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
two of our three children were born in a hospital birthing tub. the water made an incredible difference in pain management for me. both times i completely cleared my bowels hours before going into labor. neither baby breathed in any water as they didn’t take a breath till they were brought out of the water and onto my chest. very shortly thereafter we got out of the tubs. vernix intact. would do it all again exactly the same way 🙂
you have stated several times that being in the water did very little for you. almost feels like you need to validate that by delving into the harms of the “toxic birthing tub”.
I offered to have a midwife from the UK who is a leader in waterbirths write an article to refute this one which I offered to publish on this blog. She couldn’t come up with the information, studies or research necessary to do so. She just said that she and her pro-waterbirth colleagues didn’t think the short transit time in the toxic tap water would negatively affect the baby’s microbiome. I disagree. And, from the emails I’ve been receiving, it seems most women would agree that exposure to toxic tap water is not a good idea for a newborn. I ran into a friend at the healthfood store the other day who has had a waterbirth before (good experience) and is pregnant again. She said she is leaning toward not doing it again as she had not considered the effect of the tap water before, and her midwife had never mentioned it either.
For starters, I love what your blogs and follow most of Weston A Price. I rarely comment but I think this is important because you don’t have the latest research, or haven’t disclosed it.
I appreciate bringing up the importance of the microbiome in all situations, but in this one in particular I find it misleading and with dated information. Yes, chlorine might effect the bacteria on the outer surface of the skin if the vernix isn’t thick and protecting the baby ( like it should). For example, a woman who gives birth at 41 weeks might have little vernix on her baby’s skin. But all this aside, research shows that the microbiome is actually created in the womb. The placenta is not sterile, it actually has live beneficial bacteria that feed the baby and help create her microbiome/health gut flora. The comparison of the bacteria in the baby’s gut mostly matched the mom’s placenta and very little were from the vaginal ‘gulp.’ Here is an article about the study newscientist.com/article/dn25603-babys-first-gut-bacteria-may-come-from-mums-mouth.html#.VV1trFVViko
Women should consider the water source when having a water birth. My first water birth was in a home with a 7 filter machine that filtered water through the entire house. My second concerned my because there was no filter from the source that filled the birth pool. I think it’s what we do throughout pregnancy and our diet that is most important. Then it is what we do daily that is second in regards to creating a healthy gut flora for our future generation.
Research more yourselves if you are considering a water birth, but I wouldn’t worry about the gut microbiome.
I agree with this article, even though water is super helpful for pain relief. I wouldn’t object to using water during labor a bit, but not after the water breaks and not while pushing. I got a uterine infection after spending a lot of time in the water after my water had broken – I think it was the pool to be honest. I wouldn’t do that again.
Same here! I also got a uterine infection and my midwife said it could e been from the water. I wouldn’t birth in a pool again maybe just labor till my water broke. Had I known I don’t think I would’ve taken that risk, I had to take 2 antibiotics and it have my newborn rash for 2 weeks ????
You keep talking about how the chlorine can be so toxic. Do you have factual evidence of this? I would love to see studies on this.
Yes … see the sources in the article.
Sarah, I apreciate your article…but the reality is that many of us we do bath and shower in treated waters, we eat treated food and that is part of our lives….as we chose to live here and not in the woods or the savana…and many ofthe ones living there are desesparately risking their lives to move to our (treated lifes).
I am a midwife, and let me tell you: babies are born wet, all of them, because even after braking waters babies are still surrounded in waters, as waters are regenerated and when we brake waters most of them stay in the womb, only the forewaters go out of our bodies….
It is important not to wipe them dry, but to cover them so they do not get cold…it is much easier to get cold when we are wet, …and a cold baby can have respiratory distress…and here is when midwives need to find a balance between protecting the baby’s flora and protecting its life…a narrow balance…
Worst than beeing born in water are the baths given to babies everyday with soap!!, the little skin to skin, the little breastfeeding…By the way, breast milk has been proven to be filled with tremendous amounts of toxins as well but the benefits are greater than the toxins that we are passing inavitably to our babies.
I work as an autonomous/independent midwife in Spain, and most women using pools come miraculously out of the water for the birth….however, if they feel comfortable in there, why should they think to go out ? A woman should birth her babies where she feels more comfortable/safe…and this is what counts the most…All the rest can be balanced with non stop skin to skin (days long), not bathing for weeks, and exclusive breastfeeding for as long as mother /baby wish, and that means ideally at least more than 2, 3, 4, 5 years….
Her statement “..” In contrast, babies born “on land” do not need to be patted down with a towel because they aren’t wet at birth “…… has me sitting here in shock and disbelief. ALL BABIES ARE BORN WET! Unless the room is 99 degrees (and no birthing mama can usually handle that) THEY ALL NEED A TOWEL around them. To say that land born babies aren’t born wet? I can’t even….
My babies weren’t born wet. They were moist yes, from the vernix and moisture from the birth canal, but not dripping wet like coming out of a pool.
Thanks for writing this. I hope more research is done for the safety of the babies being born in water.
And I hope midwives tell the risks of not only waterbirth (even if they’re very small) but other risk factors in out of hospital births. I think many of us here are familiar with the benefits of home birth, but I’ve found midwives reluctant to talk about the risks.
