Water Birth—A Near-Drowning Experience

Case 1

A male weighing 4155 g was born at term after an uneventful pregnancy. Delivery occurred accidentally in a water bath that was being used during labor for maternal analgesia. Apgar scores were recorded as 9 and 10 at 1 and 5 minutes, respectively. At 5 hours of age, the neonate was recognized to be in respiratory distress with oxygen saturation of 60%, requiring 100% oxygen via headbox. He was transferred to our unit and intubated and ventilated on arrival. No risk factors for sepsis were identified. Radiograph of the chest at 9 hours of age demonstrated bilateral interstitial and alveolar edema with bilateral pleural effusions. History of the water birth was not initially disclosed. Irritability and hypertonicity were diagnosed as mild hypoxic ischemic encephalopathy. Echocardiography demonstrated no structural cardiac abnormality. The neonate remained ventilated for 3 days. The patient was stable in air by the third day of life, after gradual weaning from oxygen. The infant completed 5 days of antibiotics; cultures of blood remained negative.

The infant was readmitted on the ninth day of life with seizures. Investigations including ultrasonography, computerized tomography, and electroencephalogram were normal. No additional seizures occurred, and the child’s development over the first year of life has been appropriate for age.

Case 2

After an uneventful pregnancy, a male weighing 4675 g was born by planned water birth at term. Apgar scores …