#100 | The Benefits of Water Birth: An Interview Expert Barbara Harper of Waterbirth International

There are several names for birthing and water, and one is the great Liberator. It frees you, it frees you in movement, it frees you in spirit, just getting into water changes your brainwaves into a state of state. And if you don't have a tub in the hospital, then bring a bubbly little fountain and plug it in, because just hearing the water is going to give you oxytocin.

I'm Cynthia Overgard, owner of HypnoBirthing of Connecticut, childbirth advocate 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 Podcast. 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, we are so excited and honored to have you on the down to earth show today. And as you know, Cynthia and I are both big fans of water, burger three, both each had to waterbirth ourselves. And we're always talking about the benefits of waterbirth. But we know that many providers and parents are concerned about the risks around waterbirth have fears around it have a lot of misunderstandings around it. So we can't wait to hear what you have to say to help everybody understand the beauty of waterbirth.

Well, I'm excited to be present with such enthusiasts about everything about water. And I love your show your podcast. And so it's a great honor for me to share this space with you. I started investigating water birth in 1983. I was working as an RN with a pediatric specialty. I was working in a clinic in Santa Barbara, California. And a woman who was pregnant came in with her an older child. And she I just asked her where are you going to have your babies thinking that she was going to say one of the two hospitals. And we were going to chat about that. And she said I'm going to have home birth. And I'm I'm going to be the first person to have a water birth. And I was like What's that? Tell me? Tell me about it. Okay, now it was 1983. And she pulled out of her backpack, a scientific journal called the National Enquirer. And it has pictures of women in glass tanks in Russia, with the umbilical cord still attached and babies swimming between their legs. And I looked at that I was already a mother. I had a three year old and I had divorced the husband that was attached to that three year old and said I'm never going to have another baby because I even though I worked in the hospital where I gave birth, not in labor and delivery. I was critical care. But that's a whole nother story. But I was tortured. I was it was a my baby was taken away from me for 15 hours, just because the pediatrician was on vacation. And they won't they would not let the mothers hold their babies or season until the pediatrician signed off. That was that was 1978. And so I have four not have any more babies. But when I saw those pictures, I took it home to my then fiance. And I said he'd been begging me for a baby. And I said no, but if we could investigate this, and just make sure it's safe. I would consider it and so that started the whole thing and long story short that that baby was born in water in a kiddie pool that I had purchased for this woman. I just I kind of came in and said after doing some research I think this is a good idea. And so I, I provided everything for her birth. But then the night that the baby was born, I couldn't go there because I was afraid I would lose my nursing license. California was very tough on nurses who attended home birth. And so I stayed home. And my husband and I distracted ourselves by getting pregnant that night. I can't think of a better distraction. Equipment either. So a person this is before binge watching was the thing, right? Yeah, well, we didn't have television in those days. But literally, my son and her son are exactly nine months apart. 

I gave my first professional workshop to doctors and nurses met direct entry midwives in California, about a month after my waterbirth in 1984. And to backup the information, I have actually gone to France and studied with Frederic laboy, yay, had been in touch with Michel Adar. I didn't meet him until 85. And we became very good friends. And I've been to now 75 countries to teach about waterbirth to provide certification and credentialing to providers. As well as when I first started, I was exactly like you, Cynthia, I started teaching right away and, and I would hold seminars and classes and so speech for the internet. And I started a nonprofit organization called waterbirth, international and 1988. And our mission has never changed. We ensure that waterbirth is an available option for all women in all birth settings, period, end of story. And so I'm very happy to continue teaching in hospitals, medical schools everywhere in the world, and COVID put a put a big dent in my my travel schedule. I went from 19 countries in 2019 83 flights, and 177,000 air miles in one year. I've been in 40 cities in China alone. And I was I was scheduled to leave my home February 2020. To go to China and then Vietnam to get program started in different hospitals in Asia. One day I had my tickets and the next day they were all canceled. So I like you started teaching on zoom, but not until about until about June. I'm happy to report right now that professional certifications of midwives and doctors have passed 20,000 in my classes, and that was before COVID. And now I'm teaching almost every single day. And it's a certification and education for the nurses and any doulas that come in for the hospital. And this is a small rural hospital in Wisconsin that wanted to get waterbirth started prior to COVID. And, and now they can do it. We give the hospital's protocols informed consent inclusion criteria exclusion criteria, we we do exactly what a cog wants hospitals to do. And that's to educate the staff on what to do in emergencies and educate the public on what the risks and the benefits truly are. And so my website@waterbirth.org has a big flow of traffic from all over the world. I get invitations every single day to friends seminars and education for both parents and providers. We provide so much free stuff. It's incredible. So if somebody doesn't know that they could actually have a water birth in an American Hospital, Canadian, Mexican Argentinian Chilean anywhere and all of North or South America, we can we can tell you how to do it.

So you're saying if a woman is planning to birth in New York City and none of those hospitals to my knowledge do support water birthing Are you saying the woman can say, this is my plan? This is my intention and waterbirth International will somehow support her and provide her with resources.

