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The letter from Hess is one of several opinions that are pro–water birth, and responses by Batton and Lucey present the conflicting viewpoints.
To the Editor.—
The pediatric community, through the journal Pediatrics, deserves to be treated in kind regard of their intelligence and in their capabilities to discern "fads" from evidence-based practices, even new practices, such as water birth.
A serious attack was published in Pediatrics in October 2003.1 Pediatrics has repeatedly been negative and condemning of water birth. I must question how the research for these articles, including the May 2005 commentary,2 concluded with this opinion that water birth is a dangerous childbirth practice.
Many providers and parents, including pediatricians and the American College of Nurse Midwives, have tried to respond with their own commentaries, but Pediatrics has not printed one positive word about water birth. Is Pediatrics refusing to print anything positive about water birth? The silent nature of Pediatrics on the benefits of water birth leads to a deep question of the ethics involved in editorship of the journal.
For many mothers, water birth has been the best possible means for their infants to be born and gain the innumerable benefits inherent in avoiding drugs, operative delivery, and separation from mother at birth.
I encourage you, and the physicians involved with you that are opposed to water birth, to take a fresh and honest look at water birth. To find out more, go to www.sheilakitzinger.com/WaterBirth.htm or www.gentlebirth.org/archives/watrbrth.html.
As a provider of maternity care, I have seen incredible benefits to mothers and infants, and have researched thoroughly the evidence behind the safety!
REFERENCES
In Reply.—
I was asked by Dr Lucey to respond to Ms Hess’ letter regarding a recent commentary on underwater birth recently published in Pediatrics,1 which I co-authored as a member of the Committee on the Fetus and Newborn of the American Academy of Pediatrics. Since it’s publication, I have received a large number of e-mails much like yours, attesting to the value of underwater births without providing any additional data on which to base such an opinion. I understand that there are many people similar to you who are convinced that underwater birth has merit. In fact, it is clear that these individuals feel very passionately about this conclusion. Unfortunately, as we discussed in the commentary, we could not find any definitive studies to support your point of view. If proper randomized, controlled trials have been done (which we missed), I would appreciate it if you could bring them to my attention.
I think it might be important for you to realize that for us to endorse a therapy such as underwater birth, we need conclusive data that it is safe for infants (and preferably some evidence that it is actually beneficial to them as is claimed). Testimonials or the expressed opinion of individuals who believe in the procedure are of little value to us, because they are just as likely to be incorrect as they are to be valid. We believe it is the responsibility of everyone involved with the care of infants to advocate for their safe transfer from the intrauterine to the extrauterine environment. The best way for underwater birth as a method of delivery to gain support (rather than scrutiny) is for those who believe in it, such as you, to strongly advocate for a proper study to be done. This study would have to be large (at least several thousand participants) to evaluate for differences in low-frequency complications and controlled for all possible confounding variables such as the reasons for why women might choose underwater birth in the first place. If such a study was done and demonstrated either a benefit or at least no harm, then I am quite sure our committee and the pediatric community in general would endorse underwater birth as an acceptable alternative to traditional childbirth. However, at the present time, we believe such data do not exist, and we are concerned that harm could be done to infants delivered by this method.
I strongly encourage you to work with your colleagues to do such a study so that we can all have an answer to this important question.
Thank you for your interest in our commentary.
REFERENCE
In Reply.—
We do not publish articles that are not based on scientific evidence. We have never received a scientific article, such as a randomized, control trial, supporting water births. The commentaries on the subject that we have published have cited some studies that call attention to the possible dangers and the lack of scientific evidence of a positive effect of underwater births. I have not received any science-based commentaries from the groups that you cite in your letter. We cannot publish every letter, based on opinions only, that we receive.
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