This page is based on my response to a question from the Homebirth UK egroup:
My midwife has said that I must not touch my baby's head during a birth in water, otherwise the baby might breathe underwater. Is this true?
It is sometimes mentioned in
guidelines for midwives that they should avoid over-handling the baby
as it is born, in case they over-stimulate the baby which might, in
theory, trigger it to breathe as it's brought to the surface.
a) this relates to MIDWIVES touching the baby, not the mother - it is reasonable to expect that the touch of a mother catching her baby might be different from that of somebody strange (more discussion of why this might be, below),
and b) many water babies are indeed caught by the mother, and in even more cases the mother feels the head during the birth, and yet I'm not aware of a single case where the mother touching the baby has been cited as a possible cause of actual problems, rather than theoretical ones.
Many women who give birth in water do describe touching the baby's head as it's born - many of them go on to catch the baby. You can see this happening on several of the births filmed for Homebirth Diaries and Home Grown Babies (two series of home birth films shown on UK television) or if you search YouTube for waterbirth films. It's never been shown to cause a problem as far as I'm aware. It's what women do instinctively, and I think you need very good grounds for stopping an instinctive behaviour in labour, not unproven worries. Now there might still be a small, theoretical concern, but midwives who are experienced in waterbirth never seem to find this a problem. I have yet to hear of an independent midwife who asks her clients not to touch the baby during the birth, for instance, despite the fact that for many IMs the majority of the births they attend are in water.
My own five children have all been born in water, and in each case I have felt the baby's head as it crownded, guarded my own perineum as the head descended, and felt it as it emerged, and caught the baby and brought him or her to the surface. None of my midwives ever tried to intervene or to advise me what to do in this situation, and it was automatic - instinctive - for me to do this; it would have been extremely difficult to stop myself. Many waterbirth mothers report a similar experience, although certainly not all; it's also common for women to feel no urge to do this.
I cannot find any authoritative bodies which recommend that the mother should not touch her baby during a waterbirth.
Certainly the RCOG/RCM joint position paper on waterbirth doesn't suggest it ( http://www.rcog.org.uk/index.asp?PageID=546) - the only relevant cautions there are that if the mother raises herself out of the water and exposes the presenting part of the baby to the air, she shouldn't resubmerge it.
One of the midwifery Today e-news editions has a quote from a midwifery textbook on waterbirth which is relevant to this issue:
"...It is best to avoid touching the baby as it is born. If the mother is undisturbed, she will touch the head herself, and the baby will spiral out (literally pushing itself out with its feet) and turn to face her. It may expel fluid from its lungs (seen getting into the water), and may reach one arm toward her with the other bent, as if swimming (the asymmetric tonic reflex). Mom and baby will then make eye contact, and she and her partner can lift it and bring it to her chest."
— Elizabeth Davis, excerpted from Heart and Hands: A Midwife's Guide to Pregnancy and Birth, chapter 2, pg 59, Celestial Arts: Berkeley, CA http://www.midwiferytoday.com/enews/enews0803.asp
Again, this is referring to the midwife avoiding touching the baby, not the mother.
Mayes' Midwifery textbook (12th edition - 13th is out now and may have superseded this advice) says, in the chapter on waterbirth:
"The midwife and/or the woman control the fetal head to prevent sudden expulsion and risk of perineal tearing" (p399)
There are lots of links and discussions on the excellent US Midwife Archives. Bear in mind most of the posts are from the US and birth generally seems to be more 'hands-on' there, even at home and in water - but it's interesting reading different midwives' perspectives: http://www.gentlebirth.org/archives/watrbrth.html
Another excellent waterbirth resource is an article aimed at midwives and healthcare providers - Waterbirth Basics by Barbara Harper - it's a 9-page pdf (http://data.memberclicks.com/site/wi/Waterbirth_Basics.pdf ). Doesn't seem to mention this particular issue, though.
So what would the difference be between the mother touching the baby underwater during the birth, and a midwife touching the baby?
Firstly, the mother is unlikely to be doing any more than gently touching the baby's head or guarding her perineum. This is in contrast to the fairly common hands-on midwifery approach, where the midwife may manually turn the baby's head to the side before the shoulders are delivered, for instance. If you watch 'dry land' birth films you can often see this happening - where a midwife practises 'hands on' instead of 'hands poised', she may actually use some traction (pulling) to turn the baby, rather than just waiting for the baby to turn itself and deliver its shoulders itself, as in a straightforward hands-off birth. There is variation between different midwives, and between different births - many midwives have a preference for hands-on or hands-off (hands-poised) practice, and even the keenest supporter of spontaneous birth will have some cases where she feels hands-on is necessary. You can imagine that, if this is a midwife's usual approach, a waterbirth trainer might be concerned about the amount of handling that the baby could experience before his body was delivered.
I would also expect that the mother's touch will be instinctively tuned in with her contractions and perfectly timed - whatever she's doing will be in sync, if you like, with what her uterus and baby are doing - because she will have more information about what's going on than anyone else - she is the person who knows when her contraction is building, when it's peaked, and whether it's declining or building to another peak etc..
I suspect it may mean that you're only going to be guarding your perineum at the height of a contraction, and also that any feeling of your baby's head is likely to be just gentle touching to feel progress, rather than more invasive poking around to see what's going on.
Since many women regularly feel the baby's head as it descends in the birth canal, how are feeling the head as it crowns, and as it emerges in a waterbirth, different? Sometimes waterbirth babies seem unaware they've been born until they reach the surface. I can understand people being circumspect about over-stimulation in a waterbirth as, in a way, the safety of it depends on that illusion being maintained and the baby not realising he's been born until he reaches the surface. However, no evidence has been given that the mother touching her baby is, in fact, likely to make it gasp.
I think that if this issue arose for me, I would (as ever) want to put it in writing, along the lines of:===
Dear Community Midwifery Manager,
I am booked for a home birth with Team X. I will have a birth pool and may give birth in the water if it seems right on the day. Some members of the team have commented that they believe I should not touch the baby's head as it is being born, if I remain in the water. They are worried that my touching the baby during the birth may stimulate it to breathe underwater.
I am aware that some midwifery guidelines on the use of water for birth recommend that the *midwife* avoids over-handing the baby in a waterbirth. However, I have not found any guidelines which advise that the mother gently touching her baby during a waterbirth is dangerous. Moreoever, I am not aware of any single case where the mother touching her baby during a waterbirth has been suspected to have caused harm. I understand that it is, in fact, extremely common for mothers to feel the baby's head during a waterbirth, and for a mother to catch the baby herself and bring it to the surface. Midwives who frequently attend waterbirths commonly report this happening.
If you have any evidence which suggests that a mother touching her baby during a waterbirth is dangerous, I would be interested to see it and would be grateful if you could send me references so that I can consider it when making my decision.
I would like you to make the members of Team X aware that I have researched this issue and will make my own decision. I am sure you can appreciate that I would not want to enter into a debate about the subject with them while I am in labour. The midwife in attendance may, of course, write on my antenatal notes that they have made me aware of their recommendations in this area before, so that the team's position is well documented.
Many thanks in anticipation of your help, etc,
It is worth noting that, legally, the mother can of course touch her own body and her own baby any time she wishes. It is the midwife who needs permission, and if the mother instructs the midwife not to touch her then the midwife will be committing an assault if she goes ahead and tries to catch the baby without the mother's permission. One would hope that it would never come to that, though...--
This page updated 18 May 2008
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