October
26, 2016
American College of Nurse-Midwives' Statement Regarding the new ACOG/AAP Committee Opinion, "Immersion in Water During Labor and Delivery"
ACOG's new committee opinion released this
month reflects a significant change from its past opinion which called for
women having a water birth only as part of a clinical trial. While this
new opinion is a positive step, ACOG continues to recommend against water birth
in second stage labor.
ACNM believes this new opinion still does not
accurately recognize women's desire for access to this option, nor does it
reflect the large and growing body of research that supports water birth as a
reasonable choice for healthy women experiencing normal labor and birth.
The new bulletin continues to reinforce that immersion in water during the
first stage of labor may be associated with numerous benefits to women, which
ACNM and American Academy of Pediatrics (AAP) also agree.
ACNM has been in
communication with ACOG to express our concerns and our disagreement with the
conclusions of this committee opinion, and has sent additional, up-to-date
information on water birth outcomes to ACOG and AAP for the committee's
consideration.ACNM, in collaboration
with AABC, MANA and NACPM, has completed the development of a Model Practice
Template for Hydrotherapy During Labor and Birth. This template, which will be released by the Journal of Midwifery and Women's Health
in the next month, will provide guidance for protocol development in order to offer
water birth as an option to families who desire it in the home, hospital and
birth center settings.
As this ACOG committee opinion is disseminated and media stories emerge, it is
critical that ACNM members are equipped with accurate information to have
informed discussions with women and families, as well as with professional
colleagues. The nation's top experts in water birth have been working closely
with our national office staff team and ACNM leadership to encourage the
dissemination of accurate information about water birth.
Please refer to
ACNM's position statement on Hydrotherapy
During Labor and Birth.
Summary of ACNM
position regarding water birth and the ACOG committee opinions:
- Women need accurate, reliable information when making decisions about
the birth of their child, including how to manage their pain so they can be as
comfortable as possible. Consulting with a qualified healthcare provider will
ensure that the risks, benefits, alternatives and research are discussed so
women can make informed choices. After consulting with her health care
provider, if a woman chooses to labor and give birth in water, she should
receive all the support she needs to make it a safe and pleasant experience.
- Midwives are experts at working with women during pregnancy to ensure
that their concerns are heard and their questions are answered. They help women
understand the evidence and choose what is works best for their pregnancy, labor
and birth and they listen to the personal preferences of the women they serve.
- Most water births occur under the care of a midwife and it has been a
safe option for decades that provides comfort with good outcomes for the mom
and her baby. ACNM members serve women who are having water births in
hospitals, birth centers and the home. ACNM supports ongoing access to water
birth and we encourage more maternity care providers to become educated about
its safe use in order to ensure that women are fully informed.
- ACNM concurs with results of randomized clinical trials - a reliable
form of research - that demonstrate that "immersion in water during the first
stage of labor may be associated with decreased pain or use of anesthesia and
decreased duration of labor." With healthcare organizations (like ACNM, ACOG
and AAP) in agreement on this, more healthy women are likely to have access to
this information and practice-which is great news for women.
- However, this new ACOG/AAP opinion statement cautions about immersion in
water during the second stage of labor. These cautions are similar to those in
their prior publications, including warnings about a lack of data on the safety
and benefits of water birth. The organizations refer to case studies of adverse
outcomes, but case studies are not a reliable form of research, and should not
be the foundation for their conclusion that women should get out of the tub
when they enter second stage labor.
- ACNM believes that this committee opinion does not accurately reflect
the large and growing body of research that supports water birth as a
reasonable choice for healthy women experiencing normal labor and birth.
Despite limitations, the best available research indicates that water birth is
associated with perinatal outcomes similar to those expected in a low-risk
population. In other words, healthy women and their babies generally stay
healthy during and after normal labor and water birth. One of the largest studies
of outcomes for women and newborns experiencing a water birth confirms this
finding. See JMWH article. Therefore, water birth is a reasonable choice
for healthy women to make in collaboration with their care provider, given the
state of the science.
- We agree that more quality research about water birth is needed,
particularly in the US, but international studies already support water
immersion as an option that women should consider for their labor and birth,
and the additional studies since the last publication of the ACOG water
immersion clinical bulletin continue to reinforce this conclusion.
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