Intro

All content of this blog is my own opinion only. It does not represent the views of any organisation or association I may work for, or be associated with. Nothing within this blog should be considered as medical advice and you should always consult your Doctor.

Waterbirths - a hidden cause of breastfeeding problems?

The popularity of water births has increased dramatically in recent years; not only do many hospitals now offer a pool, but the price to hire or buy one has fallen too, making them more accessible to mums birthing at home.  Water births are also often suggested as a natural way to try and avoid pharmacological pain relief, which may impact upon labour outcome, baby or breastfeeding.

But is the assumption water births do not affect breastfeeding correct?  I've always been a big advocate, but I'm now not convinced things are that cut and dry.  I know this will probably raise eyebrows for a lot of people, but I now think there is a very real possibility that water births can contribute to problems.

As many lactation supporters will know, when a healthy baby is born naturally without exposure to medication, when placed on mums chest they will crawl to the breast, root, self attach and begin breastfeeding.  All their instincts are primed for this immediately after birth, which is why UNICEF and  the World Health Organisation strongly recommend skin to skin and initiating breastfeeding within half an hour.



As long as there are no underlying issues such as tongue tie or palate abnormalities - this group by far has the highest rate of early lactation success, and it's far less common to find mums in this position suffering from problems such as sore nipples, latching issues, breast refusal and so on.

But I'm not sure this is the case for water births; as the "breast crawl" becomes more well known, mothers are starting to mention it - and I'm finding more are stating their baby simply didn't do it.  In fact now when I'm supporting a mum who describes a normal unmedicated delivery followed by problems initiating feeding, my next question is "was it in water?".

How could water cause a problem?
As mentioned above, the primary instinct for a newborn is to locate the breast and feed - but how does it do that?  We know that during pregnancy the nipples and areola darken and enlarge,  because we know newborns with immature vision, see the contrast between dark and light most easily; but infants do not rely solely on sight, in fact it may actually play quite a small role in terms of initially locating the breast.

The infant's senses are stimulated by the sounds and feel of the mother's body and more importantly in this case, scent - as you can see in the clip above, baby is constantly smelling and tasting.

Why?
Mum's sweat and the amniotic fluid on baby, both play a very significant part in the breast crawl and newborn breastfeeding (and many sources also link this with bonding, but one for another blog post I think!).  Mum's sweat smells the same as amniotic fluid, which is still present on baby's hands - so he uses this taste to guide him to the breast, which is also conveniently located close to the armpit.  As the breast is actually an enlarged and modified sweat gland, this means the odour is strongest in the area baby needs to reach.

A 1994 study examining whether the infant found the nipple by smell states:
One breast of each participating mother was washed immediately after delivery. The newborn infant was placed prone between the breasts. Of 30 infants, 22 spontaneously selected the unwashed breast.  We concluded that the infants responded to olfactory differences between the washed and unwashed breasts.
Lancet. 1994 Oct 8;344(8928):989-90 
I don't have access to the full study to find out what the other 8 did, but they may not have crawled anywhere or become disorientated due to analgesics, perhaps separated from mum too - which as seen in the clip above can also influence co-ordination.  I think this also clearly highlights why babies should not be removed, wiped and wrapped in a towel before being given to mum!

Evidence?
A 1997 study entitled "Unique salience of maternal breast odors for newborn infants" found:
Human infants are particularly responsive to olfactory cues emanating from their mother's nipple/areola region. Beginning within minutes after birth, maternal breast odors elicit preferential head orientation by neonates and help guide them to the nipple. Such odors also influence babies' general motor activity and arousal, which may contribute further to successful nipple localization and sucking. To some extent, the chemical profile of breast secretions overlaps with that of amniotic fluid. Therefore, early postnatal attraction to odors associated with the nipple/areola reflect prenatal exposure and familiarization
There's more...
I also found a small study from 2001 that specifically explored crawling behaviour based solely on scent:
Breast odour as the only maternal stimulus elicits crawling towards the odour source -This study investigated the influence of breast odours per se on orientated physical movement of neonates. In total, 22 babies were observed during two trials on a warming bed. In one trial, a pad carrying the mother's breast odour was placed 17 cm in front of the baby's nose; in the other trial a clean pad was used. More babies moved towards and reached the breast pad than the clean pad. Conclusion: Natural breast odours unsupported by other maternal stimuli therefore appear to be sufficient to attract and guide neonates to the odour source.
Birthing in water strips the process of these vital odours and tastes for baby - given the above it seem to me it at least explains why some babies born in water don't crawl.  I cannot locate any research examining breastfeeding success rates following a water birth, but I would be fascinated to see any if it exists.

My first thoughts were that if using water in later, it would from a breastfeeding point of view make most sense to use just in early labour, to give time for mums body scent to return to normal levels; but many advocates suggest hitting the water too early can slow labour.  I wonder how feasible it is to keep waist up out of the water if the room is nice and warm and perhaps if you have large breasts that would still end up submerged, wearing a comfortable bra (amazingly as per the picture I managed to find!)  it may also be worth leaving the pool for delivery and ensuring you were dried thoroughly to prevent any dilution of amniotic fluid.  If this does not appeal, until I've seen hard evidence examining water birth impact on the breast crawl - I'd say it's worth considering staying where we normally reside, on dry land.

Alternative natural pain relief ideas:
Exercise during pregnancy: may make your labour shorter and less painful. A study published in the American Journal of Obstetrics and Gynecology, reported that women who continued running or aerobic dancing during pregnancy enjoyed labours about 30 percent shorter than women who stopped exercising. Women who maintained a regular exercise program also required less labour stimulation and fewer epidurals, episiotomies, and caesarean deliveries. An Italian study in the same journal examined women having their second or third babies, who rode an exercise bike three times a week for thirty minutes. They began around the fifth month of pregnancy, and during labour maintained higher endorphine levels and reported less pain than a matching group of sedentary women.  The link contains more information about exercising safely whilst pregnant.

Heat: In the same way heat can help period pains, it can also help in labour.  Wheatgerm bags (or alternative filled bags) may be safer than hot water bottles if you are moving about lots and perhaps applying pressure with them.  The link also contains details of how to make your own.

Active birth: although the media most often portrays labour women flat on their back, this is the not a productive position - think about gravity.  Trying positions like kneeling over a bed or birth ball; squatting and rocking hips can often not only offer more relief but help to keep labour progressing.

Massage: Some mums like to be massaged during labour, whilst others prefer not to be touched.  Avoiding oils on the chest which could mask mum's own odour would appear to be a sensible idea.

Hypnobirthing: Many mums swear by hypnobirthing as a fantastic way to reduce pain.  If you do not fancy going the whole hog, visualisation techniques such as imagining the baby moving down the birth canal or balloons inflating with each contraction, then floating away as they dissipate can be great coping strategies.

Nesting: Some mums find making themselves a big nest of beanbags and duvets to snuggle in can provide security to feel comfortable and relaxed during labour.  As muscles are contracting, the more relaxed you can be, the less pain you will feel!

Explore the pain and breathe: A natural reaction to pain is to recoil and if it's your first labour, perhaps be afraid.  Some women find focusing on the pain and exploring it mentally, helps to reduce how much it hurts.  This is based on the concept that pain is how the brain interprets labour contractions because of our inbuilt cultural belief labour hurts - read about the opposite end of the spectrum and orgasmic birth here

Tens Machine: Another popular choice although scientific evidence shows mixed results.  Women seem to find this method of pain relief most effective, when worn over a longer period, ie it's less effective if put on when the pain gets severe in labour - you need to put it on as soon as you get the first twinge for maximum benefit when things get going.

Finally...
Good pain relief in labor is not the same as a perception of personal control or satisfaction in childbirth. In other words, you may have significant pain during your labor, but feel in control during the process and have great satisfaction afterward. On the other hand, you might have total pain relief during your labor, but feel totally out of control and unhappy about your experience when it is over. 
In most languages, the word for the process of giving birth describes a process of work (labor), not of pain. Remember that labor pain is more than a physiological process; coping with labor pain is emotional and complex and results in feelings of fulfillment and achievement for women. Therefore, satisfaction with labor is not necessarily related to the efficacy of pain relief. Your midwife should work with you during the prenatal period to identify personal coping strategies and encourage you to make efficient and effective use of these resources (2).
from an excellent article here

79 comments:

  1. Interesting post. I have had 4 children, 3 breastfed, and have given birth in water with two of them. The other breastfed baby was a c-section. I've never had a problem with breastfeeding any of them, indeed my son had to be rescusitated after birth (in water)and against the odds latched on as soon as he was handed back to me! However, for both waterbirths i have worn a tankini top, and have been upright, with my top half out of the pool, for the vast majority of the time. So its pretty inconclusive in my case :) I'd be interested to hear other people's experiences

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  2. Personally after two water births and experiencing contractions before getting in the pool and after, wild horses would not induce me to labour or birth without a pool! First baby didn't feed straight away but after a good throw up of gunk during the night he settled easily to the breast with no problems the next day. Second baby latched on whilst still sat in the pool and fed for half an hour. Purely anecdotal obviously. I can see your reasoning in this area but I believe that if more women were able to labour and birth in water we would see a massive reduction in interventions and therefore a rise in normal births. (Water has been shown to reduce length of labour, instances of tearing, need for pain relieving drugs) This in my mind would have to increase breast feeding rates so I think that the benefits would far outweigh the risks in this case.

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  3. Hi Ladies
    Thanks for your comments :) as always we are definitely not talking in absolute terms - nothing pain relief wise is definite. My first was a highly medicalised birth; induction, pethidine, epidural and entinox - yet my daughter was born and latched like a pro.
    This doesn't however change the fact that evidence shows pethidine and epidurals MAY interfere with breastfeeding; it's all about veering from the norm and increasing risk factors isn't it? After all some women pick baby up fine after a section and breastfeed easily, whilst another with struggle.

    The point I'm really trying to make is that fluids and smells are an importantant part of a normal physiological process, removing them may very well impact FOR SOME dyads.

    Also if putting the baby to the breast in a pool, this is obviously skipping the breast crawling process altogether - again for some this will cause no problems, but it may for others.

    As well as water lots of other things have been shown to reduce labour time and the need for other pain relief, as discussed at the end of my piece. We accept water as "natural", but if it removes so much sensorially, how natural is it for humans? I think if we know water can impact, we should tell mums this - just as we tell them the pros and cons of other methods of pain relief :)

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  4. I gave birth in a pool (amazing experience) and my baby didn't latch on for 36 hours after he was born, I had to express and feed him from a syringe because he just didn't get it. I had never associated the 2 things before, although my husband thinks he remembers the midwife saying that in her experience it takes waterbirth babies a bit longer to latch on.

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  5. Hi juicy lucy - yes I do think some babies may well be likely to need all their senses stimulating to respond effectively. Very interesting comment from your midwife too!

