question: How do babies not drown during water birth?
comment: They’re going from one “water” environment to another water environment pretty quickly, so there isn’t really a change in their environment when they come out. Their lungs are still collapsed at that point, so it’s not until they take their first breath of air that they start breathing actual air!
passages: In a 2005 commentary, the Committee on Fetus and Newborn of the American Academy of Pediatrics (AAP) released an analysis of the scientific literature regarding underwater births. The Committee noted several positive studies for underwater birth but went on to criticize them for lacking proper scientific controls, a significant number of infant deaths and diseases, and the general lack of information to support the use of water births. The paper concluded:
   Ordinary bathtubs found in American and British homes are not adequate to provide enough room for women to comfortably move and try different positions in labour, such as squatting or kneeling, and are not deep enough to create buoyancy. In order to create the feeling of weightlessness through buoyancy the water needs to almost cover the women's breasts while she is sitting and should cover her belly while she is squatting, leaning over the side of the pool or kneeling upright in the pool sitting back on her heels.
   Immersing in water in a birth pool is one of the methods available to manage pain during labour, in addition to TENS machine, Gas and air, Pethidine injection, deep breathing, massage and epidural.
  
  Section::::Birth pool.:Characteristics.
  
  Before birth pools became readily available there are many stories of women labouring and birthing in re-purposed tub-like products including animal watering troughs.
   Section::::Development.:Rupture of membranes.
  
  The forewaters are released when the amnion ruptures. This is commonly known as the time when a woman's "water breaks". When this occurs during labour at term, it is known as "spontaneous rupture of membranes". If the rupture precedes labour at term, however, it is referred to as "premature rupture of membranes". The majority of the hindwaters remain inside the womb until the baby is born. Artificial rupture of membrane (ARM), a manual rupture of the amniotic sac, can also be performed to release the fluid if the amnion has not spontaneously ruptured.
  
  Section::::Function.
   Section::::Birth pool.
  
  A birth pool is a specially designed vessel containing water for women to immerse themselves in for pain relief during labour. Birth pools work on the same principle as a bathtub, but are distinct from them due to buoyancy and freedom of movement, factors deemed to be important in labour. A birth pool can either be permanently installed or portable. Getting into a pool of water for labour is often called "water birth" because some women choose to remain in the water for birth as well.
   Health policy in England stipulates women should be given the opportunity to labour in water through the publication of Intrapartum care guidelines issued in 2007 by the National Institute for Health and Care Excellence (NICE). The Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives have jointly supported labour and birthing in water, and encourage hospitals to ensure birth pools are available to all women.
   A mother's water has to break before internal (invasive) monitoring can be used. More invasive monitoring can involve a fetal scalp electrode to give an additional measure of fetal heart activity, and/or intrauterine pressure catheter (IUPC). It can also involve fetal scalp pH testing.
  
  Section::::Complications.
   A 2014 review reported that it has been found that water immersion during the first stage of labor can reduce the length of the first stage, reduce labor pain, and the use of epidural/spinal analgesia. It is also associated with a lower rate of cesarean delivery and stress urinary incontinence symptoms 42 days after delivery. The review reported that immersion during labor did not appear to increase the rate of infections for the mother or the baby, and APGAR scores for the baby were similar to that of conventional births.
  
  Section::::Risks and concerns.
   Most infants, though not all, will reflexively hold their breath when submerged to protect their airway and are able to survive immersion in water for short periods of time. Infants can also be taken to swimming lessons. Although this may be done to reduce their risk of drowning, the effects on drowning risk are not reliable.
  
  It is extremely important to note that while babies can imitate swimming motions and reflexes, they are not yet physically capable of swimming.
  
  Section::::Infant swimming or diving reflex.
   The volume of amniotic fluid increases with the growth of fetus. From the 10th to the 20th week it increases from 25ml to 400ml approximately. Approximately in the 10th-11th week the breathing and swallowing of the fetus slightly decrease the amount of fluid, but neither urination nor swallowing contributes significantly to fluid quantity changes, until the 25th week, when keratinization of skin is complete. Then the relationship between fluid and fetal growth stops. It reaches a plateau of 800ml by the 28-week gestational age. The amount of fluid declines to roughly 400 ml at 42 weeks. There is about 500 cc to1L of amniotic fluid at birth.
   Toddlers can wander off and fall through ice or be left out in cool or cold weather and experience hypothermia. This low body temperature is often fatal but instances of survival after a near drowning occur.Of all drowning deaths in 2013, 82,000 occurred in children less than five years old.
  
  Section::::Drowning.
  
  Toddlers have wandered off and drowned in ponds. Toddlers can easily drown in small, shallow ornamental ponds.
  
