#361 | Is Water Birth Dangerous? Barbara Harper Debunks Fallacies

Water birth has long been controversial, but more recently, a wave of claims has emerged from the natural birth community that water birth is dangerous for babies and disruptive to the physiologic process of birth. In this episode, we sit down with midwife Barbara Harper, the world's leading expert on water birth and founder of Waterbirth International, to explain the preponderance of evidence supporting the safety of water birth and to dispel circulating fallacies.

We talk about the idea that babies can aspirate water, whether the diving reflex can fail, and the claim that water immersion interferes with a mother’s ability to respond to her baby during birth. Barbara explains what actually initiates a baby’s first breath, how the transition from fetal to newborn circulation works, and why arguments that water immersion causes a disruption to physiology that compromises babies don't hold up when you truly understand the physiology.

 Join us for yet another educational and fascinating discussion with Barbara.

Catch our other episodes with Barbara here:

#200 | Physiologic Birth of the Placenta in Water, Optimal Cord Clamping and Preventing Postpartum Hemorrhage with Barbara Harper

#122 | Provider Green Lights: Interview with Barbara Harper on Holistic, Respectful & Supportive Birth Providers

#100 | The Benefits of Water Birth: Interview With Barbara Harper

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Transcript

I'm Cynthia Overgard, birth educator, advocate for informed consent, and postpartum support specialist. And I'm Trisha Ludwig, certified nurse midwife and international board certified lactation consultant. And this is the Down To Birth Show. Childbirth is something we're made to do. But how do we have our safest and most satisfying experience in today's medical culture? Let's dispel the myths and get down to birth.

Barbara Harper, the woman who needs no introduction, you are definitely a fan favorite on Down to Birth Show. Your three episodes with us have been wildly popular. Those were episodes 100, 122, and 200, so we missed the mark on episode 300. We’ve got to get you back for episode 400, whatever we do. But thank you so much for taking the time. You travel the world all the time, and we are so grateful whenever you make time for us. So thank you for being here.

Oh, it’s my great pleasure, Cynthia and Trisha, to revisit you. It’s my pleasure to listen to you all the time. You’re on my favorite podcast list, and I do like to check in. You have some interesting guests, so it’s always a pleasure to come back.

Thank you. Well, you’ve probably been hearing us chatting a little bit lately about some of the latest rigmarole around water birth, and I never really thought we would ever have to go back to defending water birth. It seemed like that was a thing of the past. We finally broke through in the natural birth community and got obstetricians around the world to understand that water birth is a beautiful option for women if they choose it. And now there is a backlash in the natural birth community. This is all coming from the natural birth community about the safety of water birth, and I want to just pick your brain about the various claims that are going around about basically water birth being dangerous and harmful to mothers and babies.

Oh my gosh. Let’s get down to water birth. Yes, ma’am. So what’s the first question that you want to cover?

Yeah, so let’s start, I think, with the one that’s probably the easiest to just quickly debunk, and that is that babies born in the water are at risk of aspirating water.

If they were at risk, let me just put out in front, we would not be doing water birth, end of story, because that was one of the things that we thought in the very beginning, and I’m talking about 40 years ago, to prove: that the ratio of babies that needed to be admitted to NICU for aspiration or respiratory distress, the fear was by the pediatric community that it was going to be very high. That was one of the risks that they labeled. And so if you were signing an informed consent, we had to put in all these hypothetical situations, and that was at the top, that every baby was going to aspirate. And so if we take a look at the 600 to 700 peer-reviewed articles in the literature, a couple of researchers around the world have looked at the statistical analysis and meta-analysis and systematic reviews of published articles with a focus on, are babies at risk? Is the risk higher? And there are now on my computer seven huge meta-analyses. And the two researchers that know the most are Jennifer Vanderlaan, who is a certified nurse midwife, MPH. I watched her career. She started as a doula, then went to nursing school, on to midwifery school, and she and I were close friends. She made it her business to do a master’s-level or a PhD-level analysis of the risk for babies in water birth. And she called me when she finished that study. It was published in 2018 with her study partner, Patricia Hall and Lewitt. I can’t remember her first name. It’s coming to me. Starts with A. J. Anyway, she called and she said, Barbara, you need to sit down. And I said, what? She said, we finished the meta-analysis, and there was this big pause. And I said, okay, well, tell me what you found. Well, we found that it’s better on every single marker, less NICU admissions, no aspirations, no higher level of care. So the seven studies that I’m referring to, and I can send you copies of all of them, they all focus on neonatal outcomes. So if there were bad outcomes, we would have seen it. And I’ve been attending water birth for 40 years, and in my own practice of about 1,200 births, not a single baby has ever attempted to take a breath while they’re under the water.

