Reasons to reconsider water birth due to toxins found in birthing pools and destruction of beneficial flora in the birth canal and vernix caseosa that can compromise proper seeding of baby’s immune system.
Waterbirth has become an established practice in parts of the United States where midwifery is strong and natural childbirth is popular. It is also gaining momentum in Canada, Australia, New Zealand, the United Kingdom, and Germany.
Advocates of water birth say that it is safe, offering Mom drug-free pain relief, better oxygenation during labor and a calm, peaceful entrance into the world for baby as the warm water simulates the intrauterine environment.
In addition, the umbilical cord pulsates longer after water birth, helping to remove damaged red blood cells from the baby’s circulation which reduces the risk of neonatal jaundice.
I birthed all three of my children naturally in a birth center with only a midwife and a birthing assistant in attendance. I chose to use a birthing tub briefly during labor with my first child.
I did experience some pain relief from the experience. I was particularly grateful to have the birthing tub available as an option during the challenging transition phase.
The decision to give birth in a tub is a lot more significant than the decision to labor in one, however.
Alarming Effects of Water Birth Few Mothers Are Told
The decision to labor or give birth in the water should be approached with extreme caution, and it is disturbing that the very real health risks of water birth are not typically discussed in prenatal examination rooms.
Not a single one of my prenatal exams over the span of three full-term pregnancies ever covered the risks discussed below nor were they even mentioned in passing.
A concern rarely if ever mentioned about water birth is the significant chlorine exposure that both mother and baby experience during the labor and delivery process.
Many mothers who are careful to filter their drinking water during pregnancy to remove chlorine and other toxins seem to give little to no thought about soaking for hours in the very same water or giving birth to their precious newborn in it.
Bathing or showering in tap water is known to expose a person to a significant amount of outgassed chlorine that is absorbed via inhalation and the skin.
For example, taking a seven-minute shower in treated city tap water (pool water would be much worse) exposes a person to more chlorine, disinfection byproducts (DPBs), and volatile organic compounds (VOCs) than by drinking a gallon of tap water. (1)
This absorption happens in two ways according to Dr. Mercola:
- The chlorine that enters your lungs is in the form of chloroform, a carcinogen, and chlorite, a byproduct of chlorine dioxide. These forms of chlorine hit your bloodstream instantly before they have a chance to be removed by your organs of detoxification.
- The DBPs that enter your body through your skin also go directly into your bloodstream. And the warmer the water, the more the absorption of toxins is maximized by the skin.
Chlorinated Water Harms Birth Microbiome
The most insidious result of exposure to treated water during the water birth process is the adverse effect on gut flora. Most water births use chlorinated tap water straight out of the faucet attached to the birthing pool.
According to Dr. Zoltan P. Rona, M.D., chlorinated water destroys most strains of friendly intestinal (and vaginal) flora, known as probiotics. (2)
The compromise to bodily flora comes at a time when the baby’s gut needs to be seeded properly with the beneficial microbes that will guard the health and bolster immunity for a lifetime.
Any beneficial microbes present in Mom’s birth canal will be either weakened, destroyed, or severely damaged by exposure to the chlorinated water by the time baby passes through.
While colostrum and breastmilk also contain beneficial bacteria, there is a wider variety of strains in a healthy mother’s gut and birth canal than in breastmilk alone.
Babies born via C-section are also not properly seeded with beneficial bacteria from the birth canal, which may explain why they are 5 times as likely to develop allergies by age two as babies born vaginally. (3)
Think about it … all that work you have done with your diet for 9 months limiting sugar, consuming fermented foods and taking probiotic supplements to optimally prepare the birth canal for baby’s birth potentially wiped away (literally) by choosing water birth.
In addition, exposure of the baby’s skin to the chlorine and other chemicals in the birthing pool tap water destroys the healthy living biofilm on the baby’s skin called the vernix caseosa which should be ideally loaded with probiotics from passage through Mom’s birth canal. (4)
The vernix is protective of the baby’s delicate skin and has anti-infective and antioxidant properties. It should never be exposed to toxic chemicals like chlorine or wiped/washed off until it comes off naturally some days after birth. (5)
Moreover, the moist air in the delivery room coming off the warm birthing tub water (filled with tap water) is the first air that baby breathes, and it is contaminated with chloroform, VOCs, and carcinogenic disinfection by-products like trihalomethanes.