Do we have a magic wand? How does it work? If they call, if they call before they get pregnant, we have a much better chance hospitals. We were up to 150 hospitals in the US that offer waterbirth. Okay, out of our 3000 if you go to the UK, they have 275 hospitals in the whole NHS system. Guess how many have cubs? 

Let me ask you this, if you had to answer in a word, or a phrase. Why has there been opposition? ignorance? Yeah. And resistance to change.

Several years, I went to a cog and ran continuous waterbirth videos. And doctors, especially students, physicians, were clamoring to come in and watch and they would stand there and they would cry. And over 1000 booths were there. And mine was always 20 people deep, there was a passion. In positions they discovered while they were watching the waterbirth videos, medical students are robbed of a whole education. They're just robbed of it. I know a woman who gave birth using HypnoBirthing to twins in a local hospital here. And 22 medical staff ended up in the room witnessing her birth. And I always tell my clients, you can just kick them right out. You don't have to give them the education they should have received in medical school. But it's pretty remarkable to me that a doula can't obtain her certification without attending at least three natural births. Yet a doctor a doctor who's the quote, expert in the industry can end up with their degree without witnessing any the look on their faces. Well, I'm showing films of normal birth. It's as if they'd never seen it before. They have never seen it before. It's like oh, wow, that's actually not one. The place where normal physiologic birth is respected, is where midwifery has had a foothold for two centuries.

Barbara, can you please get into the benefits of water birthing.

There are several names for birthing and water and one is the great Liberator. It frees you. It frees you in movement. It frees you in spirit, just getting into water changes your brainwaves into a theta state, which is the most receptive state that we use in hypnosis. I'm a certified hypnosis teacher as well, and it diminishes the receptivity to pain. It changes your brainwaves. Dr. Wallace J. Nichols is a marine biologist and his book blew mind how being near on in our underwater changes your brain and gives you peace, calm and relaxation. Water liberates your movement. Water increases your intimacy, your intimacy with your body, your intimacy with your baby, your intimacy with your partner who is ever there with you. It creates profound relaxation, and it has a physiologic benefit of pressing on your body. It's called hydrostatic pressure at presses. This is why you need a deep tub. You need 45 centimeters of water which is equal to 18 inches and that covers your belly. And if you want the whole benefit physiologically emotionally and spiritually of of water, you're going to get into a deeper tub, a 13 inch tub. Sure you can have you can birth your baby in a puddle. But it's not going to give you the whole physiologic benefit and the benefits that we have seen and that you've both experienced our immediate and uninterrupted skin to skin contact with your baby. And on necessity, which is also a benefit is delayed cord clamping because the the way the lungs transition from being supported by the placenta to being an exchange of oxygen and carbon dioxide It is dependent on the transfusion from the placenta. The baby cannot take a breath while it is suspended in the water head out, waiting for the next contraction. That is the I think the biggest fear that people have is that the baby is and we get this question all the time, that is my baby gonna breathe underwater. So, okay, if every baby were born in an intact amniotic sac, that's the original waterbirth because the physiology of that does not change as the baby comes out of the vagina. We have this whole misconception that as the baby's coming through the vagina, squeezes out the fluid from the lungs, and changes the pressure. And as the baby comes out, the baby goes, ah, and inhales and that is so wrong. And I tell every doctor that I work with, please erase that. And all we have to do is go back and look at the physiology of newborn breathing.

So how to how does it work? If because we know in a surgical birth, the babies aren't born with fluid, filling their lungs, it doesn't have to get squeezed out through the vagina, how how does it work? How does the water get out of the lungs? And what does cause the first breath,
the placenta is the key element here. The first thing that happens when a baby comes out of the water and comes into the atmosphere. As if you remember, the the first home alone movie, Macaulay Culkin looks in the mirror and goes like that, okay, this has has chemo receptors innervation, the fifth cranial nerve, and it senses the presence of nitrogen in the atmosphere, you have nitrogen receptors. And we thought it was all about oxygen. But it's not. It's about nitrogen. And it's about gravity 14.7 pounds per square inch, and that signal goes to the brain and says lower your pH goes slightly acidotic which sends a signal to the whole system, the cardiac system to close the chanson the heart, cut off the valve going back to the placenta and flood the lungs 8% of cardiac output in the fetus goes to the lungs. To be able to have your first respiration, you need to increase that to 55%. So blood comes into the lungs bed. And every single of the life babies have newborns have 50 million cells of via live and they're in case by capillaries, there's pulmonary venules, pulmonary arterioles, and they all get in gorged with blood. And they literally squeezed the fluids into the bloodstream.

So what people really need to understand is, as long as that baby's face and head are underwater, and there's no exposure to gravity and nitrogen, none of these things are going to occur so they can sit at the peronism for as long as they need to, with their head out under the water without breathing until the shoulders are born. 

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So the head is out. And that's when placental transfusion is happening for a normal vaginal birth. For the water baby and the breech baby. It doesn't happen until their whole person is out. And so are our scores on water. Babies are a little bit lower, not not drastic, great, but you might have a seven. As opposed to an eight, you might have a six as opposed to a seven, because there's not as much color. There's still dusky. But my my good friend, Cornelia ma from Germany created an aquatic app.