The other aspect, well, what is the physiology? What happens in a normal birth? Let’s talk about a bed birth, a squatting birth, a toilet birth, you know, the porcelain, self-cleansing birthing stool. As soon as the head is out, it sends a signal. Well, it receives stimulation from the atmosphere. You put it in an IG post yesterday, and you know this stuff because you’ve studied the literature and you’ve taken my classes before. You know, basically, and now we actually send people a 288-page workbook so that they can look at everything about this.

I was going to pull up, Barbara, that’s a beautiful workbook. You give that to the women who take your courses?

Oh my gosh.

Wow. That is gorgeous.

All my courses. And you see this picture right here? I’m going to let me make it.

Yeah, okay.

Now I can’t, yep, that’s good right there.

There she is, Doctor Judith Mercer. If we read one of her articles from 2002, not about water birth but about neonatal transitional physiology, what happens, what needs to happen, what causes the stimulation? Okay, baby’s face in a vertex position comes out. So if a hand came out, would the baby start breathing? No. If a butt comes out, would the baby start breathing? No. If two feet come out, would the baby start breathing? No. Only when the head and the full face comes into contact with the atmosphere of Spaceship Earth. And in that atmosphere is a high level of nitrogen and a very low level of carbon dioxide and a small level of oxygen. There’s also a few other chemicals in that, but that sends a signal to the brain that says, welcome, you’ve landed. Now you’ve got 10 minutes to switch from fetal circulation to newborn circulation.

In the lungs during pregnancy, during gestation, the lungs don’t get a lot of blood flow because the placenta is the lung. The placenta is the oxygen source.

Yes. You might just say something about that 10 minutes. So what you mean by saying that is, this is why we can’t hold a baby under the water for an indefinite period of time, because eventually this transition happens. Eventually the placenta separates anyway from the uterine wall, and the baby’s not going to get the oxygen anymore. Is that what you mean?

Yes. In 1987, I’d already given birth to two babies myself in water, and I had assisted 15 births by then in water and been on television shows and newspaper interviews. In 1987, somebody sends me a newspaper from Spokane, Washington, and it says baby drowns in backyard hot tub at birth. I showed it to, we were working on getting water birth started at a number of hospitals in the Portland, Oregon area, later in the 90s, but now I’m in Santa Barbara, California. I’m working with a bunch of home birth midwives, and we have doctors that absolutely refuse to even look at any literature, and there was very little at that point. So we had a discussion. We came together as midwives and said, well, of course the baby’s going to drown if you don’t bring it up. And I said, it can’t do that because even if you run completely out of oxygen, you have not switched from fetal circulation to newborn circulation. You must be in the atmosphere to do that.

Judith Mercer, and I’m going to quote her from her 2002 “Transitional Physiology of the Newborn,” respiration is dependent on the adequate flow of blood into the lung bed, and the flow of blood into the lung bed does not start until your face hits the air. And it doesn’t even start then. It’s a signal that changes the pH of the cerebrospinal fluid. It goes slightly acidotic, and we’re talking from 7 to 6.999, and it’s just this miracle, this incredible path of creation that allowed us now, if we’re going to go back 300,000 to a million years ago, to develop in the water as a species. And that’s covered in the workbook as well. It’s called the Aquatic Ape Theory, and Desmond Morris talked about it. I have a book. I’m going to grab a book.

I’ve got to interject with a question, though, on this before we move on.

Okay. There’s The Descent of Woman by Elaine Morgan.

Oh, you’ve told me to read that book, Barbara. Yeah, it’s like an anthropological book, isn’t it? It sounded very interesting. It’s somewhere on the list.

She was an anthropologist, and she didn’t wake up one day and say, oh, I think we had a couple million years where we evolved in the ocean. But Michel Odent talks about it. Frederick Leboyer talked about it. Desmond Morris in his book.

Barbara, can I ask a question to clarify on this point? Can I interject with a question here, please? So this is very interesting. I never thought about this or knew this before. I knew that from you. I knew that we have nitrogen receptors in the cheeks, so a baby will not take a breath until he or she touches air. It makes all the sense in the world that the lungs are not ready because they haven’t been exercised in that way before. So this 10-minute transition is very interesting. Here’s my question. What about all the babies who are born in a hospital bed and have immediate cord clamping so they’re not obtaining oxygen from the placenta as they’re supposed to for the next several minutes? What happens to those babies with the lungs not being totally ready at the very early part of that window? How do they breathe?

The lungs will take from the circulation. So let me back it up. Head is born. The switch begins. Click. Welcome to Spaceship Earth. By the time the shoulders are born, you should have had at least three minutes of perfusion.