I had a waterbirth (at home) and it turned out to be a nightmare (my baby ended up seriously ill and in the hospital). Not sure how much the waterbirth played into that. Maybe a coincidence.
The natural birth community needs to learn how to handle disagreement, and uncomfortable topics like this.
I truly appreciate this article, thank you for writing it. It tells a side of water birth that I have not seen elsewhere.
Well, you know you are doing something right when the Skeptical OB attacks you 🙂 The arrogance and vitriol is astonishing. Would you want to have this woman be your doctor?
skepticalob.com/2015/05/more-comedy-gold-from-sarah-pope-the-healthy-home-economist.html
Gotta love when the SOB writes about you…amazing how she can completely rip your words apart. She did this to me a while back.
agreed! she’s malicious and unkind and, honestly, I think bi-polar
I showed her nasty article to my older teenager and the first thing he said was that she must be a very unhappy person to think that writing this type of thing about another person just because you don’t agree with them is ok. Indeed.
“I think this article is full of misleading information written with the intention of scaring women away from water birth without any evidence to support her thesis.
1- of course the tub has to be thoroughly cleaned after each birth or the levels of bacteria will be dangerous. Of course they will use chemicals to do this, just like on any other surface in any hospital.
2-I have never seen chlorinated water used for water birth. Usually tap water is used. I am not informed on the levels of chemicals of US tap water but considering that you take showers, bathe in it and wash with it all your life I doubt women should freak out about bathing in it in labor. Also, what water will you use to bathe your baby at home?
3. The idea that you kill your vaginal bacteria in a regular birth pool is already pushing it, but the notion that if you step out of the tub to birth you avoid the problem is just wrong. If the pool water killed your bacteria it wouldn’t be enough to step out of the tub, it would take quite a long time for the vaginal flora to build itself up again. By the way, any antibiotics given to mom in labor is much more devastating for the bacterial flora than bathing in tap water. C-section babies are often exposed to antibiotics and don’t go through the birth canal at all so their bacterial imprint is completely different.
4- the fact that some studies don’t find benefits to water birth doesn’t mean it is harmful. It means they didn’t find any significant difference with out of the water birth and that’s ok. Women should be informed that it may not protect them from lacerations and other outcomes of birth, as well as the benefits like receiving less unnecessary interventions like episiotomies (because they are out of reach from the medical staff).
5-newborns don’t breathe underwater when they are first born. This is not the opinion of 1 midwife (as the author suggests) but it is proven science taught in universities. Babies have receptors that fully function after 37 weeks (reason for the contraindication for water birth before this time). These facial receptors keep the baby from taking the first breath until in contact with air. The risk of drowning is present only if you put the baby underwater after you’ve taken him out and let him start breathing air. So once you pulled up the baby out of the water and brought him close to your heart you and your team need to keep an eye on his nose and mouth and make sure he doesn’t accidentally slide down in the water. Just like you would make sure is face isn’t underwater when you bathe him at home.
I believe water birth is a wonderful option for healthy women with a healthy pregnancy, supported by specialized professionals who feel confident in offering this option to mothers. Our exposure to chemicals cannot be avoided by avoiding water birth since the same chemicals used in tap water and cleaning products are part of our daily life and they will be part of your baby’s life as well.
Every woman should get involved in her birth options and make informed choices and please don’t buy into these fear mongering articles. When in doubt you can always use the Evidence Based Birth site for a good dose of science based information.
Sorry for the long post.” Elena Paprello
Do you not even realize that the tap water is chlorinated? This is what kills off the beneficial flora in the birth canal and the probiotics in the vernix. I never suggested stepping out of the tub would avoid this. I only suggested stepping out of the tub before pushing IF THE WATER WAS FILTERED. And, why are chemicals being used to clean those birthing tubs? Chemicals are not appropriate and there is absolutely no justification for this practice. Only nontoxic cleaners should even be considered.
You have even said yourself that toxic tap water is being used for most water births and chemicals are being used to clean the tubs. And how again is this article off target? Seems right on the money to me. I respectfully suggest that you need to re-read the article thoroughly as you have not comprehended what was written.
Filtered water was already chlorinated before being filtered,,,and not much of the chlorine is filtered away…
After having taken a guided tour of our city’s water treatment facilities, I can attest to the fact that not all cities use chlorine in the water supply. Our city uses ozone. Assuming that we all drink, essentially, pool water is a serious problem with your assertions in this article.
Sarah, I am very disappointed in this article of yours.. There is such a vast difference pain wise for me being in the water (which was filtered) and I was only in the water, maybe 30 minutes… Total labor only 1 hour and 47 minutes…
How about the stess hormones of pain affecting childbirth and recovery?? And being willing to go natural again? Just a lot of holes in this article.. Keep on, keeping on.. And i do enjoy reading your blog. 🙂
I appreciate the feedback Natalie. I don’t dispute the pain reducing effects of water birth. Just be sure to use only filtered water and the tub cleaned properly with nontoxic cleaner and get out of the tub before pushing to avoid birthing that baby in contaminated water. Just my 2 cents. I want women to be fully disclosed on this as midwives aren’t doing a very good job of it at the moment. Hopefully, this article in some small way will help change that.