That's what's needed. because by definition, one component of the app Gar is going to have to do with what is impacted by air circulation breathing, there should be a water version of it.

Yeah. So it's because it's different. It is, the To me, the goal of using water, water assisted labor is comfort, peace and profound relaxation. And if you get to expulsion, and it happens in the water, that's a wonderful consequence. And you need to know how that baby looks different from a baby That's born on the bed. And that's, that's, that's the main part of my certification and credentialing as to make those decisions around your use of the water. because water is not the problem. The problem is people that are making bad decisions, because the the placental transfusion provides an increase of anywhere from 40 milliliters to 100 milliliters of blood. And in utero, the baby didn't need circulation in his skin. That's why all babies are born, white or dusky. Okay, the capillaries have to fill and the capillaries in the lungs didn't need it. And it caused a high pulmonary pressure. And so nothing can go in the baby cannot get things into the lungs. The temperature of the water has to be between 92 and 95. And no hotter than 99. skin temperature is 95 or 90 to 95. We want it we want the water temperature to be ambient. Not too hot, not too cold. But on a cold on a hot day in the Yucatan and a home birth that has no air conditioning. Can you birth in 78 degree water? And the answer is yes, absolutely. It's not a harm to the baby. Because that is not going to stimulate a breath. There's only one thing that stimulates a breath. And that's nitrogen receptors in the face. So yes, the wahaca Indians burst in in cold water. The the there's Indians in the highlands of Panama that have always birthed in the streams and they call it the lazy way to give birth to a mountain streams. And so when can you get in the water? Anytime you fucking want to? I did not see that coming. Just as an aside, I've been in touch with people that the CDC for 25 years because I before I started manufacturing birthing pools in the old days. I wanted to make sure that we we taught people how to clean them well. I invented miners, miners for tubs if you bays in if your shower in it, it's good to birth in it and don't do VADs exams through the water. Okay, especially if your membranes ruptured. And if our membranes have been ruptured for eight hours, 24 hours, 36 hours, 72 hours, five weeks, she can still have a waterbirth.

Why not do vaginal examsin the water?

Okay, vaginal exams are useless. Anyway, it's more position and station than it is dilation. The Royal College of midwives suggest that you have one saj exam and you get permission for that and and if the woman refuses, so, I have attended hundreds of births without any batch exams, because the birth not over until the baby's in the sanctuary as we just discussed this in our March q&a episode, how important consent is how they're not necessary. My own friend and mentor Nancy Waner, by practice, doesn't give vaginal exams. She will if she needs to, if there has to be some head adjusting. But she's been at birth where she wouldn't dream of it. And when I asked her why, she said because in birth Cynthia everything is meant to go down and out and nothing is meant to go up and in.

Exactly. And and Okay, just just picture this, your membranes, your ruptured your midwife puts on a sterile gloves and goes through the dirty water and into your vagina and into your cervix. Right. No, thank you. Okay. So it's so much for that sterile glove sold? Surely, no more convincing necessary? Let me ask you a question. The most common question I get asked about waterbirth is, and you've made, you've made many references to the wonderful relaxation, what do you tell people when they say what if I relax so much? It slows my labor? Is there something to that possibility? And what do you say about that, in my own experience, I'll, I'll use water for prodromal labor, go in, take a bath. And you'll either stop, or you'll kick in labor happens between your ears, not your legs. Your body's gonna do what it's supposed to do. And what I have found the water did its job, which is profound relaxation. And profound relaxation is not a concern that the labor is going to stop, in my experience, it kicks it into full gear. And that's because of the hormonal flow, you get much more oxytocin and if you don't have a tub in the hospital, then bring a bubbly little fountain and plug it in. Because just hearing the water is going to give you oxytocin get into the shower, it's going to stimulate your see a ferret fibers.

Yeah, that was my question. What about women birthing in a place where they don't have access to a tub? To what extent is a shower going to benefit them?

It's going to produce more oxytocin and with oxytocin come endorphins and with endorphins come adrenaline and prolactin, there's a there's an endorphin that's responsible for the prolactin. So you're going to have better breastfeeding. And a few of the studies we see that we get we result in 100% breastfeeding rate for those mothers, and probably because they're educated and self selective. But also, as you said earlier, in the episode, it's mandatory skin to skin after waterbirth. It's there is no other option.

Exactly. And also, when you compare babies born on the bed with babies born in the water, when you do retrospective analysis, you'll see that your three minute app or your five minute app gart of the water babies are always better than the best babies. Why? Because the best babies gets immediate cord clamping remains desires to be comfortable in labor is reasonable. And there are only two things that I've seen that provide unmedicated, profound relaxation and that's hypnosis and water. And making money is going to bless a memory said it's a perfect marriage. And it is and by examining your own fears, and facing them and creating that space for this baby, because the baby is the driver of the experience. It's the baby's birth, your this vehicle and the more you're relaxed the easier it is a calm woman. A calm birthing person gives birth to a calm baby and water is a miracle.

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And so if you want the baby to move, move the mother and he wants the baby to move moves the mother if the baby looks get the mother upper changed positions, have her shake her pelvis around and we go up and down.