Okay.

Okay. And this is why in a shoulder dystocia, where the head is out and the switch has happened, you get a line of demarcation because the blood pools in the head because the body is trapped.

Trisha, yes.

And so the baby who has a true shoulder dystocia comes out very purple in the head and very white in the body because the perfusion has begun, but it can’t reach the places because there’s no gravity with that perfusion. And so it becomes an emergency, so to speak. But I want to mention in just a moment that that’s why sticky shoulders, I usually call failure to wait, because of the placing reflex that moves the baby with its own feet. It pushes its way out of the introitus unless there is a manifestation of a pelvic insufficiency or pelvic floor insufficiency to allow the baby to emerge. And so in water birth, it actually becomes safer because none of that happens. I’ve seen a baby’s head hang on the perineum in the water for 15 minutes, and there’s no transfusion.

Let’s just reiterate that point. A baby who is at potential risk of sticky shoulders is actually going to transition better, be safer, be more protected by being born in the water than out of the water, because their face is not going to have that exposure to nitrogen, air, and gravity. Therefore they are still getting plenty of perfusion. Their lungs are not making that transition, and it gives you time. It gives you more time. So a shoulder dystocia is less risky, I guess is the word, if the baby and the mother are in the water than out of the water. If you just think about the physiology, it makes sense. I don’t really understand how you can argue with that, because also, when a woman is out of the water and in the bed, we’re more inclined to have our hands in there and pulling on the baby and doing things to actually maybe get the baby even more stuck.

Let’s look at the statement that I make, that it’s physiologically impossible to gasp. Okay? Because a gasp means that you have blood in the lungs, in the lung bed. What does that mean? It means that the capillaries that surround 50 million alveolar spaces, the alveoli, are these tiny, itsy-bitsy, microscopic cells that are completely encased in capillary venules, capillary arterioles, so veins and arteries, and they, Judith Mercer talks about it, they have to become erect, filled with blood, so that the fluid that is naturally in the lung cells can go through a somewhat permeable membrane and open up the space for oxygen-carbon dioxide exchange.

So the newborn needs, I want to go back to that question, well, what happens with a normal baby? Okay, we get a little sidetracked on shoulder dystocia, but the normal baby starts switching by the time their body’s born. Yes, you can actually leave the cord intact for another 60 to 90 seconds and have enough blood because you’ve just had a contraction between the head and the delivery of the body. The delivery of the body is with a contraction, and so you’ve got more perfusion now into the lung bed, and babies start switching, and it seems like it’s right away. So let’s look at the baby that’s under the water. Head is out. You wait for the next contraction, and that might be two minutes, that might be three minutes, that might be four minutes. And because you’ve been so culturally exposed to bad birthing practices on the bed, you suddenly go, oh my God, the baby’s going to try to breathe. Because we’ve all seen a baby whose head is hanging on the perineum on the bed sometimes start crying as it’s being born.

The newborn needs 55% of all of that blood that’s circulating in the whole body, in the cardiac circulation. The fetus only needs 8% in the lungs. So we have to go from 8% circulating in the cardiac output to 55% so that the newborn can breathe. Respiration is dependent on adequate blood in the lung bed. So the stimulation is not going to happen under the water. The stimulation is not going to happen from cold. Baby could be born in 60-degree water and it’s not going to gasp. It cannot gasp because the lung bed hasn’t been evacuated yet, and that can only come three ways. So the baby that has immediate cord clamping on the bed actually has had a head start, hopefully waiting for the next contraction, but if it’s extracted, pulled out, then it has less blood.

Let’s just look at what happens in a water birth. Remember, hands off. How did hands off develop? Because midwives didn’t like leaning over the tub and putting their long gloves on, and they thought, oh, if we touch the baby’s face while it’s under the water, it’s going to cause it to gasp. I heard those things in the 80s, the 90s, the 2000s, the 2010s, the 2020s.

That’s still a common belief.

It’s not true. So back to 1987, baby drowns in backyard hot tub. It was a home birth, a free birth, no prenatal care. They read one book by Sandra Ray, who was a rebirther, and I know her. I talked to her. I’ve taken some courses with her in the 80s. Her book was called Ideal Birth. There is no ideal birth. It’s a fallacy. A birth is a birth is a birth is birth. How do you get into your body? It has challenges. So they read this book that said the water is the most peaceful entrance for a baby. I’m not going to argue about that. It is, yes, it’s very peaceful, but peace is communicated through the mother’s brain and her chemicals. I don’t want to anthropomorphize our newborn because this baby, this fetus, who transitions is responding to chemical signals and what the mother is thinking, feeling, and behaving, what she’s experiencing. So if a mother begins her birth or goes into her pushing phase in trauma, and if any one person in the room goes into that birth thinking, oh my God, this is dangerous, it’s going to have an influence on how the baby responds because it’s chemical data, high cortisol levels, fear. This is what Cynthia and I do every time we teach a class. We help couples understand that the presence of fear is to be deterred, to be replaced with courage.