Not exactly the optimal air to be filling baby’s lungs with at birth, don’t you think? The picture below shows a mother nursing her baby for the first time right in the birth pool!
Remaining in the birth pool for some time after birth is very common and exposes the new baby’s fragile lungs to very contaminated water and toxic air off-gassing from the birthing pool.
What About Untreated or Filtered Water?
Unfortunately, using untreated well water for a water birth isn’t much better.
Below is a list of some of the toxins commonly found in natural well water from contaminated runoff due to dumping by the millions of pounds into soils every single year: (6)
- Herbicides (like Roundup, proven to damage beneficial flora)
- pesticides
- estrogen-mimicking hormones
- drug residues
- heavy metals
Filtering the water would be a much better alternative, but the risk of infection is increased due to the lack of chlorine as a disinfectant to maintain water hygiene.
A study in 2004 of the water in a birth pool that had been filtered and thoroughly cleaned found high concentrations of the pathogens E. coli, coliform, staph, and P. aeruginosa. (7)
One report found that a baby in Texas died from contracting Legionnaires’ Disease from a contaminated birthing pool.
The infant was born in a tub full of well water that hadn’t been disinfected and died after 19 days in the hospital. (8)
Given the unsanitary nature of the water in a birthing pool after potentially hours of labor and delivery, it is not hard to understand the risks from contamination.
Vernix Caseosa Damage
One final note on using filtered or untreated well water for water birth: this will still at least partially remove the baby’s beneficial, protective biofilm called the vernix caseosa from patting the wet baby down with a towel.
The vernix should never be compromised in any manner until it flakes away itself in the days following birth.
The vernix protects the baby from infection and has antioxidant properties affecting immunity that science does not yet fully understand. (9)
In contrast, babies born “on land” do not need to be patted down with a towel because they aren’t wet at birth except in the very rare case of a baby born in the caul, which isn’t an ideal scenario as baby doesn’t get exposure to Mom’s flora in the birth canal when born in the bag of waters.
My third baby would have been born in the caul, but I asked the midwife to break the bag of waters just before I started to push so that my daughter would get exposure to my beneficial flora and have her immune system properly seeded during birth.
Other Water Birth Dangers
Waterbirth supporter and midwife Annie Sprague, author of the book Water Labor, Water Birth, refutes the 2005 warning by the American Academy of Pediatrics on water births which states,
The safety and efficacy of underwater birth for the newborn has not been established. There is no convincing evidence of benefit to the neonate but some concern for serious harm. (10)
Ms. Sprague asserts that current research has shown that babies do not breathe underwater at the time of birth so concerns for water inhalation are unfounded.
While some studies have shown benefits to water birth, a 2003 retrospective study found little to no benefit to the infant and no clear evidence of reduced labor duration or risk of tears. (11)
In addition, a 2004 review of the medical literature found 74 articles and 16 citations of infants who experienced serious complications from water birthing. These included death, drowning, near-drowning, waterborne bacterial infections, cord rupture, and fever. (12)
Contraindications
Even under the best of circumstances, water birth is not an option for some pregnant women. Waterbirth contraindications include: (13)
- Women who do not want to be in the water when laboring or giving birth.
- Women who have a fear of the water.
- Women who are less than 37 weeks gestation.
- Women who show increased maternal pulse rate.
- Situations where maternal fever or infection (including herpes) is present.
- Decreased fetal heart rate during labor.
- Any concerns regarding the health of the fetus.
- Maternal preeclampsia.
- Complicated or overly lengthy labor.
- Less than ideal fetal presentation.
- Women who have used a narcotic analgesic within the previous three hours.
Best to Pass on Water Birthing
It is surely a pleasant experience to labor and birth in water.
Pleasant should not be confused with safe, however.
I had a very positive experience with water labor as it eased my discomfort during the transition, and I felt much more relaxed which obviously improved blood flow to my baby.
However, pregnant women need to be fully apprised of the risks to their babies’ health and their own if water birth is attempted, and as of this writing, this is occurring in few prenatal examination rooms.
