The baby or the bathwater: which one should be discarded?

One of the most important developments of modern obstetrics has been the humanization of the labor and delivery process. This includes a family-centered approach, a liberal visitation policy, attention to appropriate pain management, and the central role or respect for patient autonomy w6x. In these efforts it is essential that the safety of the fetal and neonatal patient must not be neglected. Proponents of underwater births give many reasons for advantages of water labor and birth including that buoyancy in water helps women to relax and that the warmth of the water may help to reduce pain. Waterbirth is being promoted as leading to fewer injuries to the birth canal and enhancing maternal autonomy w9x. While supporters of waterbirth espouse certain benefits to the mother, there are no proven benefits to the newborn w5x. To the contrary, there is sufficient evidence that delivery in water can cause serious adverse outcomes to the neonate including death. There are numerous case reports of neonatal deaths, pneumonia, hyponatremic seizures, infections, and multiple drownings attributed to underwater births w8, 10x. In their report of four infants with water aspiration Nguyen et al. provide further evidence that waterbirth causes adverse outcomes to the newborn w7x. A recent study looking at women with labor dystocia in the first stage who were randomized to water versus non-water/augmentation of labor showed that significantly more babies born to the water-labor group were admitted to the neonatal unit when compared with those in the augmentation group (6/49 in the water group were admitted to the NICU versus 0/50 in the augmentation group; ps0.013) w2x. Bowden et al. have stated: ‘‘«we are convinced there is no evidence to support any benefit of underwater birth for the neonate, and plenty of evidence to suggest harm. With the potential for drowning, hyponatremic seizure