It’s as physiologic as any other component of birth. I think that’s what people really don’t understand.

Absolutely. From 21 weeks of pregnancy to the end of the third year is the fastest, most intense wiring of the neurological system of this new human being. So baby born in the hot tub, and it goes back to sleep. Nobody ever told this couple, and I know them today, okay? I know who they are and what happened, that they were accused of second-degree manslaughter. They were threatened with a court case. They caused the death of their baby. So what was the question? As midwives gathered, and we didn’t have the answer to this question until we got a copy of the autopsy report, because everybody said, well, of course the baby’s going to gasp if it runs out of oxygen when the placenta separates from the wall of the uterus. And I was shaking my head and said, I don’t think that’s possible.

So fast forward to 1995. This is ’87, so eight years later. I’m at the very first international water birth conference. I think we called it a congress. We had 1,500 people come, doctors, midwives, mostly midwives, pregnant parents. One of the lecturers was Dr. Paul Johnson from Oxford University. His 1996 article was based on his lecture at that conference, and I took some time with him separately and I told him about the 1987 case. Well, the autopsy report said lungs filled with fluid consistent with fetal life. The baby had passed away from a buildup of carbon dioxide. It had no way, after the placenta separated, to discharge the carbon dioxide.

Did they lift the baby out of the water quickly, or did they wait a long time?

Twenty-two minutes.

Oh my gosh. They just kept the baby underwater all that time.

Yes.

So to speak specifically to the physiology you were saying, the lungs were filled with carbon dioxide?

Yes. Well, the system, you have to discharge the carbon dioxide. The placenta takes the carbon dioxide and gets rid of it. Carbon dioxide is a byproduct of mitosis.

So this wasn’t oxygen deprivation, which is the whole argument. This was the baby’s inability to release what we must exhale.

Well, and it had no oxygen to feed its brain. Yes, there was oxygen deprivation, but it was a multilayered thing.

Right, because it went on 22 minutes. It would run out of oxygen by then, of course, with the detached placenta.

And this is the other misconception. Prior to birth, the fetal breathing movements of the diaphragm and the intercostal muscles stop at four centimeters of dilation. They slow down about 72 to 48 to 24 hours prior to labor beginning, and that is because of high prostaglandin E2 levels.

Prostaglandin E2 is a hormone. That’s the hormone that gets our cervix opening in labor.

And it affects the mother. It affects the baby. For the baby, it slows the movements because you don’t want a baby moving. What’s the biggest movement? It’s 40% of the time in utero, the expansion and contraction of the intercostal muscles and the movement of the diaphragm. If you read Kelly Germaine in her book on the lungs, she’s one of the top physiologists. But the book that informs me the most about the hormones of birth, besides Sarah Buckley with her focus on oxytocin, endorphins, adrenaline, and prolactin, there’s actually 33 hormones at work, and that is the work of Peter Nathanielsz. His first book was A Time to Be Born, and he integrated that into a bigger book called Life Before Birth. Peter Nathanielsz with a z. He was a physiologist. Oh my God. He’s written so many articles at Columbia, who’s now, I think, in Montana at a university in Montana. He talks about the high prostaglandin levels doing those jobs of slowing the baby’s movement.

Why do we want to slow the movements? Because movement is aerobic. It demands oxygen. So the baby has to slow down its movements to follow the neurobiological programming to get out. The baby is programmed. And yes, I have seen bed births, water births, floor births where the mother was in a complete state of what we would call in yoga terms samadhi. I’ve seen an unconscious mother give birth in the hospital, in the intensive care unit. The baby knows how to emerge. We put all of these barriers, like locking a woman into a supine position. So that’s a whole other thing. But babies have this ability.

Yes, I just want to ask one question, going back to the gasping situation. I want to make one point and ask one question. One of the concerns is that the diving reflex will fail, that the baby will gasp. You just explained in that whole scenario with the hot tub why that baby under the water for 22 minutes didn’t gasp. Gasping is not why the baby had fluid in the lungs. Now, the diving reflex does not exist. They can’t gasp. It can’t fail because it doesn’t exist. It actually doesn’t exist until the baby makes this first transition. So the diving reflex is only intact after a baby is born. If you were to put a baby back under the water, the diving reflex would activate in that situation.