The biggest risk of water birth, it seems, is the very real potential of the decimation of beneficial microbial populations in the birth canal from exposure to toxic chlorinated tap water such that the baby’s gut (via mouth contact with the birth canal) is not properly seeded at birth. Lack of beneficial flora in Mom’s birth canal means that the vernix caseosa, which is ideally supposed to be a living biofilm, will not be exposed to probiotics either.
Why so many in the natural health community are flippant about the risks to baby’s microbiota from water birthing is concerning! This is especially true given the almost daily research coming out about how CRUCIAL good gut flora is to lifelong health.
Even if filtered water is used, there is the risk of infection from contaminated water (e.g., many women defecate when pushing). The protective biofilm called the vernix caseosa on the baby’s skin would be exposed to these contaminants and then partially washed/wiped away. This protective coating has anti-infective and antioxidant properties that science believes may affect innate immunity. It should never be exposed to contamination or inadvertently tampered with via towel drying.
The second biggest risk is the absorption of dangerous and carcinogenic toxins from skin contact and breathing outgassed chlorine and other chemicals present in treated water. And what about the toxic chemical cleaners used to disinfect the tub itself by hospital or birthing center personnel? Obviously, this can be controlled in home birth, but not elsewhere. And, finally, the risks of other complications including death from drowning, while small, are very real.
If you absolutely must have a water birth because the pain management and relaxation benefits really work for you, here’s a good compromise: Labor in the water (make sure the water is filtered [this one is a good model to consider] and the tub was cleaned with non-toxic, green cleaners) and then get out when it is time to push.
This approach won’t negatively affect your vaginal flora, and you won’t expose your baby to pathogens in the filtered water that has no chemicals in it as disinfectant nor will there be any risk to the integrity of the vernix caseosa.
Author Sally Fallon Morell, author of The Nourishing Traditions Book of Baby and Child Care, summarizes it well:
“So, despite glowing reviews, water birth should be embraced with caution.”
(1) Tap Water Toxins. Is Your Water Trying to Kill You?
(2, 4) Rethinking Chlorinated Tap Water
(3) C-Section Babies 5 Times More Likely To Develop Allergies
(5) Wait! Don’t Wash That Newborn!
(6) The Quickest, Easiest Way to Help Detoxify Your Body
(7, 13) The Nourishing Traditions Book of Baby and Childcare
(8) Texas Infant Dies of Legionnaires’ Disease After ‘Water Birth’
(9) Unraveling The Mystery of Vernix Caseosa
(10) Water Labor, Water Birth
(11) Water Birth: experience at a university clinic and a district hospital in Austria
(12) The Risks of Underwater Birth
I’ve read and followed your blog for years and always felt you tried to put forward facts objectively even if they weren’t conforming to the norm. I am sorely disappointed in this attacking stance you have taken on with waterbirth. Plenty of facts have been submit by others, so I won’t bother to rehash. Just state that I have given birth to all of my children through waterbirth and all of them are extremely healthy (no allergies, no asthma, no health issues). I am part of a large group of women that have all given birth this way and that tends to be the trend. Very healthy and robust children. I think this article is fear-mongering and based on lack of evidence. For whatever your reason may be that you felt the need to attack this peaceful and gentle option for birthing, it’s pretty disappointing. All of your concerns are dealt with by the midwives quickly and appropriately. They keep the environment clean and comfortable. And should I have more children, I wouldn’t hesitate to do it in water again.
You do realize that “chlorinated” in the studies refers to the level of chlorination in a pool, right? It’s not talking about the miniscule amounts that are present in tap water. I do try to filter that when I drink it, but this is taking it a bit too far. By your logic, we should never drink any water, take a shower or bath, or even wash our hands. In other words, you are completely over-reacting and exaggerating the “harm” of using tap water for a few hours during a singular event. Chill out and stop freaking moms out about things that aren’t true risks.
Where are the studies showing the harm from water birth specifically? Not the generalized “chlorinated water” studies because, as I said, those are talking about a much higher level of concentration, not the rather benign levels present in most tap water. Are babies born in the water sicker than babies born on land? Are they more prone to infections? Do they have a higher morbidity rate?
You are talking about “concerns” and “risks” without the actual evidence to back you up. At best, it’s just poor journalism bent on scaring people.
