspected fetal macrosomia is encountered commonly in obstetric practice. As birth weight increases, the likelihood of labor abnormalities, shoulder dystocia, birth trauma, and permanent injury to the neonate increases. The purpose of this document is to quantify those risks, address the accuracy and limitations of methods for estimating fetal weight, and suggest clinical management for a pregnancy with suspected fetal macrosomia.

Practice Bulletin #174, Evaluation and Management of Adnexal Masses

Adnexal masses (ie, masses of the ovary, fallopian tube, or surrounding tissues) commonly are encountered by obstetrician–gynecologists and often present diagnostic and management dilemmas. Most adnexal masses are detected incidentally on physical examination or at the time of pelvic imaging. Less commonly, a mass may present with symptoms of acute or intermittent pain. Management decisions often are influenced by the age and family history of the patient. Although most adnexal masses are benign, the main goal of the diagnostic evaluation is to exclude malignancy The purpose of this document is to provide guidelines for the evaluation and management of adnexal masses in adolescents, pregnant women, and nonpregnant women and to outline criteria for the identification of adnexal masses that are likely to be malignant and may warrant referral to or consultation with a gynecologic oncologist.

The American College of Obstetricians and Gynecologists (The College), a 501(c)(3) organization, is the nation’s leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of more than 57,000 members, The College strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women’s health care. The American Congress of Obstetricians and Gynecologists (ACOG), a 501(c)(6) organization, is its companion organization.  www.acog.org