You need different, you have to have initiated breathing, the exchange of oxygen and carbon dioxide, and have a baby that is fully integrated into its newborn body for a dive reflex. I’ve seen this work because back in Portland, we rented a space. We had prenatal aquatic classes for women, and we had baby swim, up to 75 babies in our baby swim program for years. None of those babies, our youngest one was 24 hours old, our oldest babies were between four and five, and all of them had intact dive reflexes, which means if you even put water on top of the baby’s head, they’re going to go—

If you just put it in their face, they don’t even have to go under the water. If you just put it on their face, they go and hold their breath. So the question is, what do you think that mothers, doulas, and even midwives are seeing and being concerned about when they say I saw a baby breathe underwater? I saw a baby go to the NICU. My baby had respiratory problems or whatever because they took a breath underwater. Are they simply seeing a mouthing movement and assuming it’s a gasp?

Babies make faces. There’s also something called the neurosomatic reflex. A neurosomatic reflex can happen out of the water, in the water. When it happens in the water, it looks like this. Okay, you ready? I’m going to scoot back here a little bit.

Really hope everyone’s watching this on YouTube.

Yeah, yeah. Like a startle reflex.

It looks like a startle reflex, but it’s not. It’s called neurosomatic integration. It’s like, oh my God, I’m in a body. It’s part of the neurology of birth to express that reflex. Right after that reflex, then the baby starts moving contralaterally.

This is exactly what happened to me with my first water birth. My second was born underwater. Her head came out, her body came out, her mouth wide open, and the hands flailed. My first thought, even though I was a midwife and I believed in water birth, my first thought was, oh my God, my baby’s trying to breathe. So I brought her up to the surface, and of course she was perfectly fine. She wasn’t breathing. She was doing exactly what you were describing.

It was explained to me by osteopathic doctors at Life University, chiropractic and osteopathic, when I came there to teach and I showed a film that was done in ’95 from H. Serruys Hospital in Ostend, Belgium, with the famous Dr. Herman Ponette. Herman Ponette has probably, in his career alone, just him, facilitated 30,000 water births, including about 3,000 breeches in water. So with somebody that I practice with, and I’ve visited the hospital several times, they have a prenatal aquatic program. They have an after-birth infant swim program and water birth. Any woman walking through the door can choose to birth in water. They even put in a swimming pool in the birthing suite, a swimming pool, so they can swim and labor in the water. And when they feel like they have to push, they get out and get in the small birthing pool.

So you can see why some mothers or midwives even, or doulas, would say when a baby is born and it’s compromised, it has low Apgars, it has some other issue, it needs to be transferred for a different reason, not the water, if they see that baby making that mouthing movement and the baby is compromised already for some other reason in labor, which we know those things can happen. It’s not because they were in the water. It’s not because they gasped, but they’re making that association.

Yes, and I want to talk about Apgars. The traditional Apgar that Virginia Apgar created was to evaluate babies who were born in the 1950s. Her article came out and was published in 1953, the year after I was born. She said, evidence of breathing or vigorous crying. So when I make a statement that crying is not necessary, it blows people’s minds, right?

Or when they watch a birth where their baby isn’t crying, it makes people very uncomfortable. They think something is wrong with the baby. I always say, listen, the baby needs to be obtaining oxygen. The baby doesn’t need to be crying to be doing that.

People are extremely fearful.

Not to mention, if we could just rewind 40, 50 years, Barbara, it was the norm to actually hit a baby to make them cry, a perfectly normal, healthy baby with good color who was breathing. Hit them like, oh, phew, the baby is crying now. I mean, the things that a society will start to believe, and that’s what’s so concerning. You have all the research in the world to defend these accusations against water birthing, but it almost doesn’t matter. We see all kinds of, from political rhetoric to medical rhetoric, there’s rhetoric within every field. You must have seen this happen in waves since you founded Waterbirth International in the 80s. I bet you’ve seen waves of movements against water birthing that get strong and then they get squashed, and then they get strong with a new generation and then they get squashed.

Yes. I’ve heard, if we were meant to give birth with water, we’d have gills. We would have different physiology. You will have water birth at this hospital over my dead body.

I think this is an interesting time, though, because now it is really actually coming from believers in physiologic birth. This is coming from women who strongly, so strongly, believe in physiologic birth, which is what we believe in, that their argument is that water birth is actually disruptive to physiology, that water hinders physiology.