Did you read the source above that talks about exposure to chlorinated tap water via bathing and showering? You get more chlorine absorbed into your system in a 7 minute shower than drinking a gallon of tap water. You would obviously get much more in a swimming pool that has more chlorine.
I am very happy to say that this article is putting forth information most women are not considering in the decision to home birth, and it NEEDS to be considered. It’s extremely important and from my judgment and the sources listed in this article, the benefits do not outweigh the risks.
I actually have considered the chlorine issue in regards to my first home birth I plan on having with my second child. Honestly, this article failed to convince me. I find the comments refuting your “evidence” much more convincing and I was approaching this with an open mind without bias.
I often appreciate your posts, but this one seems a bit premature, alarmist, and not very factual. I chose to write a response to it, so that moms considering water birth can have all the facts:
What the h*ll? This can’t be right. I can’t be reading this from Healthy Home Economist. While I am all for the differing of opinions, I simply cannot get on board with this. My heart feels a bit shattered as I have had two beautiful water birth experiences that almost bring me to tears of joy just thinking about it. This must be what women who have had c-sections feel like after reading article after article about how c-sections are awful for this reason or that. Man, really? This article. Here. Devastating. Not to mention I just can’t help but to say, “Really?” The baby is in the water for like a minute. I just can’t live in a world where it seems nearly everything is to be feared or cautioned against, especially something as birthing in water. I would rock my births again tomorrow chlorine or not. Sending this over to my midwife, I’m sure she’ll be thrilled to read this.
Sorry to be a disappointment Rama. Just being honest. I’m not on board with this practice and wish I’d never set a toe in the pool with my first labor (it used chlorinated tap water … no one told me of the problems with it … I should have researched first). Too much exposure to chemicals (most water births use tap water) and potential pathogens. Someone needs to be talking about this stuff and no one is, so I decided it needed to get out there. Glad your babies got out of the tub fast after birth. It wouldn’t have been good to stay in there chlorinated water or not.
So do you only bathe your kids in filtered water?
You know how we can freak women out about birth EVEN MORE in a country with AWFUL birth statistics?! Tell them being in their tap water will out-do every other healthy decision they’ve made their entire pregnancy.
Seriously?
Yes, that is correct. We only bathe/shower in filtered water. It’s easy and cheap. Have done this for over 10 years. Attach a filter to the shower head or faucet. Buy them on Amazon.
So we’re supposed to say nothing about this because we might freak people out? Not a good solution in my book. I choose full disclosure about these serious problems with water birth.
Also, this post does not say that bathing in tap water will outdo all the other healthy pregnancy decisions. It says that the beneficial flora in the birth canal will be at the very least severely weakened by sitting in chlorinated birthing pool and birthing in it. And, this will serve to harm the proper seeding of baby’s digestive tract with health boosting flora. That is what the article says.
I actually haven’t done the tub during labor or birth, just because it simply hasn’t appealed to me for any of my 3 labors, but I do think you are trying to make an awful lot of stew from one small oyster here. Yes, nontoxic pool cleaners make sense, as does filtering the water, but I think your concerns about vernix and microbiota were well-addressed in the first few comments. And that you ought to say so, rather than standing your ground.
Kate – I think this article is very well-rearched. I’m sure you will present the opposite perspective, but why should you be believed over the Healthy Home Economist? At least she allows for dissenting opinions. You simply ban them on Facebook or don’t post them on your blog.