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  6. My DD had a "lovely" (insofar as birth is lovely) waterbirth. But we had an agonising 5-6 days before we got a latch.

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  7. I've had two dry-land births and one water birth. The first was medicalised and I had huge problems breastfeeding ending in giving up. My second was a natural homebirth with no medication. Baby was not at all interested in feeding for about 12 hours. Third was a home water birth with no drugs again. Baby started 'crawling' the second he was in my arms! He was desperate to latch on, the only hinderance to this was that I had sat back so I was worrying about keeping him above water enough to let him wriggle his way there properly, so we got out and he fed and fed and fed and hasn't stopped since! We did have problems but this was more due to early positioning causing raw skin that just got worse and worse until we sussed positioning etc. I don't know if you could attribute this to being in water?

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  8. I have 4 children, the first two were dry land natural births and had no probs breastfeeding at all. Child no. 3 was a waterbirth and had latch problems on and off for 9 months. Child no 4 was also a waterbirth and didnt feed for 12 hours plus had latch probs for the first 7 days. Very interesting article - especially to do with scent but also to do with positioning as I could not get him to latch on in the water due to slipping etc.

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  9. Hi Scarlett - my feelings are that probably some babies will attach fine even if they are unable to effectively breastcrawl - just like some do after an epidural or section. Others need the full sensorial experience to attach well - perhaps if their agpar is lower, or they have endured a longer labour or are more tired etc - then removing half the sensorial side may impact.

    I think when the studies I mention show the power of scent - we do need to examine closely whether removing it or diluting it has the impact I very much suspect it does.

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  10. Food for thought as usual Armadillo. You have explored an area which i had not considered re: waterbirth. I feel that for many women water is the one thing that stopped them going down the medicated route for labour, so it is important to consider the balance of risk (as with everything surrounding birth!)medication and associated risks to breastfeeding or water birth and the possibility that baby may not crawl to the breast. maybe there is a way around some of the potential problems that you raise; once out of the pool mum could put on the same clothes she was wearing before she got into the pool (probably not practical for a breast crawl)or rub her breasts with her pre pool clothes or bra.
    Initially i was concerned that your post may deter women from choosing waterbirth, but if a woman is giving real thought to birth and breastfeeding then she wouldn't choose medication over water.

    Having had one water birth, if i were to give birth again i would still plan to birth in water and deal with breastfeeding problem should they occur.

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  11. I also commented on FB but, for the sake of simplicity will also comment here. I understand what you are saying in terms of secretions and the crawl but, how frequently is this how breastfeeding is initiated? I think it is far more common that a mother actively brings the baby to her breast. In a water birth, the baby is naturally brought up out of the water, usually by the mother herself, and to the mother's chest for skin to skin and immediate nursing. This was my experience, anyway.

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  12. I wonder though - there is a lot of mention of "women would choose drugs without it" - but could a part of this be because we are now so focused on water, and not fully exploring and using other areas such as say heat application. I think it would have been amazing during my posterior back labour but it was never mentioned by anyone, neither was breathing beyond slowly in and out and pant lol yet both have been shown to also reduce labour times and pain levels as mentioned in the article.

    What I mean is whilst there have for a long time I believe been small pockets of women who have used water ie birthed near it or used sauna/steam in labour, the amount who years ago used to actually birth in it was small. In terms of being popular it's only really in the last 30 years - did women really not have drug free fulfilling births prior to this?

    I guess whilst I see water as something that can be beneficial, if it CAN impact on breastfeeding - just like epidurals, for those happy to use analgesics that are considered safe, there IS less benefit to choosing "natual" - I think we need to know exactly what the impact is in terms of problems...

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  13. Yes Leah - and it is this that I feel can impact on breastfeeding. As I stated on my facebook comments and I think probably also here (a bit confused what I've said where now!) some infants will manage fine without the normal process of the breastcrawl.

    This is not land v water - but land WITH THE BREASTCRAWL (ie the biological norm) we know improves breastfeeding initation versus water...

    If not given the opportunity to crawl online, this too has the potential to impact.

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  14. I have been present ayt 2 water births , and both babies had latch problems. They both eventually nursed, but not without assistance. Anecdotally interesting, but I would love to see an actual study.

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  15. Interesting however I don't agree with the theory, you sweat constantly in labour and in the water, baby who is covered in vernix, fluid etc is placed on the chest, you don't then go swimming with it. You smell like you've just given birth. What you're providing is anecdata and jumping to some big conclusions, it
    would be about as useful as me telling you it's not my experience having had two waterbirths with large pendelous breasts spending lots of time under water and having two babies that breastcrawled. I can't say it's anything that's cropped up in supporting many mothers who've birthed in the water either, I will however ask the same question with future mums I see.

    To reference it with links of alternative forms of natural pain relief is a little previous when
    there has been no quantitive study done and it's clearly musings, I think by including them you're leaving the post open to misleading mothers that this is a proven link.

    Is there any controlled study adjusting for maternal factors such as are they being left undisturbed either in the pool or reclined skin to skin on sofa/bed etc afterwards. In NHS waterbirths there's often a fuss to get mothers out due to water embolism which Michel Odent says he wishes he never said as it's never
    happened but is still listed as a theoretical risk. It could be as simple as rushing mums out of the pool. It could be mums not knowing about the breast crawl and misinterpreting baby's signals. Some mums stop the babies thinking
    they're falling or to try pop baby on the boob themselves. Midwives may also place baby disturbing breastcrawl.

    So many babies I see, and I'm now working 3 days a week with newborns doing solely breastfeeding have never breastcrawled until we initiate it with the mums (usually day 2-4 or on postnatal ward),despite skin to skin being undertaken with virtually every birth.

    I think nothing is ever certain, you get bad breastfeeding experiences out of some of the most ordinary natural births, but what's known for sure is you reduce the risk by having less intervention. Without water as an option
    intervention levels will rise, which are proven to impact breastfeeding.

    The water has to be a certain depth to work, restricting a mothers position in labour is
    never a good idea, stranded beetle anyone. I don't think your suggestions for this are realistic and could cause more breastfeeding issues than they resolve by restricting a mothers choice on how she births.

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  17. Seconding Suzanne! If Blogger will let me post yet...

    To AA, I suggest the following. :) Do a twelve hour workout then sit in the tub without washing and tell me whether you still smell in the regions that were submerged?!

    You are taking tenuous anecdotal evidence and basing a theory around the idea that water birth babies can't breastcrawl because of lack of scent, without being able to tell me if you have any evidence of - or have actually experienced - this loss of scent?

    After two water birthed babies who breastcrawled and a land baby who didn't - never latched without breast compression in fact - (and plenty of experience of washing without soap due to children who like to squish it down the plug hole), my anecdoatal evidence is to the contrary! Waterbirth does not mean lack of scent. Which is where the whole theory falls down.

    Your entire article here is the equivalent of telling women that because all your friends who had epidurals had babies who DID breast crawl, they ought to consider having an epidural just in case. *sigh* Such "science" may undo much of the impact of the sensible commentary and peer-reviewed research you post. :(

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  18. Hi Suzanne
    Wouldn't life be boring if we all thought the same :)

    Sweating in water covering the breasts to me is different to sweating not in the water - just like sweating in a bath is. How can the sweat remain strongest in the breast area in a pool?

    My term baby didn't have any vernix at all and I find it unlikely signifcant amounts of amniotic fluid will remain on baby when they are sat in a large tank of water.

    I haven't referenced the article with alternative forms of pain relief? those are points at the end for anyone wanting to think beyond water. I referenced the article with a study showing scent was important and another showing how it played a part - plus a third showing scent alone could get infants to the breast. I don't see as there is massive leap from there to how water could potentially impact negatively - there is no evidence proving water does not influence, any more than there is any proving it does.

    Furthermore other supporters are also finding increased problems with waterbirths, including being told specifically the baby did not crawl!

    What are the reasons you feel babies are not breastcrawling in your unit, are midwives very hands on? Certainly on a forum I visit which is very pro natural labour, a lot of the dry land infants have breastcrawled unassisted - perhaps it's one for another poll :)

    QUOTE "without water as an option intervention levels risk which are proven to impact breastfeeding"

    Yes but potentially water could also be an intervention which impacts on breastfeeding??

    I'm interested does your unit offer other options than water? Maybe heat therapy with lots of wheatbags or specific labour massage? or is water the only thing you feel reduces other interventions? (despite other research suggesting plenty can reduce interventions)

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  19. Does it not also occur to you that the increase in reported lack of breast crawl in water births may simply be a result of the level of thought which has gone into both birth and breastfeeding for some women? Do you not assume that women who water birth are likely to have done more reading about natural childbirth, and therefore will have any IDEA what the breast crawl is in the first place?

    Purely lack of reporting in many women who birth naturally but without preparation may be the issue? If I have lots of reports of problems after water birth, and some after land birth, but more of the prepared camp birthed in water in the first place... As with cosleeping, we can say more deaths occur in cots, but more babies sleep in cots in the first place, so we don't know for sure it has any significance - it is a pattern without any context in which to place it.

    Perhaps this is in fact evidence that the breast crawl is not universal even in natural birth, and that women should not be taught to expect it - with the special implication here and elsewhere that maternal initiation of breastfeeding is likely to lead to failure?

    Potentially, telling women that there is only one way to initiate breastfeeding has its consequences, surely? IF water is proven to change the breast crawl this would still not imply difficulty latching!

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  20. Arwen-Tiv thanks for your post :) As I said when I posted the link, I expected this post to be controversial because there are a number of avid water birth supporters, plus no doubt a healthy financial market for the hire and sale of pools -who I suspect would not be at all happy at any suggestion of such a link (and I'm not suggesting this is the case for yourself, just talking generally :)).

    Firstly my blog quite clearly states it's food for thought, and I feel I also quite clearly state that the reasons I started thinking more about this were totally anecdotal ie that I support women in three different ways (on the phone, in person and online) and I very rarely see a women who has had an uncomplicated vaginal drugg free birth, where baby gets immediately to the breast on land who has problems. In contrast I get a lot of calls from people with waterbirths that have problems - as it seems from the lactation list Suzanne also visits, at least two other people have also recognised.

    So yes it does seem logical to me that something about water is impacting - particularly when I have women who understanding the breastcrawl state their baby did not do it and to me I CAN see how water could easily interfere with bot amniotic fluid on baby and sweat on mum.

    Suzanne feels the infants in her unit born on land don't do so anyway, because of midwives - yet the vast majority of women I support antenatally have infants that crawl just fine. Even if we look at all the crawling evidence I mentioned and the crawling clips - are we suggesting there were no midwives present for any of these births? if midwives made a big difference we would need to freebirth to see a crawl?

