As I was pondering on the question of why water birth seems to get obstetricians in a bit of a tizzy – I realised my own experience of learning to support women at water births provides some clues. This week’s post is a reflection on what I have learned as an obstetrician who has been present at over 100 water births.
The early days
While I had been interested in learning to facilitate water births for some time, it wasn’t until the mid 2000’s that all the ducks lined up (yes, that was a bath pun, sorry). I had moved my private obstetric practice to a new regional town and the hospital was well known for supporting water birth. As the first new obstetrician to start there in many years, there was no specific orientation program to water birth, so I was asked to complete the same process the midwives used. Namely, to complete a selection of readings, and attend a number (I think it was five?) water births under the supervision of an experienced midwife. (Shout out to @KelliZak who was there for number one!) I then had a debrief with the maternity unit manager and was signed off.
I still recall that debriefing conversation – I was asked what was the most important thing I had learned from the process. My answer was that water birth was just birth – only wetter. I meant this in the sense that everything I already knew and applied to my practice for vaginal birth out of water translated across to water birth. What I hadn’t yet learned was that facilitating water birth was about to change everything I thought I knew about vaginal birth…
What I learned
At first, I would don gloves up to my armpits, lean over the edge of the bath and get fairly hands on with the birth – just like I did outside the bath. After far too many experiences of dipping my breasts into the pool and having to go home wet-shirted, I figured I would try what I saw the midwives doing – not touching and letting the woman lift the baby from the water. Well that worked!
The next lesson was to learn to shut up during water births. I had been taught that I needed to coach women, telling them how to breathe, when to start and stop pushing, when to pant, or the baby would never appear. Turns out that wasn’t the case either. Instead, I said very little other than offering quiet encouragement for a job well done at the end of really productive pushes. Women still got their babies out, and honestly, it was nice to have some peace and quiet for everyone while it was happening.
And then I had the aha moment where I realised I could probably do this for births that were not happening in water too (with some necessary modifications when an epidural was in place as this messed with the biofeedback required for the woman to tell whether she was getting somewhere with pushes or not). And yes – that worked too! Many of the things I was doing (coaching, being hands on) were aimed at preventing perineal trauma, and it turned out that they were not actually needed after all.
Letting go of ego
The entry hallway to the maternity unit was filled with thank-you posters from women who had given birth (scrapbooking was HUGE at the time…). As I took a more hands off role at births I noticed that I wasn’t getting mentioned as often in these. Dr X and Dr Y still had lots of “oh I could never have done it without you!” praise, but that pretty much stopped for me. To be honest, I was a bit crestfallen. A certain amount of my ego was tied up in the idea that I was the one “conducting the delivery” and if it went well it was because I had done a good job. Now that I was taking a back seat, women were discovering they could give birth pretty much all on their own, and where did that leave me!?
That same maternity unit manager saw me looking at the posters one day and we talked about how I was worried that people weren’t naming me anymore. She very gently helped me see this as a good thing (yes – I am familiar with the quote many of you are thinking about, no need to share it with me!). There was a sense of grief for a while, as I let go of my ideas about what it meant to be a good obstetrician and worked to build up a new frame of reference. It made me a better obstetrician, but in a way that put me at odds with the majority of my peers – and that hasn’t always been a cosy place to inhabit.
So why might obstetricians be a bit bothered by water birth?
I was actively seeking to learn to facilitate water birth and am grateful for the learning experiences it offered me, but I can see why it might get under some obstetrician’s skin. First, you have to get through the getting damp phase – that uncomfortable period where you simply must acknowledge that you are NOT the expert in the room today. I suspect some will never allow themselves to be this vulnerable in front of the midwives they work with, or the women who seek their care.
Then you risk having everything you thought you knew about birth disappear down the plug hole. There is a strong professional identity tied up in the sense that you (the obstetrician) are in control of the birth process and of the outcome. It is a very powerful position – and the Foucault scholars among you know that power and pleasure are intimately linked. I derived pleasure from the sense that I was the one controlling the birth process, and felt disoriented when I gave it up.
Letting go of that power and knowledge is hard – and again, not all obstetricians will come willingly to this. I suspect that it is easier to cherry pick water birth research findings to find a reason to opt out, than it is to come sit by the edge of the bath, with the lights turned down, stay quiet, and watch the power of a woman giving birth without your coaching.
When I started learning water birth skills (or more precisely unlearning vaginal birth interventions!), I would hear comments from obstetricians about women not being dolphins and it not being “natural” or historical to give birth in the bath (the same is true for inductions or epidurals, but they seemed unconcerned by this). Or they would make arguments about babies drowning or having some other poor outcome – and there are now large wads of research showing this isn’t true. There was even the totally fictitious risk of water embolism being tossed about. (Read about that from Sara Wickham here.) I do wonder whether the more recent focus on water birth and perineal trauma is simply the next convenient excuse.
Join me again next week, as I explore more about water birth and perineal trauma.
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References
- When is CTG use in labour a good idea?
- Water birth and the perineum – what is all the fuss about? Part 3
Categories: Obstetrics, Reflections
Tags: Perineal trauma, water birth
Birth Small Talk 
Great account of your journey of enlightenment about birth Kirsten. I’m proud to have witnessed part of your awesome metamorphis. You’re an obstetric unicorn of the very best kind 😀 love your words and your work. Lois Wattis
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Thanks Lois xxx
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This!!!
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Was your experience similar?
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