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
You mentioned you bought a shower filter and can find them on Amazon? Is there one in particular you like best?
Yes, the one linked to in the article is the exact model I’ve used for many years. You will need to buy replacement filters for it periodically. YOu will know it’s time to replace the filter when the water pressure coming out of the shower/filterhead slows down.
Thank you so much Sarah for taking the time to write this article. I have had 3 water births so far and am planning on a 4th one in December. After reading your thoughts on it, I am changing my strategy! I consider myself to be a mama who is very concerned with health and the well being of her family…but I can’t always think and remember everything! So grateful for the support and advise I receive from your blog! Keep up the great work! I would really like to purchase a shower head filter…is there a particular one you like best? Thanks again!
Hi Tara, thank you for your comment. I use the very inexpensive shower head plus filter mentioned in the post. Have been using this particular model (showerhead plus a detachable filter) for many many years. You just need to buy a new filter (the filter attaches to the special showerhead) every year or so or whenever it gets gunked up depending on how bad your tap water or well water is .. this varies depending on location.
I’m really surprised you failed to offer the suggestion of vitamin c powder for those who may may still choose to labor, birth, and bathe in . A couple teaspoons of powdered vitamin c would completely eliminate the chlorine in a birth tub filled with municipal water. Even if you are birthing at a hospital with birth tubs or a birth center, just bring some vitamin c powder with you and then there is no need to worry about what kind of filter they may or may not have. We add a teaspoon of C powder to our baths, along with epsom salts at home. It is cheap and easy.
Here is a good post on vitamin c for eliminating chlorine from bath water: wellnessmama.com/13181/reduce-bath-water-chemicals/
Great suggestions. Thanks. Unfortunately, even filtered water, though a much much better alternative, has its own set of problems if you read through the article to that section.
Which would be worse for the baby as far as toxins and microbiome is concerned: 1) a home water birth in tap water, or 2) a transfer from home to hospital for a c/sec? If #1 can prevent #2 from happening (and I truly believe it can for some women), then it is a very beneficial option that women should have on hand if they so choose. Could I have birthed my 12-pound son (complete with nuchal hand) without shoulder dystocia or even a single tear to my perineum, if I didn’t have the warm soothing relaxing effects of the birth pool? I don’t know, but I am sure glad I didn’t have to find out.
I agree there are benefits, even if it is not ideal. During my home birth, I had a birth pool on hand just in case, but I would not have used it if it weren’t for my blood pressure going up. The midwife wanted me in the water to lower my BP. Plan B was to transfer me to the hospital. My water broke as I pushed so baby was not “seeded” in that way, but I was also Group B strep positive so that was a good thing…and maybe the chlorine in the water acted as an added protection against my baby contracting GBS.
I find it disappointing when authors cherry-pick “facts” to “prove” a point they were already set on making. Pregnant women would be bathing in that same water for months before birth. Birthing tubs are often filled a day or two before, and chlorine can off-gas. The baby is only in contact with the water for moments, and during their first bath, they’d likely be using the same water, unless you plan to bathe your baby in bottled water. And what about people that use filtered water in their birthing tub? Why is that bad, feces? Why do you think evolutionarily, the anus would be so close to the birth canal if feces was so toxic to a baby? What about the complications that come when a woman is not comfortable during labor? Do we need to create fear so that during the most wonderful moment of birth, she’s thinking about external details (quick jump out of the tub, the baby is coming into toxic water!)? You and the Weston A. Price Foundation normally do a good job helping provide the opposite view of the mainstream story to help people make informed choices without fear. What is your purpose here? Would you like to convince more women home birth and water birth are harmful? Maybe a sterile hospital birth would be better? I just don’t get it.
Mothers shouldn’t be bathing in toxic tap water either. Midwives should be counseling women to get a very inexpensive shower or bath filter to counter this problem. Two wrongs don’t make a right.
Appalling! WHY did you write this? Have you identified ANY actual negative implications/outcomes from water birth? Or is this all speculative conjecture that you, personally (via WAP), feel necessary to inform people about? Clearly you’ve taken the Blue Pill and follow the dogma and limited perspective that get many into trouble. Again, what was your compelling need to share this? Do you feel you’ve done a common good to invite fear where none was warranted? We’ve got enough fear mongering going on in the mainstream media, and don’t need it coming from (ostensibly) trusted/beloved sources of information (throwing you a bone there)
The negative effects of a poorly developed microbiome for an infant can sometimes take years to assess. Don’t you think it’s better to play it safe given how established the negative effects of chlorinated tap water already are in the research?
Why not ozonate the water? Could be a solution to disinfect the water and remove toxins.
Definitely a better choice than toxic tap water which is what is most commonly used for water births.
What would you say to the research presented in the following article presenting evidence that birthing in water contaminated with the mother’s feces actually shows the lowest infection rates for GBS?
“A single case of early onset newborn GBS was reported among 4,432 hospital births into water in the absence of antibiotic prophylaxis (1,2) suggesting a 300% lower rate of EOS among low risk women giving birth into water compared to 1/1,450 currently for hospital births into air where CDC protocols are adhered to (3).” webmedcentral.com/article_view/2953
I don’t have time to refute your claims with research and statistics right now, but as a Certified Professional Midwife who specializes in water birth, and who has done my research in the past, I can unquestioningly say that your premise is not well founded.