    I also think that not all women have 12 hour labours and that we are talking breasts not nether regions.

    As you state - your anecdotal evidence is no more hefty than mine, but to be honest if I see a potential link, I can present a theory about anything I like - because that's what it is, a THEORY. Not a certain or anything claimed to be an evidence based fact, but a post that has a question mark at the end of the title. To me there is sufficient logic that I would want to see more evidence - but then breastfeeding is super important to me and that was the only reason I avoided the epidural and went for a totally natural birth second time around.

    I'm not sure my article is at all comparable to your epidural analogy - but many thanks for taking the time to comment :)

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  21. Hi again Arwen-Tiv - I'm more than happy for people to share different views, but I can't help but feel your messages come over as a little bit aggressive - do you intend this or is it just because you are typing emphatically? (I know things can often come over differently in type)

    No I personally don't think level of thought is massively significant - I know lots of mums who give labour lots of thought and don't choose water :) whereas you seem to feel if they give it thought more do. Simiarly I think roughly as many mum who have dry birthed and known enough to try the breastcrawl - but crawl aside, I generally have far far less issues with normal unmedicated births on land, regardless of whether they knew enough to try it.

    Should mothers be taught to expect the crawl - hmmm I guess it depends how you look at it. In effect all the crawl results in is biological nurturing as I think someone else mentioned here. I think there is quite extensive evidence that more babies feed well in BN positions than not - because we know this position enables all their feeding reflexes, compared to western positions which hinder. We also know an infant's reflexes are primed for the crawl & BN - isn't it the whole point of them having the walking reflex for the first 6 weeks? So I think from there it's quite fair to say that more mothers in a normal delivery can expect BN to work than not? Of course length of delivery, agpars, interventions etc may all impact.

    I'm not sure it's as much about suggesting that maternal initiation of breastfeeding is likely to lead to failiure, as much as we know when babies BN we have improved rates of successful feeding? But perhaps that is just saying the same thing the other way around? if so I guess I agree with it...why do we need to initiate before giving baby a chance to do it? plus of course baby not being able to self attach and so needing help, could be considered different to a baby who has less chance because mum is upright in a tank of water with diluted bodily odours?

    I don't think this is the same as telling women there is only one way to initiate feeding - it's telling women we know the most successful way of initiating feeding surely?

    QUOTE ""IF water is proven to change the breast crawl this would still not imply difficulty latching! "" - on this I think we will have to agree to disagree :)

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  22. In as unhindered as a hospital can be many of those dry land births are answering no to the did those babies breastcrawl question. I saw one earlier, day 1, no drugs, no intervention, skin to skin commenced asap after birth, baby had not crawled and baby was not latching well today. I specifically ask mums if they crawled when skin to skin after birth as I'm usually explaining biological nurturing when doing this and it's a good thing to liken it to. I do not get many positive responses, we can dismiss a high percentage of these as impact of drugs or interventions, however not all. I see a huge range of options for women to birth without drugs and intervention, water is one of them, and a very valid one at that. I do not believe it's the only one that reduces intervention at all, but it's a commonly used one that does make a huge difference.

    Information from many different sources tells mothers to use water only when washing, rather than anything scented to preserve their own smell. Babies are attracted to the secretions from the montgomery glands in a big way, sure water will dilute some of this, and this study uses very diluted amounts of the sebum with amazing results. A waterbirth won't wash all secretions away.
    http://www.plosone.org/article/info:doi/10.1371/journal.pone.0007579

    It also cautions about wiping it away, which I think is what you're trying to say waterbirth does, would it reduce it enough to disturb the scent trail or is this more related to the immediate post-partum period? If mums know about it are they trying to speed it up, are they not staying skin to skin long enough. Are they trying out of the pool, which would seem like the logical first step if it's not working in the pool.

    I would say it's worth looking into to see if a trend emerges but in no way should the first response to be to hinder a mum in the pool and propose shallow waters that could be harmful for a baby. Get down with the bodily fluids, there's still plenty on hand from the vagina, squeeze and rub secretions from the montgomery glands, rub sweat down from your armpits that won't have been submerged. There are loads of waterbirths vids on youtube, it would be topical to watch to note any differences in what's happening postpartum to see the perspiration on those mums.

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  23. I used water during my daughter's birth at home 8 weeks ago. It was a very fast labour and very intense. The TENS machine wasn't any use to me this time but I got great relief in the shower for about an hour and in the birth pool for about an hour. I think I would have seriously struggled without these "interventions". In the end her head was born in the water but I had to get out of the pool so her body was born on dry land.

    I was very keen to try and see if she would breast crawl and was quite surprised that the midwife (independent, very pro home birth and well up on the research) dried her off as she passed her to me. She later explained that newborn babies can lose heat very easily and said warm towels are necessary. Anyway, she was laid on my chest on the sofa after the birth. I had to sit up do deliver the placenta (first 30 mins or so) and after that she did start breast crawling iirc. But she did seem to be getting upset (I think - it's a bit of a blur) plus I found lying on my back really uncomfortable with the afterpains. So I laid on my side and helped her latch on and she fed really well for over an hour.

    I did have sore nipples the first week, but I am convinced that she did latch on well and feed well and that the soreness was because she had to suck very hard to get the colostrum out. Once my milk came in she sucked more gently and the soreness went away.

    For me, I would not change the way I laboured. The birth pool was really important to me particularly with my pelvic pain as it meant I could easily get into the positions I needed to, which aided a smooth birth.

    As you point out, babies can breast crawl at any time up to about 8 weeks or so, so there are plenty of opportunities to try it if it doesn't work out perfectly straight after birth.

    Let's not throw the baby out with the bathwater ;)

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  24. I had a waterbirth. I had no problems with breastfeeding. My baby did not self attach straight after birth, but I'm not sure if being born in water was the reason.

    1. I was upright the whole time I was in the water. My breasts were never submerged. Almost as soon as she was out, I wanted to get out, so we were both wrapped and helped out of the pool. There was still vernix on her body and very likely still fluid on her hands.

    2. I had some gas and air during labour. She may have still been affected by that.

    3. The placenta didn't want to come out. So I latched get on, rather than give her full opportunity to do it herself, hoping that it would help with the placenta.

    4. She did self attach over the following days, so even tho she didn't do it at birth, I don't think it was a major set back for us. Given the enormous benefits of birthing in water for so many women, I don't think this [possibility breast crawl might not happen] should put anyone off.

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  25. Is there evidence that using water significantly reduces smells? I had a waterbirth - there was no soap in the water I used and I did not "wash" nor were my breasts submerged much. On the day you typically wash your hair, stick your head under a faucet and scrub with your fingers then dry - is the scent of your scalp reduced or removed? Nope.

    Also, of course, babies don't typically just crawl by themselves, we help them, and waterbirth does not affect women's abilities to help their babies nurse EXCEPT to help them with pain relief, as many who use water can attest to its positive effects (myself included).

    I had a medical birth my first time and my eldest had to be helped quite a bit to breastfeed. Waterbirth with my son and he fed just fine.

    Interesting article!

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  26. Thank you for your post. I found it very interesting. I am a homebirth midwife and while I assist many women with water birth, I have no particular bias for or against them – it is simply a matter of what is best for the woman at the time. Of course, I have no scientific data for you, but I can offer you my observations over the years.

    There is no doubt in my mind that generally the time from birth to self attachment is lengthened with a water birth. There are always exceptions to this of course, as some babies come out and just jump on!! However, this is where I depart from your conclusions. While the time is lengthened – the breast crawl still happens. With a water birth, the smell may be less concentrated or on more areas than the nipple, but it is still there! Have you ever smelt birth water? It smells distinctly of amniotic fluid! And I have never seen a baby confused by the “watering down” of the smells. They STILL display the breast crawl. In fact, I have never assisted a mum whose baby did not breast crawl - not all of them attached (2 I think, 1 water born and the other born out of water) but ALL displayed all of the other movements, at vastly different times, water birth or not.

    Some bubs come out ready to jump on straight away and they show signs they are ready right there in the pool (even doing the leg movements trying to get closer) and there is nothing wrong with the mothers holding them so they can feed. Other bubs take a little longer to want to feed and so patience is needed, warmth and comfort for both mother and bub. Many bubs who did not breast crawl are usually the result of interference or impatience. I have found that all babies, regardless of birth in or out of water, are REMARKABLY similar in not only their movements, but the sequence of their movements. It is fascinating. The only difference I have noted is TIME. And when it comes down to it – why does that matter?

    I think there are vital misunderstandings of the breast crawl and baby’s responses to labour and birth, and a general ignorance of birth attendants in how not to impede the process. Gina’s comment above is a good indication. Wiping the baby interferes on 3 counts – removes birth smells, is uncomfortable for the baby and interferes with their initial recovery and interrupts vital first bonding with mother and baby. Simply ensuring that the room is warm enough and perhaps placing a light blanket over the two of them is more than sufficient and does not interfere with any of those things.

    When you are interviewing women who report no breast crawl, I think it is more pertinent to ask questions about
    1/ how their labour was (sometimes that journey is long/difficult and bubs need extra time to recover)
    2/ warmth of the room
    3/how noisy the room was – how many people, how bright, how much celebrating, how much chatter etc
    4/how much interference there was – drying, holding, moving etc
    5/how long did they wait.

    I think if you asked the above questions, you may change your theory to birth attendants have a poor understanding and often impede the process of breast crawl, rather than babies don’t breast crawl after water birth. Because my practice definitely shows that they DO.

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  27. To compare the fact that skin with head surrounding it can withstand water to maintain its oils and then say breasts are the same is to misunderstand basic anatomy.

    I used water in labour twice and my armpits were in the water, at times I dipped my face in to cool it when I was working hard. Both times it felt right to me to actually push on land however so I do not have a frame of reference for that, although of course it would be anecdotal evidence. I'd love to see research on this, as if I take a step back outside my initial "BUT BUT BUT WATERBIRTH IS SO GREAT!" reaction, it does make intuitive sense to me that of course immersion in water could rinse off natural body emmissions. What about women not in a pool, that is, a small body of water, those who choose to birth in a sea or lake? Obviously that would be much more diluted yet.

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  28. QUOTE if I take a step back outside my initial "BUT BUT BUT WATERBIRTH IS SO GREAT!" reaction, it does make intuitive sense to me that of course immersion in water could rinse off natural body emmissions END

    Yes - Waterbirth has become so entrenched in our culture this is common knee jerk reaction I think. I planned a waterbirth nyself with my second (only 34 weeks isn't waterbirth territory) so I'm certainly not anti waterbirth for any reason!

    Other things have also made me wonder recently just how biolgically normal it is though. For example we now know that the baby is intended to be born near mums anus and feces - so much so many advocates are suggesting we do not clean up mothers who have done so. This bacteria helps to colonize the gut and is a natural exposure - not sure how this works if it's floated away in a large bath!!