You’re mistaken about water birth and are clearly biased against it, using bits and pieces of studies to support your bias and not presenting the subject as a whole. You are are making generalized, broad sweeping statements that don’t accurately portray water birth. Feces and blood aren’t always in the pool. There weren’t present for my water birth. At least not in scary, toxic qualities that you seem to assume. As a birth doula, I’ve seen many moms give birth in the water without defecating or bleeding. Typically, there is no blood until after the placenta is delivered, plenty of time to get out of the pool and into bed for that portion of labor. You’re also stuck on the fact that water removes the vernix, which is simply not true, and is supported by the dozens of mothers that have responded to this article alone. If the vernix is removed, it’s by the care provider. If you’re having a water birth, you are outside of the norm and it’s safe to assume that you’re with a care provider who knows the benefits and doesn’t wipe it off. Through your unbalanced writing and scare tactics, you are putting pregnant women off of a strategy and technique that helps many. Just because your version of your water birth didn’t do much for you doesn’t mean it isn’t a tremendous help for someone else. What you’ve done here, is scare someone (who might not know enough to do the research for themselves and see that you are presenting a largely bogus chunk of information here) away from the idea of a water birth who then will find themselves in an ordeal they can’t manage and will have no recourse but to turn to the “traditional” way of giving birth, i.e., pitocin, epidurals etc….and what risks will they be exposed to then? As another commenter said, birth is inherently risky, no matter what. So is getting up in the morning. But you Sarah, have a platform to share information that helps your readers make choices that are appropriate for them however, you’ve gone over the edge of the cliff with your slanted writing this time. If you’re going to write about risk around any thing, do the research – ALL OF IT – and present both sides – EQUALLY. Unless of course you just want a bunch of people to agree with you. Then by all means – continue writing in the manner of which you’re accustomed.
“Feces and blood aren’t always in the pool”? Like you can actually predict when they will or won’t be? You’ve just confirmed a very important point in the article by summarizing your experiences as a birth doula attending water births. Just wow.
Wow, first, I want to say that your response above seems very rude and unprofessional. Second, I was planning a water birth. It didn’t happen though because the pool had feces. That’s when I got out. You have to be flexible.
Good call to get out of the pool.
Having feaces in the water is not a problem. As a midwife I fish them out (the big parts) the tiny bits can stay there and will not be harmfull…mums bacterias are familiar to baby’s bacterias and they both have the same antibodies to them…I have never had any children having problems out of bwwning born in waters where mum had some feaces before their arrival!!
This makes a lot of sense! I noticed that my asthma went away after several years spent not swimming in public pools very regularly. I grew up on swimming lessons. A bit of a different question here, but how would you recommend to affordably teach your kids to swim and not to have a fear of the water, when pools are so filled with chlorine and the lakes around are filled with pesticides? 🙁
Ozonated and salt water pools or a clean ocean somewhere in the world. It’s a dilemma for sure.
I respect your thoughtful decision to examine the risk of chlorine in the water (we should be careful of that, as well as fluoride and I agree that it’s best to avoid those things), but you have once again made your own experience trump that of everyone else. Just because you didn’t find that it helped you that much doesn’t mean that it is not a HUGE benefit for others (myself included). The benefits of the tub far outweigh the risks when you take into consideration the very short time the baby is actually in the water and how waxy the vernix is. Just because the mother is in the water at the time of birth doesn’t mean the baby is soaking in it for hours. The benefits of water birth are realized by thousands of women who find it very useful for pain management, which encourages a natural birth as opposed to a medicated one. In my experience my son came out so quickly since I was able to be as relaxed as possible and labor efficiently. You seem to forget how quickly the baby is swooped right up and put on mom’s chest…which is out of the water by the way. I don’t doubt the water in the picture is bloody. But it doesn’t follow that it has to be “filled with feces” as you suggest. The water in my tub was completely clear when my son was born. Quite a few minutes had passed after the birth happened before the water began to look bloody, there was no feces in it and my son wasn’t in the water by then anyway. He had obviously been picked right up and given into my arms where he belonged. Everyone’s experiences can be quite different. So I am not trying to suggest that my experience is what happens every time. But just thinking about how short a time the baby is typically in the water (in most cases) should tip the reader off that your conclusions about damaging the vernix are illogical and unfounded. Please don’t give water birth a bad name when it could potentially help so many achieve the natural birth they are hoping for. Hands down, birthing my son in the tub was the easiest birth out of the three times I have brought children into this world and I would never do it again any other way…but you see, that is my choice based on the comparison of my own birth experiences, not what some abstract study dictates.
Forgot to say, in short, don’t throw out the baby with the bath water! Sorry, couldn’t resist saying that!
Thanks for the response 🙂 However, unless a mother has an enema before or shortly after labor starts, there is no doubt that there will be feces in that birth water from the pushing and birth. And, if the water breaks in the tub, that will add additional fluid etc. Warm water in the tub will encourage rapid proliferation of pathogenic bacteria. This type of water would never be allowed at a public facility for anyone to be in .. let alone a newborn who would get it in the eyes, ears and mouth (probably even swallowing some) from being birthed underwater.
