Water births

BMJ 1995; 310 doi: http://dx.doi.org/10.1136/bmj.310.6994.1602b (Published 17 June 1995) Cite this as: BMJ 1995;310:1602

Could saline in the pool reduce the potential hazards?

  1. C N Barry
  1. General practitioner Wroughton Health Centre, Wroughton, Swindon SN4 9LW

    EDITOR,—I have recently attended four water births; three went smoothly, but in one the baby had some difficulty breathing and was admitted to the special care baby unit, where he had a convulsion and was found to have a low sodium concentration. Inhalation of water was thought to be a likely cause for this, and the diagnosis on discharge was freshwater drowning. Apparently the inhalation of even a small quantity of fresh water can cause appreciable haemodilution and the kind of problem experienced by this baby (who made a full recovery).

    The proponents of water birth argue that a baby cannot inhale water even after the head is delivered because of chest compression in the birth canal. I do not believe this: on several occasions I and midwives have heard a baby whose head has been delivered make an attempt to cry. If the same happened under water a small amount of fresh water would be inhaled.

    If the contents of the birthing pool were not fresh water but isotonic saline then presumably this haemodilution effect could be avoided. In the most recent water birth I attended, the patient was a qualified pharmacist, who told me that the birthing pool held 909 litres of water, to which the addition of 9 kg of salt would produce a solution of isotonic saline. I have discussed the idea locally with colleagues, who can see no obvious flaw in it, and I would appreciate others' comments.