    QUOTE To compare the fact that skin with head surrounding it can withstand water to maintain its oils and then say breasts are the same is to misunderstand basic anatomy.

    I quite agree - where is the evidence being in water doesn't change anything? water CAN impact on the skin as it can evaporate removing natural oils and dry it out - yet we can suggest 12 hours in a birthpool does nothing?

    I will return and comment on individual posts soon - school run calls first...

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  29. Having read the comments...

    Surrly water birth decreases intervention, and not just pain relief. Mws can't be hands on when the bit they want to put their hands on is submerged. At least, not easily. Mum has to expressly allow it. This also lends a feeling of security and privacy, which facilitates a smooth labour & delivery.

    A water birth almost guarantees that a woman has given her birth some thought and planning. If a woman does not give any thought to it at all, she's almost guaranteed to do it on land, probably supine. That doesn't mean that dry land birth = mum hasn't thought about it or prepared at all. She may have, or she may not. With a WB she probably has.

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  30. Suzanne - yes there may well be ways around it such as wiping sweat and fluid onto pads before hand, then wiping them back over mum etc as has been suggested. As I said before how women choose to take my theory is totally up to them! If there's a way round it - great!! I'm purely talking in terms of biological norms and if we were meant to birth in water (rather than a cultural trend), would we need to do all the above to not interfere with feeding? perhaps feces as gut colonization fans will suggest bagging that up too so we can somehow expose baby to that if they are not naturally. But as I say to me these are just solutions to try and undo how something is interfering in the process.

    As to whether water does or doesn't interfere with the normal scent process - in all honesty I don't see how any claims it doesn't are any more evidence based than my theory it potentially could. And obviously to me at least my theory makes sense.

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  31. Gina - Thanks for your comments, they're v interesting; particularly that your daughter was wiped (which from your comment would seem to be a practice not unheard of in waterbirths to keep baby warm)did try the breastcrawl as per her reflexes - before becoming upset. Perhaps this was because she had the skin contact which triggered her reflexes - but her other sensory tools had been removed?

    We talk lots about not wiping land born infants because removing birth smells can impact - why would it not for one water born? The study mentioned highlights how wiping removes the scent - so it would seem even if the water hasn't, in order to keep the infant warm many will have it removed straight after.

    QUOTE - I did have sore nipples the first week, but I am convinced that she did latch on well and feed well and that the soreness was because she had to suck very hard to get the colostrum out. Once my milk came in she sucked more gently and the soreness went away.

    That's an interesting theory I don't think I've come accross before. Did your milk take a week to "come in" rather than the typical 3-4 days? I guess this means if a mum has soreness until her milk comes in - this could be due to sucking strength rather than anything else?? I think some may also theorise that perhaps your daughter was not attached as effectively as possible and she mastered this skill around the time your milk came in? perhaps as you say because milk was more abundant and so this helped.

    QUOTE - As you point out, babies can breast crawl at any time up to about 8 weeks or so, so there are plenty of opportunities to try it if it doesn't work out perfectly straight after birth

    But I think this is sort of totally missing the point. We know infants that establish feeding with the least amount of problems are those that feed in the first half hour or so after birth - thats why there is such a big push to do this now. With this logic we could say ah well there's plenty more opportunities to feed later, after all they can do it anytimes...yes for some babies they will have a poor first feed and still go on to latch well - but others (a significant proportion) are more likely to experience problems.

    The first feed as I say is full of smells and tastes and it is from this feed baby learns it's own mother's odour. Yes the reflexes are there 6 weeks, but the rest of the package isn't. My feelings are some WILL go to the breast fine having missed out on the sensorial introductory package they are supposed to receive - for others the violation of normal will likely impact.

    I think there are two different issues here - the first is whether you believe that the "breastcrawl" allowing baby chance to locate and attach to the breast themselves, followed by biological nurturing - all immediately after birth with an unwiped baby and mum improve breastfeeding rates. If you don't feel this aspect is important and that first feeds don't matter - or as many do well in western positions initiaed by mother - the importance of whether water or not impacts on this is likely to be massively different to you...

    I'm really glad to see such a lively debate on the subject though :D certainly keeps the old grey matter going lol I did expect lots of "well I had a waterbirth and no problem" posts - just as I would if I posted C Sections could interfere with feeding; I guarantee I would get twenty replies from women telling me they had one and fed just fine! But that doesn't change the fact that not only myself, but other lactation supporters are noticing as waterbirth becomes more popular, when all other things are equal these mothers experience more problems. For me SOMETHING is impacting, and this would seem the most logical thing to do so :)

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  32. QUOTE SAM Given the enormous benefits of birthing in water for so many women, I don't think this [possibility breast crawl might not happen] should put anyone off.

    Yes I think your views on this are likely to vary depending on how important you feel the initial breastcrawl and BN is.

    I also know others feel not all infants do it anyway, even on land - so.... but my thoughts are we should be supporting the kind of labours that encourage as many as possible to do so. Up until not that long ago, many believed we were the only mammal not to be born, locate milk and attach. Since then everything has shown actually we have the reflexes and instincts to do this too. Of course SOME wont, just like sometimes a farmer has to give a helping hand to a cow or sheep - but he always steps back and gives them chance first, allowing this process is considered super important, yet is often totally overlooked for humans.

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  33. Kelly - I cannot find any evidence comparing sweat levels out of water compared to in, I suspect if I went to the gym and didn't shower, or went to the gym and showered even with just plain water - I would smell very different afterwards. So I would have to ask have you any evidence it DOESN'T interfere with scent?

    It seems to me when evaluating water births in the 80's and 90's - the focus was on safety for baby, rather than breastfeeding initiation. Of course as the majority of mothers particularly at that point bottlefed - it perhaps wasn't viewed with much significance.

    QUOTE - Also, of course, babies don't typically just crawl by themselves, we help them

    And this is I think where we are perhaps striving for a different outcome. Maybe many infants born in typical birth situations today DON'T crawl - but instead of saying that makes it ok for water, shouldn't we be looking at how we can make more births closer to the biological norm and ask what is stopping our infants doing this?

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  34. Sam - but I'm not arguing water doesn't reduce interventions. My point is if it can potentially cause other issues (and not breastfeeding is massively significant in terms of health outcome) then it's surely not as cut and dry as that?

    I also think there are lots of things that reduce interventions - but they are rarely used because society has focused so much on water in terms of a cultural norm shift. There is also the real potential for placebo effect - if women are under the belief that water will have an amazing impact, read birth stories about it etc, this in itself could also contribute to outcome. After all many midwives state labour is as much mental as physical - that of course doesn't make the outcome any less valuable, but does mean there are other options beyond water for someone wanting natural. I don't see the it's water or the drugs argument that is often presented (not least by those hiring or selling pools)

    I agree about the security of water in what has become a very hands on profession for many. But I'm not sure this alone is a good enough reason -this is why some women like to build nests from duvets, beanbags and cushions etc. It is reason enough to educate midwives that mothers need to feel in control and safe and to remain hands off as much as possible.

    I'm also not sure waterbirth means a mum has specifically given oodles of thought to anything - not given the availability of pools now. They may be suggested to a mum in a hospital labour scenario (as per several friends I know)

    I'm also not sure if you're not informed that automatically mean flat on back on land - many midwives are now aware of why this is not a good plan and encourage the women in their care to keep active, moving and/or try different positions. Much much more than they used to.

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  35. "instead of saying that makes it ok for water, shouldn't we be looking at how we can make more births closer to the biological norm and ask what is stopping our infants doing this?"

    That sounds ideal but only if you aren't taking social aspects of birth in context. First, given today's birth culture (at least in the US), no, I don't think we should be striving for the "biological norm" (more about this in a minute) as our number one goal but rather be striving to create safer environments for women and their babies, empower women, respect their bodies and their choices. Sadly we are in such a wretched position re: birth we have more baseline to get to than badgering women about a measure that has helped so many.

    Another fallacy you keep repeating is your "biological norm". There is no such thing really as a "natural"/ideal/biological birth. Human beings have coped with birth in many ways. I read a great article from an anthropologist detailing methods used in many cultures, including hot rocks on mama's tummy and birthing in a sling and using force to yank on the baby and all sorts of goofy stuff. It really was quite extensive and challenged my belief there is a "natural" way to birth - if so, humans haven't been doing it, we've all been interfering and using tools at our disposal to assist (for instance I'm sure you're pro handwashing and/or rudimentary fetoscope/stethoscope etc). If I can find the article I'll send it on to you.

    Over and over I see you postulating a theory - that waterbirth significantly interferes with breastfeeding - and then just repeating "It sounds good so it must be true" despite midwives posting here saying they haven't found your theory bourne out empirically. Look, go ahead and study it, but to repeat over and over "my theory is a good one because you can't prove it isn't" seems like a waste of time.

    By all means let's have a study, hopefully one done by someone who understands the scientific method.

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  36. QUOTE Another fallacy you keep repeating is your "biological norm". There is no such thing really as a "natural"/ideal/biological birth. Human beings have coped with birth in many ways. I read a great article from an anthropologist detailing methods used in many cultures, including hot rocks on mama's tummy and birthing in a sling and using force to yank on the baby and all sorts of goofy stuff. It really was quite extensive and challenged my belief there is a "natural" way to birth - if so, humans haven't been doing it, we've all been interfering and using tools at our disposal to assist (for instance I'm sure you're pro handwashing and/or rudimentary fetoscope/stethoscope etc). If I can find the article I'll send it on to you.

    But surely all the things you describe are cultural/social tools used? perhaps "biological norm" isn't the right term - but yet we seem to agree that the same basics make up that "ideal" -"to create safer environments for women and their babies, empower women, respect their bodies and their choices".

    In terms of birth it seems to me there WELL may be a pattern of normal things baby expects immediately after birth - enough that we do know indicates this surely? I call this a biological norm...as I say perhaps it's not the right term?

    We fundametally seem to disagree on what information we present to women and what that means. I see information such as this as food for thought and discussion, and that women have a right to make their own minds up. You seem to see it as - given birth is so far removed, why "badger" women with something that helps (even if it may also have other implications we don't understand)

    People discuss water births as centuries old, yet despite lots of references to birthing near water, and using water in lots of different ways. Spending hours submerged to the neck and giving birth IN water seems to me to be a very new idea. Even though there is no evidence it doesn't impact on breastfeeding (as this has not been examined) you seem to have had no problem accepting that concept - yet asking for evidence it doesn't impact on breastfeding seems to really annoy you?