  Section::::Animal attacks.
   A wet nurse can help when a mother is unable or unwilling to feed her baby. Before the development of infant formula in the 20th century, when a mother was unable to breastfeed, a wetnurse was the only way to save the baby's life. 
   Water birth may offer perineal support for a birthing mother, and some theorize that this may decrease the risk of tearing and reduce the use of episiotomy.
   Infant swimming
  
  Infant swimming is the phenomenon of human babies and toddlers reflexively moving themselves through water and changing their rate of respiration and heart rate in response to being submerged. The slowing of heart rate and breathing is called the bradycardic response. It is not true that babies are born with the ability to swim, though they have reflexes that make it look like they are. Babies are not old enough to hold their breath intentionally or strong enough to keep their head above water.
   Just before plunging into the pool, swimmers may perform exercises such as squatting. Squatting helps in enhancing a swimmer’s start by warming up the thigh muscles.
  
  Section::::Infant swimming.
  
  Human babies demonstrate an innate swimming or diving reflex from newborn until the age of approximately 6 months. Other mammals also demonstrate this phenomenon (see mammalian diving reflex). The diving response involves apnea, reflex bradycardia, and peripheral vasoconstriction; in other words, babies immersed in water spontaneously hold their breath, slow their heart rate, and reduce blood circulation to the extremities (fingers and toes).
   The fluid is absorbed through the fetal tissue and skin. After the 15th-25th week of pregnancy when the keratinization of an embryo's skin occurs, the fluid is primarily absorbed by the fetal gut.
  
  Section::::Development.:Contents.
  
  At first, amniotic fluid is mainly water with electrolytes, but by about the 12-14th week the liquid also contains proteins, carbohydrates, lipids and phospholipids, and urea, all of which aid in the growth of the fetus.
  
  Section::::Development.:Volume.
   4. To avoid having the baby aspirate the contents of the amniotic sac at the moment of birth. Most often, the amniotic sac will break of its own accord, most often by the beginning of the second stage of labor. If it remains intact, it is sure to break with maternal pushing efforts. But in a rare case, the baby can be born with an intact bag that must be quickly broken to allow the baby to breathe.
   The original circular birth pool Dr Michel Odent used at Pithiviers hospital (France) in the early 1980s was two meters in diameter and .6 meters deep, large enough to accommodate two people and make it difficult for interference during the birthing process. Modern birth pools are somewhat smaller with a diameter between 110-150 centimeters and at least twenty, preferably twenty-two, inches of water.
  
  Factors to consider when choosing a birth pool are:
  
  BULLET::::- Size – is it appropriate for you and the place you will give birth
   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. Therefore, underwater birth should be considered an experimental procedure that should not be performed except within the context of an appropriately designed RCT after informed parental consent.
   The world's smallest premature boy to survive was born in February 2009 at Children's Hospitals and Clinics of Minnesota in Minneapolis, Minnesota, U.S.. Jonathon Whitehill was born at 25 weeks' gestation with a weight of . He was hospitalized in a neonatal intensive care unit for five months, and then discharged.
   Sometimes, a child is born with no rupture of the amniotic sac (no rupture of membranes). In such cases, the child may still be entirely within the sac once born; such a birth is known as an en-caul birth.
  
  Section::::Effects.
  
  When the amniotic sac ruptures, production of prostaglandins increases and the cushioning between the fetus and uterus is decreased, both of which are processes that increase the frequency and intensity of contractions.
   In waterbirthing, a woman remains in the water for delivery. The American Academy of Pediatrics has expressed concerns about delivering in water because of a lack of studies showing its safety and because of the rare but reported chance of complications.
  
  Section::::Medical and pharmaceutical methods of pain control.
   Upon delivery, the exposed bladder is irrigated and a non-adherent film is placed to prevent as much contact with the external environment as possible. In the event the child was not born at a medical center with an appropriate exstrophy support team then transfer will likely follow. Upon transfer, or for those infants born at a medical center able to care for bladder exstrophy, imaging may take place in the first few hours of life prior to the child undergoing surgery.
   BULLET::::- Fill time and process – how long will it take and what type of hose/spout is required
  
  BULLET::::- Safety – how will you safely get in and out
  
  Section::::Birth pool.:Types available in the UK.
  
  Birth pools are generally categorised between two broad types: permanently installed or portable. Many hospitals in the United Kingdom now have a birth pool plumbed in, and portable birth pools can be purchased or hired for use at home or in hospital.
   Mating occurs in the water, with the female submerged for most of the encounter, her head emerging periodically to draw breath. Female hippos isolate themselves to give birth and return within 10–14 days. Baby hippos are born underwater at a weight between and an average length of around , and must swim to the surface to take their first breaths. A mother typically gives birth to only one calf, although twins also occur. The young often rest on their mothers' backs when the water is too deep for them, and they swim under water to suckle. They suckle on land when the mother leaves the water.
  
presuppositions: Babies should drown when born into the water. Babies need to breathe during water birth.
corrections: Babies lungs don't expand until after they enter an air environment so there is no safety issue.  Babies' lungs are still collapsed when born in a water birth so they don't need to breathe air.
raw_presuppositions: Babies should drown when born into the water. Babies need to breathe during water birth.
raw_corrections: Babies lungs don't expand until after they enter an air environment so there is no safety issue.  Babies' lungs are still collapsed when born in a water birth so they don't need to breathe air.