Let me finish with the Apgar because when I teach, I’m going to be teaching in Boston next weekend at Cambridge Health Alliance Birth Center, which is connected to Harvard Medical School. I am completely thrilled that their director of OB from Harvard is coming to the workshop, okay? Because when you explain it step by step by step, that the baby that’s born on the bed, as I said previously, its head is exposed until the next contraction, which births the shoulders. Typically that’s one minute, two minutes, three minutes, whatever. So you’ve got that transition already happening. The baby that’s born in water is behind three minutes, right?

Right, meaning it has that much more time.

We bring it, okay? And this is what I teach, okay? Baby propels itself into the water. Yes, you can put your hands there, poised and ready to assist. Bring the baby slowly up so you don’t snap a cord because we don’t know how long the cord is. You can be there, or you can not. You can be observing this and then put your hands down and assist. Or the mother can assist or do whatever, and baby goes into the sanctuary of her chest, and that is when the clock begins.

So how long do I teach to observe the baby? I want you to observe the baby in the water while you take a deep breath, five seconds in, five seconds out. Baby’s just in the water, and they will do their neurosomatic integration. They’ll start moving their limbs, and they’ll open their eyes and blink. If they do all of those things and their heart rate is already over 100 and ascending, and you can take a quick heart rate at the insertion site of the umbilical cord on their body, and you know what a good heart rate feels like, but um but um but um but um but um but um, yeah. So if you have open eyes, physical movement, you’ve seen reflexes, and you have a good heart rate, you already have an eight. That’s a good baby.

But if your baby is born with a low heart rate, under 100, by 60, the baby’s no longer being perfused. So if you’re not listening to heart tones in a free birth, you don’t know what your baby’s doing. You have no idea. Believe me, I’ve been to plenty of births where we had a good baby, a second stage began, and we just didn’t listen to heart tones the rest of the way. But there’s some decision-making that happens and influences you. It’s not that the baby’s going to be influenced with a low heart rate, but that baby already has two points off of its Apgar. And then you get a baby born with its eyes open, not blinking, just blank and limp. I have to know, how long was the baby in the introitus? How long did this labor take? What was the mother thinking? How was she responding? Does she want to be a mother? All of those things matter. That influences postpartum hemorrhage as well.

Okay, so here is where the argument from the free birth community comes in and says if that mother had been on land, out of the water, she would have been more responsive to her baby. She would have had more communication between her body and her baby. That water is so calming, and maybe we need to stop calling water birth nature’s epidural, because now they’re basically saying that it’s as potent and powerful as an epidural, which is just completely nonsense because they work nowhere in the same hemisphere of physiologic impact. The argument is that water is causing the mother to, it’s such a good pain reliever that if a woman is not feeling the full intensity of the pain of birth and the intensity of birth, she is numbing down her communication between her body and her baby, and she’s going to miss the cues that her baby might need help, and that the water is therefore causing compromised babies.

I’m sorry. It is so ridiculous. Okay, I hate to hear that a woman felt that way, right, that she had that much trauma, and I just want to give her a hug and listen to her story. I want to hear her remarks. I want to know what happened, how scared she was. It’s just simply not true.

It’s natural to look for something to pinpoint, a problem, when you have a problem in birth. And this is why I’ve become so sort of activated around this topic, because I hear that women are having these experiences, and when a woman is having a bad birth experience or a bad birth outcome for herself or her baby, we have to listen to why that is. But to blame it on water immersion and to claim that the water is causing a dangerous change in a woman’s physiology and a dangerous change in her ability to be attuned to her body through suppressing the stress hormones or suppressing communication or blocking her oxytocin, I mean, the claim is that it suppresses oxytocin, prolongs labor, and babies are in the womb for too long becoming compromised, all from water immersion, and I just cannot see any evidence of this being true.

I don’t want to use inflammatory comments, but it’s nonsense, especially when I look back at 30,000 doctors, midwives, doulas who have taken my courses in 83 countries. We started water birth everywhere, and some of those births, I mean, I’ve been a home birth midwife for 39 years, and many of those births were free births just with me.

I just have to say also the whole argument about how, I mean, first of all, they’re speaking in rhetoric. You’re speaking in fact, science, research publications, meta-analyses. But their whole thing is like, well, the water is so, the problem with water is it’s so relaxing. It removes so much pain. It’s like, really? If it were that magical at reducing or eliminating the sensations of birth, everyone would be clamoring to have a water birth, even with the risk of the baby taking a breath, if that were possible. Give me a break. I mean, you can’t just say a woman gets in water and doesn’t feel birth. I had both of my babies in water. They did not prolong my labors, I’m sure, because my entire labors from the first second I suspected I was in labor till I was holding my babies was three hours in my first birth, five and a half in my second. So if that was my prolonged version of birth, I’d like to know what my birth would have been outside of water. But I also had wildly intense labors. So I mean, I was very, very vocal when I was birthing my babies out, and it was very, very intense. It took all the concentration and techniques in the world to keep myself calm, and the water was blissful and wonderful. But give me a break. If these are the legs that they’re trying to build this fallacy on, rather than just addressing the research or even discussing it.