    QUOTE despite midwives posting here saying they haven't found your theory bourne out empirically

    Forgive me but no a couple of people who say they are midwives disagreeing doesn't make me rethink things much - it might have 10 years ago. What you also obviously can't see because it's not posted here are that there are others on other lists that say themselves and other midwives have recognised for years that waterborn infants often take longer to establish feeding - and other longterm lactation supporters who have also noted a lot of the problems we experience with medicaated babies are often found in water borns. I did ask people to transfer their comments here, but then got in trouble for asking for the comments to be posted offlist!

    QUOTE - Look, go ahead and study it, but to repeat over and over "my theory is a good one because you can't prove it isn't" seems like a waste of time.

    meee-ow!

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  37. "But that doesn't change the fact that not only myself, but other lactation supporters are noticing as waterbirth becomes more popular, when all other things are equal these mothers experience more problems. For me SOMETHING is impacting, and this would seem the most logical thing to do so :)"

    Your knowledge surrounding waterbirth seems very limited from what you've presented here and elsewhere, I don't think you are making a logical conclusion, to me interference seems like the most logical thought process if you've found a pattern How can you conclude all other factors are equal without a quantitive study group? If you can present the specifics of where each woman birthed, how long the had baby skin to skin, if anyone took baby, etc etc and still find a pattern then I'd be happy to take your theory on board.

    Mums and babies are not in there having a good scrub, babies have plenty of birth fluids on them. There's pictures of me both times, in and out of the pool, chest covered in birth goo from simply having the baby on my chest. They emerge and are scooped out of the water by mum, in a matter of seconds in the vast amount of waterbirths.

    You are completely missing out the most vital point, what is happening at the point between birth and breastcrawl which has interfered with the process. If waterborn babies take longer to crawl is this because in general they also take longer to pink up, they're calm, often don't cry thus it would not be an unexpected delay.

    I wonder if you interviewed independent midwives as a select group who will on the whole see many waterbirths and are least likely to interfere in the birth process whether you'd get the same feedback on dry land versus waterbirth as that's not seeming to be the case from the comments left here by some. I think the stark reality is much more likely to be hindered birth= baby didn't crawl, unhindered= baby crawled.

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  38. I suspect we agree more than we disagree.

    I am not "annoyed" (to use your word). I don't appreciate "mee-ow" much either (sexist catfight trope anyone?).

    I will repeat as I've said: this was an interesting post, and I'd be interested in reading an actual study - if one ever occurs!

    You wrote:

    "People discuss water births as centuries old, yet despite lots of references to birthing near water, and using water in lots of different ways. Spending hours submerged to the neck and giving birth IN water seems to me to be a very new idea."

    I agree with this. (of course, my own waterbirth I was in the water for less than an hour and not submerged to my neck either.)

    Like you I think information is important and I am also tangentially interested in the "waterbirth is centuries old"/"waterbirth is new" investigation. I look forward to reading more about it.

    One caveat: I'd love to see those who claim they are being objective and only talking about information to reference the current birth culture and pressures on women and families because these is affecting birth and breastfeeding to devastating effect. For instance right now I think women need more support and if we are to criticize a beloved and helpful practice - however fact-based our criticisms are, and yes we should do the investigation - we should do so with sensitivity to the social/medical/political scenarios women are placed in.

    "In terms of birth it seems to me there WELL may be a pattern of normal things baby expects immediately after birth - enough that we do know indicates this surely? I call this a biological norm...as I say perhaps it's not the right term"

    I don't know the right term but I also think it is very interesting. I shared this with my husband last night and until then he didn't know newborns could crawl! Thanks for posting a lovely video, by the way.

    "we seem to agree that the same basics make up that 'ideal' -'to create safer environments for women and their babies, empower women, respect their bodies and their choices'."

    Yup.

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  39. You've also had a fair amount of people disagreeing with you on other lists, to say that is bringing on the infamous "others". You're quite rudely dismissing the opinions of midwives who may also be longterm lactation supporters as worthless because a couple of people agreed there may be an issue without even dissecting what their experience of waterbirth is. Is it hospital waterbirth, is it home waterbirth, are they working in NHS protocols, did they have independent support.

    The plural of anecdotes is not data.

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  40. QUOTE I don't think you are making a logical conclusion, to me interference seems like the most logical thought process if you've found a pattern How can you conclude all other factors are equal without a quantitive study group? If you can present the specifics of where each woman birthed, how long the had baby skin to skin, if anyone took baby, etc etc and still find a pattern then I'd be happy to take your theory on board.

    Suzanne you seem to feel I am presenting "evidence" when I am in fact proposing a theory - which of course you are absolutely free to agree or disagree with. Theories are called thoeries - because they haven't been studied no? That's what blogs are for surely, for people to post their opinions? and mine clearly states at the top that is exactly what is presented here.

    I have presented ample evidence scent is massively significant - I feel that would be influenced by water and rubbing down with a towel as Gina's midwife does as standard (logically a baby will get cold when removed from water if wet), you don't - I suspect we could go round in circles all day and not agree?

    QUOTE You've also had a fair amount of people disagreeing with you on other lists, to say that is bringing on the infamous "others". You're quite rudely dismissing the opinions of midwives who may also be longterm lactation supporters as worthless because a couple of people agreed there may be an issue without even dissecting what their experience of waterbirth is. Is it hospital waterbirth, is it home waterbirth, are they working in NHS protocols, did they have independent support.

    Ok well I don't read loads of lists - but on the lists I do read, there have been as many saying it's an interesting theory worthy of closer examination as those saying they disagree. And thats FINE - all I was saying was that because a couple of midwives here didn't agree, that wasn't the opinion of EVERYONE.

    The point I was making as you actually make yourself is that a few replies on a blog does not evidence make. I don't think that saying it doesn't make me change my opinion is rudely dismissing anyone elses opinion? I'm cofnused why you would think that?

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  41. Kelly - Ok cool well I'm glad you're not annoyed - the last few comments I have felt a little attacked for my opinion. Because of that I probably took your comment the wrong way - I'm sorry if my meow offended you, it was not intended! You said:
    QUOTE Look, go ahead and study it, but to repeat over and over "my theory is a good one because you can't prove it isn't" seems like a waste of time.

    And that's kinda how I feel people are presenting the pro waterbirth comments - given waterbirths and breastfeeding hasn't been studied - isn't ALL of it theory from either side? I'm sure most people who read the blog will read the post, comments and pick the side that makes most logical sense to them?

    QUOTE I agree with this. (of course, my own waterbirth I was in the water for less than an hour and not submerged to my neck either.)
    Like you I think information is important and I am also tangentially interested in the "waterbirth is centuries old"/"waterbirth is new" investigation. I look forward to reading more about it.

    Of course all waterbirths are difference - duration of time in the water and also the point at which it is may of course all influence outcome too?

    I was interested to read something someone posted in reply on another list which was:
    QUOTE Certainly Michel Odent always says his intention was to provide water for the mothers as a first stage comfort measure only, and babies began being born in the water by mistake, rather than design, because the mums refused to get out.

    Which is again food for thought I think?

    Thanks again for taking the time to post - glad you enjoyed the video, it's one of my favs :) (I love the UNICEF one but have felt some mums are overpowered by the mass of people surrounding the mum) I do wonder why all the breastcrawl videos shop mums flat on back - when this is not a recommended KMC position?

    ps - sorry for all the typos in my replies - usually done at speed around other child related things!

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  42. Breast Crawl - a scientific overview:

    How many babies successfully complete the 'Breast Crawl'?

    Widström, 1987 - 20 out of 21, the 1 reached the nipple but needed help attaching.

    Righard, 1990 - 17 out of 17

    Varendi, 1994 - 25 out of 30, the 5 reahed the nipple but needed help attaching.

    Varendi, 1996 - 22 out of 32, the 8 reached the nipple but needed help attaching. 1 not moving or didn't reach nipple.

    "Babies completing the Breast Crawl with spontaneous attachment is instinctive and almost a rule with very few requiring assistance"

    So this evidence seems in contrast to what some state about it not being a norm? As far as I can establish these studies were all land births, the last states it is c-section mums which I can't see working well in the water ;)

    One of the studies states:

    Movement of the hand to the mouth and finger sucking are components of the prefeeding behavior displayed immediately after birth. This behavior is disturbed when amniotic fluid was washed off the baby before it was given to the mother (II). Washing may therefore disrupt prefeeding behavior and proper attachment to the nipple, and related studies have shown that problems with nipple attachment are associated with early breastfeeding failure. Several common hospital care routines such as washing the baby immediately after birth and the mother's breasts before feeding interfere with this communication and should be avoided until we know more about its clinical significance.


    There are LOADS of details here about how breast crawling influences breastfeeding:
    http://breastcrawl.org/science.shtml#How-many

    Well worth a read for anyone commenting on the subject - or feels the crawl is not important - babies can just latch later...

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  43. This has been an interesting discussion except to say that you ignore those with anecdotal data that disagrees with your theory Analytical Armidillo. While I appreciate your thought into this, I find your willingness to hold to a pet theory and not enter into discussion with those who have witnessed it time and time again not to be true - well anything other than analytical.Your catty comment that those who "say they are midwives" won't make you change your mind is simply childish, and some of your comments have been very rude to people. How about you take the radical view to listen to what they are saying rather than dismiss it? Enter a dialogue?

    It is also highly offensive that you would say this - QUOTE "I think there are two different issues here - the first is whether you believe that the "breastcrawl" allowing baby chance to locate and attach to the breast themselves, followed by biological nurturing - all immediately after birth with an unwiped baby and mum improve breastfeeding rates. If you don't feel this aspect is important and that first feeds don't matter - or as many do well in western positions initiaed by mother - the importance of whether water or not impacts on this is likely to be massively different to you..."

    This debate is not about love of waterbirth over breastfeeding. I and others are telling you that the two don't have to be exclusive, and when managed properly, that are not. Rather than simply dismiss my comments, how about use that analytical mind of yours to find out why I don't find a problem, and why other midwives do find a problem. Oh I forgot - you simply dismiss those that have anecdotal eviidence that disagrees with your theory.

    You also cannot seriously equate sitting in a birthing pool with all the sweat and birth fluids with "washing". You obviously have not smelt birth water.

    QUOTE: "People discuss water births as centuries old, yet despite lots of references to birthing near water, and using water in lots of different ways. Spending hours submerged to the neck and giving birth IN water seems to me to be a very new idea."

    NOPE. New in the literature, not new in history. the aborigines here in my local area in Australia used to birth in a running stream - gee I wonder how they breast fed with the birth fluids and smells being washed away?

