BMJ  2005;330:1447-1448 (18 June), doi:10.1136/bmj.330.7505.1447-c

Letter

Underwater birth and neonatal respiratory distress

Case report does not constitute reliable evidence

EDITOR—We were concerned and dismayed to see the case report by Kassim et al of respiratory distress for a baby born in water being cited as evidence of the risk of underwater birth.^{1 2} Respiratory conditions can occur after any birth, and in the absence of discernible antenatal fetal compromise they are not particular to water birth. This account by two neonatologists and a radiologist from a prominent London centre is likely to provoke fear among practitioners and parents.

Having recently reviewed the evidence about immersion in water during labour and birth we concluded that a clear need existed for further evidence about the safety and effectiveness of water birth.³ This systematic review provided no basis to deny this care option for women with uncomplicated pregnancy.

Unfortunately this case report contributes to unreliable evidence and information women are offered when making decisions and choices for labour and birth. Safety and effectiveness of immersion in water for birth should be evaluated in a well designed randomised controlled trial. Neither opponents nor proponents serve women and babies well by continuing to accumulate anecdotal reports to support their own biases.

University of Southampton, School of Midwifery, Southampton SO17 1BJ e.cluett{at}soton.ac.uk

National Perinatal Epidemiology Unit, University of Oxford, Oxford OX3 7LF

Oxford Brookes University, Oxford OX3 7PD

University of the Western Cape, Bag X 17, Belville 7535, South Africa

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Competing interests: None declared.

References

1. Kassim Z, Sellars M, Greenough A. Underwater birth and neonatal respiratory distress. BMJ 2005;330: 1071-2. (7 May.)[Free Full Text]
2. This week in the BMJ. Underwater birth poses risks for the baby. BMJ 2005;330. (7 May.)
3. Cluett ER, Nikodem VC, McCandlish RE, Burns EE. Immersion in water in pregnancy, labour and birth. Cochrane Database Syst Rev 2004;(2): CD000111.

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Underwater birth and neonatal respiratory distress

Zainab Kassim, Maria Sellars, and Anne Greenough
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