And Cynthia, we get the same response from hypnosis, HypnoBirthing, because I’ve seen the woman lie down on the bed and not blink an eye, not move a single muscle except her diaphragm and her uterus. She does one push, and the baby crawls out.

And also, I just want to address Trisha’s comment about these being women or accounts who believe in physiologic birth. Trisha was saying how we believe in physiologic birth. Physiologic birth isn’t something to believe in or not to believe in. It just is. It is this. It is biology. It is the science of the universe. It’s not to believe in physiologic birth like you might, do you opt for physiologic birth? Sure. But this, it is. This is the fact. So it’s not right for people who are countering reality to say we believe in physiologic birth and here’s why not to have a water birth. It doesn’t matter what they think they believe in because their beliefs about water birth are wrong too. They either are informed on physiologic birth, or they’re not, and they’re not informed on physiologic water birth.

I want to talk about Abby’s mother, who was one of my clients that came into the birth center for a birth, April 27, 2023. Baby. She arrives at four o’clock in the morning. We had to do bed checks just to see where women were before admission. She was four. We lied and said she was five, okay, because it’s a third baby and she’s going to progress quickly, and I have the tub ready for her. She got into the pool, stretched out because she was short, and the pool was perfect for her. I used a noodle under her and a pool float behind her head. She was completely suspended. She didn’t blink an eye for four hours. She just was suspended, and her husband held that pool float under her head the whole four hours. The next day he was shaking, but at 8:03 in the morning, she opened her eyes and immediately changed positions with one knee down, one foot down into the proposal position and went, and the baby came out. She responded completely to the movements of her baby, and she felt the passage. She felt the baby moving down. I could time the contractions just looking at her belly. And when I asked her the next day postpartum, how long do you think you were in the water before the baby was born, she said, well, I know what time we left the house, but I don’t have any conception of time after that. I’d have to say it was about 15 minutes.

That is the power of the mind in the water. That is the power of connection. The water doesn’t diminish. The water increases your connection. The water amplifies your connection with your baby. You can feel the movements much more instinctively. You can respond beautifully as the baby’s moving through the pelvis. What I see women do is they move their bodies in a mirror of reflection. So if the baby is extending, they extend. If the baby is in flexion, they flex. So I’ve had just the opposite, watching 1,200-plus women and my own experience as well, and then teaching and viewing births in hospitals all over the world that have reduced their cesarean rates because they’ve increased their water birth rates.

I mean, if this were true, water birth wouldn’t work. You would always be getting women out of the water. We would be seeing fetal heart rate decelerations in the water if it were causing decreased placental perfusion and slowed labors. I mean, it just wouldn’t work. And there are just so many data points that show how well it actually works, in addition to the thousands of anecdotal reports.

Yeah, there’s absolutely no oxygen deprivation from this.

Barbara, what do you think our providers’ historical opposition to supporting women to birth their babies actually into the water, meaning before this particularly recent trend of all this rhetoric, and we’ve, by the way, heard, seen the same trend with delayed cord clamping. Oh, I’ve seen a baby that gets too much blood and they have to drain it out. Or, oh, you really want a baby to only get 30 to 40 seconds, that’s about optimal, then we need to clamp. Or, oh, you have to be careful. Don’t hold the baby up because the blood will flow right back into the placenta. I mean, utter nonsense that has been completely disproved by research. The same exact sort of situation. But before this recent trend that’s spreading all this bad information around water birthing, Barbara, how come it has been the norm in so many places to say, oh sure, you can labor in the tub, but we’re going to need to get you out when the baby is coming out? And for many years, I never heard any rationale. What do you think is the real reason they want women getting out? Is it for their own convenience? What’s the problem?

All hospital protocols. I wrote it in my first book, Gentle Birth Choices. I said the hospital comes with a rule book that they never share with anybody. But these are the protocols. You get into a routine. I do believe that nobody wakes up in the morning before they go to work in any hospital in any country, any state in the US, and while the doctor is shaving or the midwife’s putting on makeup, they don’t say, oh, I can’t wait to go to the hospital to torture people today and obey all of the rules, because the rules become more important. The protocol becomes more important because by creating that protocol, it has this guise of safety.