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  44. QUOTE AA: “We know infants that establish feeding with the least amount of problems are those that feed in the first half hour or so after birth - that’s why there is such a big push to do this now. With this logic we could say ah well there's plenty more opportunities to feed later, after all they can do it anytimes...yes for some babies they will have a poor first feed and still go on to latch well - but others (a significant proportion) are more likely to experience problems.”
    This is false logic. I admit the studies say this because they are all hospital based – artificial environments and interfering staff. So if you can get the bub to feed early their chances are better at imprinting before staff jump in to “help”. Well, the reality is that babies take different amounts of time to adjust/recover from the birth, begin their breast crawl and initiate feeding. The difficulty is, that because of the “scientific evidence” (that has actually failed to consider vital variables and the whole reason why early breastfeeding is more successful) staff jump in and try to force baby to feed, bypass the crawling/instinctual behaviour and CAUSE problems. This is a circular problem, because as they don’t attach in 30 minutes than it re-enforces the false evidence.
    Once again, in my practice (and I know you will simply dismiss this because it is anecdotal evidence that disagrees with you rather than anecdotal evidence that agrees with you) if babies are given TIME to recover and initiate the crawl themselves I have noted NO DIFFERENCE in success/difficulties if the bub attached in 30 minutes or in 2 ½ hours. I have highly successful breast feeding rates because of my focus on it in pregnancy, and not interfering after the birth so that the baby can initiate the breast crawl without interference. In fact only 2 mums have not breastfed fully. One had a breast reduction and we tried and tried and supplemented with donated EBM but in the end didn’t have enough and had to use artificial breast milk. (Her second bub we tried again, and the previous stimulation and acini cell growth must have been sufficient because we succeeded this time!) And the other mum had a post partum psychosis and wanted to throw her baby out the window, so she was cared for by the father and fed ABM.

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  45. QUOTE It is also highly offensive that you would say this - QUOTE "I think there are two different issues here - the first is whether you believe that the "breastcrawl" allowing baby chance to locate and attach to the breast themselves, followed by biological nurturing - all immediately after birth with an unwiped baby and mum improve breastfeeding rates. If you don't feel this aspect is important and that first feeds don't matter - or as many do well in western positions initiaed by mother - the importance of whether water or not impacts on this is likely to be massively different to you..."

    Claire - I'm not sure what you find so offensive about my comment - it was late, perhaps it wasn't phrased as well as it could be. Some have posted saying that they don't feel the breastcrawl is that important - there's lots of ways to attach an infant, plus you can always try it later if it doesn't work out.

    Therefore what I was saying was if coming from that perspective - I can understand how fundamentally people are at different places with their logic as a starting point - not that other people can't have a belief in both.

    I am a bit confused about the "smelly birthing water" people keep mentioning - as I don't see how this is automatically comparable to a mother having specific scents localised to an area - but I think I said that quite a few times already...

    QUOTE This has been an interesting discussion except to say that you ignore those with anecdotal data that disagrees with your theory Analytical Armidillo. While I appreciate your thought into this, I find your willingness to hold to a pet theory and not enter into discussion with those who have witnessed it time and time again not to be true

    I don't ignore the data Claire - I recognise that it's anecdotal, and yes I state that anecdotal alone is unlike to influence my views -I think there's a big difference between that and "ignoring". As I said however many posts back, if we only based anything on anecdotes - following my first labour I would claim pethidine and epidurals don't impact on feeding. However I recognise that I was a lucky "good statistic", and there are also plenty of mothers whose experience is totally different to mine.

    Posts on a blog don't also have to represent the truth - there's no ID test. I can post anywhere claiming I'm a midwife and here is my opinion - actually I could be someone hiring out birthpools quite miffed at such a theory. NOT saying that is the case here, but comments on a forum FROM ANYONE do not evidence make (as someone else very rightly pointed out just a few posts back) including my own!

    I think it's VERY unfair to say I don't enter into discussion given the mountains of replies I have left!

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  46. The link I posted last has some interesting information about times feeding was initiated, etc and links to further research. From your post it seems you don't agree with the evidence regarding first feeds ie that it is most effective in the first half hour to an hour ie "I have noted NO DIFFERENCE in success/difficulties if the bub attached in 30 minutes or in 2 ½ hours"

    Which is a whole different discussion I think? (whilst of course linked) and which as you say also contradicts quite a lot of research. The link does show 2 studies that found 150 mins later the intensity of sucking and rooting was diminished - which ties in with what many state ie babies are often born, feed to "meet mum" and then sleep for a good stint, tired themselves from labour. There are also potentially other implications to early v late first feed in terms of colostrum feeding good bacteria and passive immunity to baby?

    But well done you anyway - to only EVER have two people not fully breastfeeding from your entire practice, over however many years is - well astounding actually! I'm guessing you're independent - which would also likely mean all your mums really want to breastfeed, which could skew figures? What I mean is take Gina above - waterbirth, baby crawled but became upset and was "mum attached" - Gina mentions nipple soreness for the first week, but because she obviously wanted to breastfeed - got through that and things improved.

    Some mothers (perhaps those less likely to hire independent services)who are not as passionate, may get sore nipples and switch immediately to bottles. So - I'm really more interested in evidence that waterbirth doesn't hinder the breastcrawl (and yes I mean beyond the anecdotal "my baby did" or "my baby didn't" - because I do think other factors may also influence.)

    So, what may also be a pertinent question in terms of this discussions is whether in your practice ALL the infants except two breastcrawled and self attached - or just that they ended up feeding because mother was motivated and you offered good support? which realistically means most mothers can breastfeed, regardless of hitting or missing any "biological norms".

    I am now starting to feel a bit like an echo lol, so unless anyone brings anything radically new to the table - I'm not sure I have much more to add....plus I have another "Ask the Armadillo" waiting to be written...if only there were another 12 hours in a day, I'd be laughing ;)

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  47. Hi Armadillo
    I am enjoying your blog so much, so a big thank you for taking the time to write it.

    As a mature mum, I had my babies late seventies earlier eighties, I was the only person on the maternity ward to breast feed, other mums used to look at me as if I was mad. Thankfully all went well, because goodness knows who I would have asked if it hadn’t.

    Now there is so much information out there and thanks to people like you who share your knowledge so willingly, so much help too.

    I really do think it’s important to have as much information as possible whether it’s what we want to hear or not, because it’s the only way mums can make an informed choice about what is right for them.

    On the current blog I can’t say much about birthing pools as it was certainly not an option back then. As for the birth crawl, well thinking long and hard about that I think it is what nature intended. When you think about it we are the only mammal whose young don’t help themselves to their mother’s milk?

    You certainly don’t see the mother cow sat patiently waiting for the farmer to come by and latch the calf on for her.

    Although I think its has to be every mother’s choice as to what kind of birth she wants, I do think that with so much hospital intervention in these modern times, we are probably missing out on something very special.

    Keep up the good work armadillo.

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  48. Hello
    I'm an independent midwife attending a lot of waterbirths and I think this is a fascinating theory that needs studying. I'm not sure whether the question is whether water leads to worse breastfeeding outcome because with advice and help most mothers can overcome problems and exclusively breastfeed, I have a very high success rate. I think the interesting part is whether waterbirth stops babies crawling and self attaching or at least some babies, much as I love water if I'm honest I have to admit quite a lot don't crawl or try and become distressed. I thought that not all infants do anyway but after reading the link you posted I am now wondering why that is and if all should do it how significant is not? if allowing babies to have this experience reduces the amount of latching issues then I think its very significant. As you rightly point out the reflexes are present for 6 weeks but the smells and tastes are not.
    As someone has already said this has to be handled sensitively until we know definitely rather than just theory but I can see enough weight in your argument for it to be feasible.

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  49. Hi Simone
    Thanks for taking the time to comment.

    QUOTE
    I'm not sure whether the question is whether water leads to worse breastfeeding outcome because with advice and help most mothers can overcome problems and exclusively breastfeed, I have a very high success rate.

    I do understand what you're saying - if only all women have great support it may not lead to worse outcome, but if mums don't get good support and then also experience problems due to not breastcrawling, it would then influence outcome?

    It's very interesting you have noted some infants not crawling after waterbirths - as others have said these are generally hands off, calming, relaxing labours (so not likely to be due to a heavily managed birth) what other factors do you think could contribute?

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  50. Fascinating article. I was planning a waterbirth for my second in 3 months time, now I"m not so sure... Also very intrigued about the 'exploring pain' comment. It hurts more because we expect it to hurt... Certainly something to think about...

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  51. Weighing in a bit late, but anyway my 2c worth -

    My 2nd and 3rd babies were waterbirths. Both times I have waited until I absolutely couldn't stand it any longer to get into the water.

    My 2nd was a posterior back labour. I used heat application on my back but there came a point where for me the water was the only thing that would bring relief. It was a hard labour, he was a big baby with a big head, so when he did finally come out I think he could find the breast because of all that sweat. haha! I was holding him in my arms and he attached within 10min. Effortless, and no dramas breastfeeding him at all.

    My 3rd was a very quick labour, anterior, again got in the water when I couldn't stand it any longer (in hindsight was in transition). I birthed her myself and I was in the pool for about 10min post-birth, I got out,put on a terry towelling robe and went to the couch to do the breast crawl. She first attached over 1hr after birth, fed for ages both sides. No dramas breastfeeding her either.

    Claire - that has been true in my experience. My first baby I had problems with - she was forced to the breast, she was just licking and not attaching - I thought she wasn't interested (at that time I didn't know that is part of initiating breastfeeding!) so I went and had a shower. And she wasn't a waterbirth either.

    My sister had a pretty rough birth with her baby, induction, epidural, forceps... she kept him skin to skin for 24 hours and did the breast crawl the next day and had a really successful start to breastfeeding.

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  52. Quite interesting so I thought I would share - someone has just linked me to a poll running on a website following my article, so far the results are as follows:

    If you had a waterbirth did your baby breastcrawl

    Yes, in the pool - 4

    Yes, out of the pool - 7
    TOTAL - 11

    No, and I knew about the breastcrawl but bf went ok - 11

    No, and I didn't know about the breastcrawl but bf went ok - 5

    No breastcrawl, I knew about it and bf difficulties happened - 3
    TOTAL 19

    Now although this is only small - and obviously a basic poll can't take into consideration other factors for comparison such as duration of labour, agpars of baby, respondent demographic (and more about that in a moment) BUT it shows that 11 waterbirth babies crawled compared to 19 that did't! (although 5 did not know about it to try it which leaves 14)

    These are very different stats to those found in the four studies above where all crawled.

    Out of the non crawlers whose mums tried it, 3 had problems - this is 21% of the non crawlers, not an insignificant proportion.

    More so because this is a homebirth evidence based site - it's catchment is homebirthing mums,those respoding are very likely to be breastfeeders (ie those who gave up due to problems are less likely to be around to reply) who are likely to be THE most determined demographic in terms of breastfeeding. They may well have read up on good attachment, or have a good level of support from independent midwives which is going to make problems far less likely -yet still 3 out of 14 did...

    I suspect if you asked this question on a very different type of forum, the difference would be even greater - may try and add a poll here but not sure that would be much different in terms of reader audience?