There is no research to refute the claims of damage to the newborn’s microbiome from water birth. I’ve been conversing by email with several midwives who have all admitted this.
There is no research to prove the claims of damage to the newborn’s microbiome from water birth either. This is all just conjecture.
Reply
I think it’s highly plausible if not probable that water birth negatively impacts flora given the concrete evidence that already exists of the effect of chlorinated water on the human microbiome whether exposure is drinking it, breathing the vapors (off a pool or bath filled with tap water) or via the skin. As a mother, you have to make decisions based on the evidence at the time which isn’t always 100% .. I would never have a water birth given the complete lack of evidence that it doesn’t harm the infant’s microbiome. Proper seeding of the infant’s microbiome is arguably the most important thing to come out of a successful natural birth … why risk it? Not me.
Sarah, the burden of proof is on you to make the case that water birth harms the baby’s microbiome. There is some excellent food for thought on this blog but where your articles are based on pure opinion, it is only fair to your audience that you make this clear. The truth is you have no evidence to support the theory that water birth is harmful in any of the ways that you have stated. And the position you have taken in defence of your theory doesn’t make sense.
Hi Richard, actually the burden of proof is on the water birth advocates that it *doesn’t* harm the microbiome! There is much more credible evidence that it DOES harm it than it does not. WHy are water birth advocates completely ignoring and casually dismissive of the very very strong scientific proof that chlorinated water is very damaging to the microbiome whether breathed in via chlorine vapors, contact with skin, or ingested via chlorinated tap water? The vast majority of water birth is in tap water … absolutely wrong that this is advocated as safe! It is not safe and benign for either mother or baby. This defensive attitude by many in the natural health community about this is very disturbing quite frankly.
^^^ THAT study alone is exactly why I chose to birth in my tub at home, away from the hospital that would force me to have the antibiotics I refused. to me, my own bathtub at my own home with my own “germs” was MUCH safer to my baby than the hospital and strangers touching my child.
As a teenager who has never given birth, I’ve only recently been hearing about water births. I read the article twice and then proceeded to read the comments here. I was shocked at the snappy, uninformed responses given to Sarah, the author. I am very disappointed. They wrote and claimed things that Sarah never mentioned and tried to say that she was “biased” or “crazy” for saying those things, when in reality she didn’t say those “biased” things and it was actually the commenter who said those things and it makes them look ungracious, unprofessional (the midwives), ignorant, and clearly defensive about something that Sarah presented both pros and cons about. I have two things to say:
1. To the midwives and other commenters who oppose the article: BE LOVING AND GRACIOUS in your responses! I understand if you are a midwife and your profession is to birth children like this, but you can also be professional and represent yourself and your business by not only removing the “attacking” attitude from your writing but to put some real logic and reasoning into your posts. For real: I counted three reasoning errors in a single midwife’s comment. How does that make you look in my eyes as I consider how I will want to birth and raise my children in the future? To be honest, not so great. Also, PLEASE read the article and know Sarah’s stance before you start going off on a tangent that she never mentioned. It’s like arguing about a decision that was never even discussed or made. It makes no sense. The chlorinated water argument, again, nobody read the sources and assumed things that are not discussed or misunderstood them.
2. To Sarah, the author: I appreciate your article. You present good sources from what I can tell, and I really liked the fact that you have water birthed before and you told your experience of it. I have heard a bit about water births recently and thought the idea was interesting, but your article (and the attacks of the midwives) has given me second thoughts that I believe are well-considered second thoughts. After all, every decision and choice that we make for our children should be researched and thought through, and I want to see both sides of everything. You give both sides very well, and I thank you for that transparency. At this point, if I consider a water birth, I will take your idea of being relaxed during labor and moving out of the pool for the rest of the time. Also, the discussion on chlorinated water is very interesting. I live on well water and even though hard water stains are a pain, I prefer the taste of well water any day. Thank you for relatively kind and informed responses. Your posts are well-written.
That’s my two cents. And for those who read this and are about to post something, be gracious and kind and read the article multiple times!
I’m a naturopath and nutrigenomic specialist. I specialise in gastroenterology and I do extensive testing on my patients’ microbiota. I can confidently say I’ve tested many stools from water birthed children and they have healthy microbiota. You have to remember that while chlorine does indeed kill bacteria, the baby is in tight contact with the vaginal membranes for a long time. There’s no water going up the vagina during a water birth – the microbiota is going into the baby’s mouth, nose eyes and mucous membranes that way. Further microbiota is then passed on via breastfeeding. Skin microbiota will be passed on regardless of the chlorine if mum and bub practise skin to skin contact in the following days. Faeces aren’t an issue as normal vaginal delivery is intended to pass on faecal microbiota to the baby. The human microbiome project have found that newborns from vaginal births have vaginal, faecal, oral and skin microbiota on and in them. A way to deactivate the chlorine in the water would be to add low dose vitamin C to the water or use filtered water.
I was wondering the very same thing about the vitamin C suggestion. Or even the bath balls that reduce chlorine. I feel like there must be some alternatives- water birth is amazing and unless I had some significant research that said it was dangerous to fetal or maternal health I’m not changing my birth plans.
YES!