I was at a board meeting in a hospital in Brooklyn, Long Island, and the risk manager was there, and she says, well, you know, she’s looking, I’ve looked over the protocol, and my only question for you is, how many babies have died because of water birth? I said none in the hospital situations, none around the world, none. And she said, well, how many cases of injury? I said, well, there have been babies born with cerebral palsy in water. There have been babies born with a shoulder dystocia where the clavicle is broken or whatever. It’s just like any bed birth. And she said to me, and I was in shock, she said, well, I’d rather see dead babies than injured babies because it’s less expensive.

No. Yeah, yeah. And you just said you don’t think anyone in the world is getting up and saying I’m here to torture women, but you are saying there are heartless, wrong people out there. You can’t deny that. I mean, that’s absolutely psychotic. What is risk?

The risk is defined by whether or not the hospital is going to get sued.

Okay, but when I was asking about why so many places have been opposed to supporting women birthing in water, even if they have tubs and support laboring in water, I still don’t understand. Are they just not trained in bending over and getting on their gloves? Is it that they just want that same old supine, put your legs up? I guess it’s the same reason they don’t want women on their hands and knees on a bed, which is perfectly reasonable, but women are not given that option. Is it just that? They just want to get into their little routine of how they do things and they don’t like it. Get on the bed, lean back. Is that it?

Birth is not black and white, and they wanted black and white. They want to eliminate any possible risk. That’s the reason.

I think you’re giving credit where it’s not due, Barbara. If a woman wants to give birth on her hands and knees, you can’t convince me that they actually believe there’s more risk there. I mean, they surely must know the first little bit of research that it’s safer.

They have less ability to control it that way.

That’s what I think. I think they want what they’ve learned to do, the position they stand in. They know that women should be able to be in a squatting position. But how many providers say no, no, no, I’m going to need you to lean back.

So the very first time I walked into a birth room as a maternity nurse, okay, this was back in the 80s. I walked into a birth room with a client. She was fully, she was ready to push. In the car ride on the way to the hospital, she was in the back seat on her hands and knees, just going back and forth and back and forth with every contraction. My hand was on her sacrum, and her water did break. I was completely soaked. As I walked into the hospital, she climbed up on the bed and stayed in that position, and a female physician walked in and said just this: get her on her back, to everybody that was in the room. There were two nurses and myself, and I was with the woman. I whispered in her ear, do not move. Do not cooperate. And the doctor looked at me and went—

So you gestured that they pointed to the door and said get out, get out.

I gestured that they pointed to the door, and the doctor followed me, and she went, how do you expect me to deliver a baby?

Oh, well, you’re not the one delivering a baby today.

And I said, it’s exactly the same. It’s just upside down. If you need me to guide you, I will guide you. And she let me walk back in. We walked in together. The mother stayed in that position, hands and knees, rocking back and forth, pelvic tilt, going beautifully. Baby crowned. She caught the baby and had it there. Of course, she cut the cord right away, and the nursery nurse took the baby because that was what everybody did in those days. The mother turned over, and that doctor refused to do supine births for the next full year.

You mean every single mother was on her hands and knees going forward? She encouraged women to get—

On her hands and knees. That doctor was convinced, like, oh my God, this is the best thing since sliced bread. You know, I’m going to do this for everybody. It just takes—

Okay, let me explain also that as I’ve lectured in dozens and dozens and dozens of medical schools, I’m thinking about a medical school in India, and I’m talking about delayed cord clamping. I’m talking about no episiotomy. It’s 100% episiotomy for all first-time mothers, most of the places around the world still. And I’m lecturing on this. The class was mandatory for 250 medical students, and a hand goes up and says, thank you, ma’am, but how can we go against our professors who have taught us how to deliver babies, which includes an episiotomy, which includes washing the vagina inside and out? How can we go against our professors? And I said, good question. Suggest a randomized controlled trial and that you’ll do all the work. You’ll keep track of the statistics, but put the professor’s name on it. He’ll be famous. And I got a clap with that, you know, and the director of the medical school came over and put his arm around me and said, if Barbara Harper tells us that this is what we should do, this is what we should do, so go talk to everybody in the hospital. No more episiotomies, no more cord clamping. Scion Medical School changed their practices.

It takes somebody standing up. We need the magical mystery birth revolution tour. Every hospital in every country and every city needs the birth revolution.

Thank you for joining us at the Down To Birth Show. You can reach us @downtobirthshow on Instagram or email us at Contact@DownToBirthShow.com. All of Cynthia’s classes and Trisha’s breastfeeding services are offered live online, serving women and couples everywhere. Please remember this information is made available to you for educational and informational purposes only. It is in no way a substitute for medical advice. For our full disclaimer visit downtobirthshow.com/disclaimer. Thanks for tuning in, and as always, hear everyone and listen to yourself.