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  53. Thank you for posting this article, it's started a lot of useful discussion and it's definitely something to bear in mind when considering a waterbirth.
    Being a bit of a devil's advocate here but there is another way of interpreting the poll above: out of 30 waterbirths (11+19 if I got that right) 3 had breastfeeding difficulties. 16 did not have difficulties despite lack of breastcrawl. It is not clear whether the 11 who experienced breastcrawl had any difficulties - assuming they did not? And if that is the case, it would mean out of 30 waterbirths 27 were followed by successful breatfeeding and only 3 had difficulties (and perhaps overcame them) - I wonder what would've been the result if these mothers didn't use water?

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  54. QUOTE - there is another way of interpreting the poll above: out of 30 waterbirths (11+19 if I got that right) 3 had breastfeeding difficulties. 16 did not have difficulties despite lack of breastcrawl. It is not clear whether the 11 who experienced breastcrawl had any difficulties - assuming they did not? And if that is the case, it would mean out of 30 waterbirths 27 were followed by successful breatfeeding and only 3 had difficulties (and perhaps overcame them)

    You could break it down simply into waterbirth who breastfed no problems, waterbirth who had problems - but in a poll so small this would surely tell us even less? This demographic are the most likely to be determined to breastfeed and educated to do so, more will have independent midwives and likely the majority home births. If I ran a poll of only 30 at a local LLL meeting, or I ran it at a local surestart centre (where a lot do end up with waterbirths because the pool is suggested) I think the replies would be very different as to whether waterbirth ended in breastfeeding problems yes or no.

    The reason I broke it down into crawled or didn't is because regardless of maternal education - crawling is something baby either does or doesn't do on a biological level. And over half the waterbirth infants in this small group didn't crawl - compared to ALL of the other small groups used for studies on land.
    Of course there could be other factors in this - were some rubbed and dried more than others, did some allow more time than others, were some labours longer than others - I'm not trying to present a one stop answer.

    Whether the breastcrawl is significant in waterbirths can surely therefore only be measured by problem rates in those who didn't do it - in this case just over 20% - yes this of course means 80% OF THIS DEMOGRAPHIC breastfed fine - but then I never at any point suggested ALL, I went to great length not to.

    So we can turn the figures about whichever way we want really, I still think even such a small number shows a very interesting outcome...

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  55. what i would have liked. is a pool big enough to swim in. move my legs. kick. i loved my water birth but a large pool would have been lovely. bit off topic but my son didn't have trouble latching and my breasts were submerged uncovered for hours as i was hands and knees until the moment of emergence when I flipped up and over...he been a great nurser for going on 8 months. I wouldn't be surprised to see that it can have an effect scent. but a large heated pool can you imagine?

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  56. QUOTE- “I'm not sure what you find so offensive about my comment”
    It was offensive because you dismissed every counter argument as not valuing the breast crawl enough. It is extremely important to me, as is breast feeding. If our basic argument is simply dismissed with this generalisation – it is offensive. If one or two people have posted that it doesn’t matter – it still does not make sense to dismiss all arguments with the same brush.

    QUOTE: “I am a bit confused about the "smelly birthing water" people keep mentioning - as I don't see how this is automatically comparable to a mother having specific scents localised to an area - but I think I said that quite a few times already...”
    Because you brought up a study that talked about “washing” the baby after birth. And because you completely ignore the fact that while I agree with you that the smells are diluted, and while I agree with you that the smells are more generalised – babies still breast crawl. Hmmmm. Maybe the “scientific literature” doesn’t know everything about the how’s and why’s? Someone mentioned earlier – I think it was Suzanne – that the Montgomery glands excrete a very powerful scent. That is most certainly localised.

    QUOTE: “I don't ignore the data Claire”
    I said you ignored THOSE with analytical data. And you did. You completely ignored my post. Absolutely completely, did not acknowledge one single point that I made as to what really made a difference to the breast crawl. And when someone pointed that out – you said “just because somebody says they are a midwife doesn’t mean I am going to change my opinion” or something similar, I don’t have time to go trolling back.

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  57. I have to say I have noticed this. Whilst we expect babies who have had a
    traumatic birth, or one with lots of anagesia to have initial problems
    breastfeeding, I've supported a number of mums with great difficulty bf in the
    first few days who have had straightforward births, but in water.

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  58. I have been asked to comment on this blog. I will state that I have also been asked this question by the master of bonding, Dr. Marshall Klaus, and when I explained to him that the water in the birth pool picks up the scent of the amniotic fluid we discussed briefly that I have rarely encountered a waterbirth mother with latch issues.
    I then encouraged a midwife to take this issue on as her area of research study, which she did. A year later she put together an amazing powerpoint and presented it at the 2004 Waterbirth Congress in Chicago. The conclusions were, briefly stated, that the baby and mother when left in the "maternal circuit" in the original habitat for post partum; ie between the breasts - that the brain of both mother and baby secrete hormones, pheromones, that are picked up by the olfactory nerves. These pheromones are fat soluble, not water soluble. I have a list of references and am including this very discussion in my new book, "The Complete Guide to Waterbirth." If there were actually breastfeeding "problems" with water babies, out of the quarter of a million children born in water over the past 40 years, including two of my own, we would have encountered this much sooner. My two water babies collectively breastfed for 73 months of my life without any latch or crawl difficulties. Over the past 38 years of my career in birth, I have assisted many women to reconnect with their babies with the crawl in the bathtub after a traumatic birth or delayed bonding. It could be three weeks since birth or even with adopted babies. The water is a miraculous medium for attachment and breastfeeding. It is the skin to skin, not mater whether wet or dry that produces said hormones or pheromones. More on that technique in the 2012 release of "Embracing the Miracle: How Pregnancy, Birth and the First Hour Influence Human Potential."

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  59. Thank you Barbara for taking the time to share your wisdom on this, and the science behind it. A most excellent addition to this discussion.

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  60. QUOTE It was offensive because you dismissed every counter argument as not valuing the breast crawl enough.

    No I didn't? Several people had stated they didn't think the breast crawl mattered - I was therefore saying for people who feel like that, we are coming from it at a fundamentally different angle. If you're not one of those people, the point wouldn't even be relevant to yourself would it?

    You also seem to feel (regardless of what I reply) that because your opinion doesn't make me change mine, that I'm ignoring or dismissing your argument - I'm not, as I think I already clarified. I appreciate you replying that you don't have problems, others have also observed they do - so we could sit an age going backwards and forwards recovering the same ground, purely on a "I believe" basis.

    QUOTE And because you completely ignore the fact that while I agree with you that the smells are diluted, and while I agree with you that the smells are more generalised – babies still breast crawl

    Nope I haven't ignored that either Claire - I've registered that's your opinion :) You state categorically infants breastcrawl after water - I'm not convinced all do. A tiny poll yesterday would also seem to show even mothers who knew about the breastcrawl and tried it, found at least half didn't do it - ok there could be other reasons (although as I think it was you that pointed out, waterbirth is hands off, calm, quiet etc and often removed from the interventions we think will impact on land) different factors may come into play that need more exploring. But "because claire says so" doesn't generally tend to be accepted as an evidence based argument ;)

    I'm not sure what from your post you wanted me to acknowledge that I didn't - let me know and I will take a look. I read it as anecdotal evidence that I didn't really have anything to add to, but if I've missed something as I say, yell :) Someone mentioned that even though two midwives disagreed I was carrying on with the theory (or words to that effect) and yes I did reply that two lots of anecdotal evidence from midwives did not evidence make - scroll back and you will see other midwives have notice a difference in water, other lactation workers have noticed a difference in latching - so even on the replies we have very contradicting anecdotal evidence.

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  61. HI Barbara
    That's great - did you encourage the midwife you mention to publish her findings? I would definitely love to see evidence if you have some :) When you say a midwife took it on as her areas of study - what exactly was the study area pls? ie was it breastcrawling or latching or scent etc?

    It's also interesting that your experience ie that you rarely find a waterbirth with latching issues, particularly when that is in contrast to what some of us have noticed. Perhaps there is something about the way you practice that is different to waterbirths where there are issues?all certainly more interesting food for thought :)

    QUOTE If there were actually breastfeeding "problems" with water babies, out of the quarter of a million children born in water over the past 40 years, including two of my own, we would have encountered this much sooner

    Will all due respect (and I am extremely grateful that someone with your level of expertise has taken the time to reply when someone asked you :)) I'm not at all sure we would have noticed a breastfeeding link sooner - artificial feeding rates have been so high during this periods, and any evidence I can locate seems to be focused on the general safety of waterbirth in terms of infection rates, direct health outcome. The assumption seems to have been made LONG ago that water = natural and so whilst studies have looked at how analgesics etc impact, it seems everyone has always just assumed water wouldn't?

    For those attending lots of homebirths - how common is drying the infant with a towel when mum leaves the water?

    I'm also intested in bacterial colonisation and waterbirths - does anyone know whether being born into water impact on exposure to mums bacteria? as described in my latest post?

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  62. Interesting idea, I've had two, first baby was a hospital/forceps delivery and not given to me for some time but we established breastfeeding really quickly and easily. Second (now 4 mths) was a water birth, I received him myself and held him against me straight away, I wouldn't say he 'crawled' because I was upright in the pool and if I'd put him on my chest he'd have slid off straight into the water, we REALLY struggled to get feeding established despite him having a very good (over an hr) first feed immediately after we got out of the pool. If I hadn't been so successful with the first I would have given up breast feeding the second long before now.

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  63. Okay.. I read a good amount if the comments but stopped about a fifteenth of the way down. Lol there are a TON!

    Let me just say, from all the references, I'm assuming you're in the uk (I apologize if you're not) but I'm from the us. It stinks and I hate it but things are just different here. Birthing had become more of a way to make money here and less about a woman giving birth.. My first cold was born, in a hospital, induced, epidural, stranded beetle, all that. I luckily had no complications and she latched like a pro. She breastfed for two years. Now... She is about to turn three and in this time I've learned a LOT. My next birth will be in my home and completely different. Haven't decided on water birth or anything specific but I do know it well be a completely different experience. Now... I had never even heard of the "breast crawl" until this article. So, I can assure you that it isn't very mainstream.. Or maybe I just missed something. Maybe with midwives you hear about it.. I'm not sure, but I know that even in all the articles and stuff I've read, this is the first one that has really mentioned it. I feel like I may have heard of it but didn't realize it was such a big deal. I sound so ignorant compared to ask of you. Lol and I guess, in a way, I am. But anyway, my point was that maybe a lot of this having trouble afterward is due to tons of other women who, like me, really had no clue what it is in the first place. With my hospital birth, all through my prenatal care, it was pounded into my head that, if you want your baby to breastfeed, you need to so it within the first hour and a half of life or you'll have problems.things are just so much different here. Maybe I didn't have a very active or daffodil doctor too, I don't know. But ugh. Rest assured, things will be different next time.