And where is the research to support this fact? Tests done of the water before, during and after birth? Information about the feces particles in the parts per million water molecules? Did you also have an enema when your babies were born on land? The vagina is so close to the rectum that the potential for contamination is there as well. Add the hands of the practitioner messing around in that area…better check those too. I would be careful if I were you – by the time you’re done, we’ll be giving birth in a sterile bubble.
Actually, enemas were standard pre-labor protocol only a couple decades ago 🙂 Probably a water enema would be a very good idea for any women who insists on a water birth because most women defecate when pushing unless they’ve had an enema beforehand. In a vaginal birth, this isn’t a problem because baby doesn’t get a mouthful of it when he/she is born unlike a water birth where the baby is essentially born into that same water.
In my home birth midwifery practice, the majority of my clients labor in the tub and more than half deliver there. I can personally attest that not every mother poops when she pushes out her baby!
If a baby has a dirty diaper at a public pool, the entire pool is shut down and with good reason even though the water is chlorinated (although lack of chlorine would make the potential pathogen problem much worse). Don’t you think a mother pushing and defecating (almost always happens) in a birth pool that has a much smaller volume of water would be problematic as well with the baby’s mouth, eyes and ears exposed probably swallowing at least some of it? And, if the water is chlorinated, the problem of chemicals is added to the mix.
Why aren’t midwives telling women this???
I birthed 4 of my 7 children in water and cannot say enough about the wonderful experience. I’m saddened with your Sarah’s position. I hope any mother’s to be out there does not decide to have this wonderful experience based on this post. Yes, there are some points but the good way out number the bad here. So please do your own research & make your own decision on this. I’m sure glad I did and this post did not come out before I tried a waterbirth. I respect Sarah and I might have foregone this experience if I read this before my first waterbirth.
My children were covered in the vernix-didn’t bathe them until it had all fallen off. I was at home in our environment with my husband & children at my side. The stress free environment is enough for me to do waterbirth’s in itself. My first 3 I was not in my environment and it was a much more stressful on me. Stress is #1 for any health problems. I will never forget the wonderful waterbirth experiences.
Out of a group of 10 mothers my daughter was the only one to have a water birth at home. All new ideas to me, however the midwife was a true expert at water births, and we were all dusted and cleaned up in no time! Real speedy, delayed cutting to cord . . . vernix in tact, not even a tear. She only entered the pool at the last phase, and baby shot out like a little otter to be caught by the midwife. All the other mothers had traumatic hospital births, c-sections, huge tears etc etc. My grand-daughther is 21 months and not seen the inside of a hospital.
It is good to put all this info out, as proper precautions as in everything is necessary, however I would be sorry if it put many mothers off, as truly efficient mid-wives is what is needed.
As I said all new ideas to me . . . including the collecting of the placenta by a doula to dehydrate and make into capsules for Mom to have for next 6 months. Even a tiny bit mixed in a fresh mango strawberry kiwi smoothie for Mom to have soon after the birth. We have photos of my daughter and she looks fabulous after the whole experience of her first birth. Once I got over the “ick” factor re the placenta and done my research I could see the benefits . . . and my daughter did really well on all of this.
I repeat . . . be a shame if this info puts Mom’s off . . . efficient midwives bless them all . . . are the brightest most amazing women, full of intuitive common sense.
water birthing always struck me as unnatural but I never thought about why. now I am thinking about it and wouldn’t the tub water act like a douche into the uterus of the mom? that sounds awful. water isn’t supposed to go up there!
Your vagina is not a vacuum, it doesn’t suck things inside of you…
actually the definition of a vacuum is “a space devoid of matter” which the uterus becomes immediately after delivering child and placenta.
But you don’t hang out in the tub after you’ve given birth. I think it’s very common to birth the afterbirth outside of the tub. I know I did it and my midwives recommend it for easier cleanup.
I have never done a water birth but did take showers while in labor, which helped tremendously with the pain. With my second child, I went into the shower at 7 cm and came out around 15 min later at 10 cm and he was born shortly thereafter.