    Thanks for the post though, very interesting read. And I'm really curious as to what people will say back to my post but I may not be able to find the comments if you do. Lol!

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  64. Detailed is whati meant. Haha not daffodil... Lol

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  65. I have heard first time about the water births. As it is written here that of the best method to get the pain relief. And many people are trying this.

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  66. Have had 4 waterbirths at home, no problems breastfeeding any of them. I am a midwife and one particular obstetrician took great delight in telling me that the only land mammal that chooses to give birth in water is the hippopotamus. I presume hippos have no problem breastfeeding and one can assume that the potential for dilution of smells is increased. in large volumes of water

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  67. I think you might have several really good bits for thought here. I've also read that babies born in water at at greater risk of Vit K deficiency due to not having the usual exposure to the bacteria in maternal faeces

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  68. I labored for 13 hours in water at home & had to transfer to the hospital because of bad meconium. We had horrible nursing issues, but it was because they hospital wouldn't let me nurse him for for almost 40 hours after I had him. (He was in a level 2 nicu) I had flat nipples which caused issues too.
    I'm pregnant with my 2nd and planning a home birth this time as well. There is NO WAY ON EARTH I could do labor at home without a pool. If I figured out how to nurse my first one with all the issues we had, I can figure out the 2nd one. I can see how it makes sense, but this would not be a valid reason to not use water.

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  69. My waterbirth baby latched within 30 minutes of her first breath. My breasts were dripping milk and smelled of it even though we were in water. I've worked in a water birthing center for 3 years and I haven't seen any evidence of a problem breastfeeding after water birth. Many babies nurse before they even leave the tub.

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  70. Yes it's interesting that some mums have no problems, whilst others do and other lactation supporters have also noticed the same. I guess though nothing is about definites? some babes have a traumatic delivery, don't feed for ages after and then latch like pros and never look back, whilst others will struggle if they don't get the immediate post birth feed.
    I would like to see more examination of the breastcrawl and water - to see whether this biological norm is disturbed any.
    Would also like more evidence re gut colonisation and whether water influences this.

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  71. This is really interesting. I've never heard of this connection before. I had a strong desire to birth my first daughter in the water, but wasn't allowed to at the hospital I gave birth in. My 2nd daughter I had at home, but I had a very very strong feeling that I should NOT birth in water, and had no desire to. Gotta love mama's intuition, because her cord was so short that if she'd been born in the water, we would have had to climb out of the tub immediately to get her above the water. I didn't get to do the breast-crawl with either child, but thankfully didn't have many problems breastfeeding them either.

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  72. I've had one c/s, one hospital drug-free VBAC, and two home water birth VBACs. My two water births were my best births by far (1st VBAC baby was 8lb 3oz and I had bi-directional really horrific tearing; 1st water baby was 10lb 8oz with only a superficial tear that needed no stitching; next water birth 8lb baby no repairs then either). They were also my best nursing experiences, though that's arguably because I knew better what I was doing. That being said, my thoughts while reading the article were A)does anybody who isn't part of an experiment give birth and then just lie there not holding and snuggling their newborn to wait and see if they'll crawl to the breast? and B)sometimes moms have trouble with nursing and sometimes they don't, regardless of the type of birth, so it seems like if water helps moms give birth without drugs and helps with birth injuries (all of which research says it does), then I'm thinking best leave well enough alone. Having done it both ways, I'd never voluntarily give birth NOT in water again.

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  73. I must say, I had a home water birth after 48 hours of labour using gas and air for about four of them, and my daughter latched on within about 3 minutes of birth and we've never had any issues. Of course, that's just personal experience, but thought I'd share. I would also never ever choose to give birth any other way.

    We also didn't really towel dry my daughter - she was wrapped in a blanket and cleaned of blood and so on, but we left all the ... whatever it's called ... on her till her first bath at two days old, until her skin could establish it's own oils.

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  74. my water-born babe latched on to my midwife's finger as soon as her head was out! As soon as she was completely birthed, I instinctively put her directly to breast; she suckled for a moment then fell asleep. Breastfeeding was established quickly, although she shares the same horrid, uncomfortably tight latch and tongue thrust as her elder sister (which didn't keep us from nursing for 3 years the first time around!)

    Having had both a land and a water delivery, I would NEVER go back to land. Ugh ugh ugh! :)

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  75. A very interesting read. I have had 3 children, all labored in water. My first daughter, I had to get out because I had slowed down, so having a dry land birth. Jessica was breastfed ,I had a small amount of latching on issues with her, but within a few wks, everything was ticketyboo! My second was born in the water, breast within half an hr and never had any issues at all! My son who was born very quickly within water 11 mths ago, again was breastfed too. This time it was within a an hr ( I fainted as I got out the pool ) and again apart from the odd sore nipple ( small mouth and large nipples) he fed very well and still is. If i have a 4th, Id still have a waterbirth, it so calming and a brilliant way of birthing your baby into this world xx

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  76. Armadillo, interesting idea, but it doesn't really seem to bear out to me, for various reasons. Here are some:

    1. I've been immersed in the world of homebirth for 14 years now, during which time I've had 6 babies of my own (all waterbirths), and have moderated the HomebirthUK discussion group, and for many years the UK Midwifery group too. In addition, I own the Homebirth.org.uk site, which carries many homebirth stories. Many, many of those birth stories are in water (I estimate 50%). I have not noticed **any** tendency towards breastfeeding problems in waterbirth babies. I *have* suspected a tendency to higher blood loss and more retained placentas in women who stay in a hot pool after birth, and there appears to be some mention of this in the literature. I'd like to see research on your idea, but really do not have any evidence, anecdotal or otherwise, to think it's an issue.

    2. Sweat is not water-soluble, so the water in a pool would have limited effect anyway. And skin scents are continuously produced and renewed. I can assure you that, after a waterbirth, you still want a bath or shower pretty soon after giving birth!

    3. Surely most women instinctively offer their breast to the baby, and don't wait for the baby to breast crawl. Indeed, why on earth should we wait for this to happen? You'd have to actively hold back. I understand why some women choose to do this, and it is fascinating, but would hate anyone to get the idea that instinctively offering your baby the breast after birth could put him off feeding. Surely that's not what you're saying?

    4. I just can't imagine focusing on keeping breasts/armpits out of the water when in strong labour. Why, why, why? I would at least want some evidence of potential harm in order to even think about it!

    There are many more

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  77. I'm afraid, having read ALL of the responses to this article (as well as the article itself, of course), I do not buy into the idea that women should be warned that waterbirth might hinder breastfeeding success.
    Breastcrawl *may* be an important indicator of future bf success, but it is certainly not necessary. As for it being a biological norm...well, I would venture a guess that most Western women have never even heard of the concept and yet the majority of Western mothers do at least initiate breastfeeding with a reasonable proportion continuing for months and years (in spite of the general cultural barriers to breastfeeding).
    To add my anecdotal personal experience, I have birthed four children, and spent at least part of each labour in water: one interventionist hospital vaginal birth; one crash c-section for placental abruption - I was in an out of consciousness and baby needed resus; one home vbac on land; and one home vbac in a birth pool (and my first vbac birth story is posted on Angela Horn's wonderful homebirth.org.uk site). All four of my babies latched and nursed within the first hour (I do not remember my cs baby's first feed, but I was lucky enough to have a husband and midwife who knew how important it was to me, so they latched baby on before I came round). None of them breastcrawled. My youngest has a fairly pronounced tongue tie. I exclusively breastfed all of them (no formula) for between 13 and 29 months. I believe our breastfeeding success is down to two things: mainly, my determination to breastfeed - for me, giving up was not an option in spite of various difficulties that cropped up, and I was surrounded by supportive people who never undermined my determination and I gave birth to healthy, full-term babies; secondly, and perhaps more pertinent to this conversation, in the first hours following birth, no one interfered with me or my babies as we 'met' each other. They weren't taken away, no one tried to shove my breast in their faces, I wasn't pressured to move to another room or take a shower.
    As an aside, I am not sure why birthing in water would interfere with gut colonisation. Warm, moist environments are ideal breeding grounds for bacteria, and if my whole naked body has been in that water for an hour or more, it seems to me the water itself would be teeming with my bacteria. Thus a baby born into this water would have a headstart on gut colonisation. But I'm no scientist, so perhaps I'm mistaken.

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  78. I have had 8 children. 1 c/s, 2 hosp VBAC w/epi, 3 HWBAC, 4 UBAC, 5-8 UWBAC.

    C/S baby REFUSED to nurse & I was uneducated. Hospital VBAC baby kept falling asleep & I was still uneducated so I gave up. My 1st home birthed & water birthed baby I GOT educated on breastfeeding and I FOUND support. He latched on within the first hour after birth but I had to WORK at breastfeeding as I was still NEW to it and learning myself.

    My 2nd HB baby was a land birth. I don't remember the first latch but I had complications with him from the get go with thrush that lasted for months before I quit (long story with near death infection).

    Baby #5 and 2nd water birthed baby, latched on well but again more complications with lethargy due to jaundice, and the nightmare thrush. I ended up exclusively pumping for him.

    Baby #6 3rd water birth. She latched well but not well enough. She was constantly clicking and my breasts weren't draining and she was losing weight. We tried everything but realized she had a palate malformation. I again went back to exclusively pumping.

    Baby #7 4th water birth, latched withing hours of birth, nursed well. I had issues with my right breast getting plugs and my son refused to nurse on the breast with plugged ducts. It was a constant battle in which I literally had to pump my right breast and feed him by bottle and nurse from the left. The constant struggle and increased work lasted for 11 months before he would nurse from both sides and I didn't need to pump anymore.

    Baby #8 5th waterbirth - absolute DREAM nurser compared to the problems I had in the past. She latched on in the birthing tub shortly after birth. After I showered & dressed I nurser her again, and 11mo later I have not had a single barrier keep up from one of the most easiest beautiful breastfeeding relationships I have had out of 8 kids now! No leaky boobs, no difficult latching, only a couple minor pumpings needed.

    I do not think it is mode of delivery, but determination of mother that makes a BF relationship possible.

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  79. Geesh...you can always just lift up your baby and put it close to your nipple! All these bloody theories get in the way of common sense. Women will automatically pick up a baby and place it close to their nipple after a while This whole baby crawling to nipple thing is just nonsense. Of course its a good idea to wait till the littleun shows signs of interest, but really, do we spend the next few months lying around naked waiting for the baby to find its own way to the nipple?
    I'm all for natural childbirth, but I hate the way it's becoming a religion rather than simple common sense and working with Ma Nature!!
    Waterbirth is such a blessing pain wise.

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