Waterbirth: A 10-Year Retrospective
by Barbara Harper, R.N.(1996)

Barbara Harper, RN, is a childbirth educator, birth activist, and former traditional midwife. She is author of Gentle Birth Choices, and producer of the video of the same name. Barbara works and lives in Wilsonville, Oregon, with her three children. Email can be addressed to: waterbirth@aol.com.

The First International Conference on Waterbirths, held in London in April, 1995 left me with a calm and inner satisfaction that is difficult to express.

I sat in the darkened auditorium, surrounded by more than 1,000 birth practitioners from 36 countries, listening to reports and statistics from nearly 9,000 waterbirths. And I wept. Gut-wrenching tears spilled down my face. I felt an emotional release, an exhausted escape, caused by the realization that I was not alone in telling the world about the wonder of water. And I was encouraged by the people who wanted me to be successful, and who respected and supported my chosen path. The support overwhelmed me. But this has not always been so.

I was introduced to waterbirth in 1983, when I was shown the book, Water Babies by Erik Sidenblah. This book chronicled the life and work of Russian Igor Charcovsky, a gym teacher, boat builder, researcher and scientist. Although not a physician, Charcovsky experimented extensively with the use of warm water immersion during the process of human labor. He wanted to observe the effects of buoyancy on laboring women. Gradually, he began allowing women to birth in the warm water-filled tubs. His focus shifted to observing newborn behavior, and he recommended that infants be immediately placed back into an aquatic environment.

I wanted to learn more about the benefits and risks of warm water immersion for labor and birth, so I traveled to Paris in search of Drs. Michel Odent and Frederick Leboyer, both familiar with labor and birth in water. I was unable to meet them, but I did talk with the midwives who worked with Dr. Odent, and with several mothers who had given birth in water. I also witnessed labor in water and non-medical births.

My whole life changed on October 27, 1984, when I gave birth to my second child in a homemade water tub. I made a conscious decision to educate the public and medical professionals in this county, if not the world, on the efficacy and safety of birthing babies in warm water. This path was fraught with controversy, rejection and ridicule from both the medical establishment and the midwifery community.

Between 1984 and 1988, fifteen women came to my home to birth their babies in my hot tub. Hundreds more called and asked for help. I began teaching workshops and holding informational nights in my home. Every woman who had a waterbirth influenced at least ten others to be curious about it. Then came Michel Odent's revolutionary book, Birth Reborn, at the end of 1984. Women finally had a model on which to base their instinctive desires for a completely natural birth experience in or out of the water.

In 1988, I went on my first trip to Russia to meet with parents who had had waterbirths. I also wanted to meet Igor Charcovsky. I met with dozens of parents and had a lengthy meeting with Igor. Midwives and parents took me to local hospitals, where I saw the incredible need for alternatives to the horrors of Soviet maternity care. During my trip, I also went to Crimea, where I was told many women gave birth in the Black Sea during the summer months. I saw no births during my brief visit, but I met more people in the waterbirth movement in Russia.

During that trip, I promised the Russian waterbirth couples and their midwives that I would found an international organization that might be able to help them gain recognition as a legitimate group by their own government. At the same time, I knew we needed a similar vehicle in the United States to disseminate correct and current information about labor and birth in water. When a negative commentary on waterbirth appeared in the Fall 1988 issue of Mothering Magazine, I responded with a compassionate letter sharing my personal experience, and asking for interested people to contact me with stories of their own births or questions and comments. The positive mail I received was overwhelming and was the impetus for me to begin my non-profit organization, Waterbirth International. Our intent was to preserve and protect natural childbirth and natural childbirth in water. To achieve that end, we would engage in charitable, educational, research, and publishing activities.

Three years ago, we changed the name to Global Maternal/Child Health Association (GMCHA) to more accurately reflect all that we do. Birth in water is simply a platform from which to inform a basically misinformed public on all the issues that surround birth. The public has become so used to seeing images on television of women being drugged, plugged probed, prodded, managed and coached! But when someone sees a waterbirth on television, what he or she truly remembers is a woman empowered to reach down and lift up her own baby. The woman is awake and aware, she moves however she wishes, and has her chosen birth attendants supporting and watching her. The whole picture of birth suddenly changed for thousands of women across America in 1993 when GMCHA helped produce a waterbirth segment for ABC's television show 20/20.

Today, our focus is still the dissemination of current and correct information, but on a broader scale. The production of the video, Gentle Birth Choices, was a priority for us because it succinctly gave midwives the visual images and voices of authority and strength to help informe the public about the benefits of midwifery and natural childbirth. In addition, we provide a complete waterbirth information service and have been offering waterbirth courses and certification for midwives, nurses and doctors in and out of hospital settings. As more and more couples ask for warm water immersion, it is important to develop similar guidelines for practice as well as for the installation and use of permanent tubs in hospital or clinic environments. Teaching remains very important, because technocracy won't change simply because tubs are installed. The rationales and research behind the reasons for allowing women to choose this option must be discussed.

To date, more than 250 midwives, 10 birth centers and 30 hospitals are listed on our U.S. referral list of practitioners who will help facilitate a waterbirth. One of our goals for 1995-1996 is to network with Midwives Alliance of North America (MANA), the American College of Nurse-Midwives (ACNM), and the National Association of Childbearing Centers (NACC) so that our waterbirth practitioner survey can be sent to their members. This way, we can provide even more accurate referral information to pregnant couples.

We are also creating a grant proposal which, if funded, would allow us to survey by mail and phone all the maternity units in the United States and Canada on the use of warm water as a pain management modality. Then we can start the painstaking process of tracking, using computer epidemiology programs, all waterbirths in all facilities, so that in the very near future we can have some usable retrospective data to offer the medical establishment. This has already been done in England through the National Perinatal Epidemiology Unit, a study funded by British National Health Service. A true prospective randomized control trial of birth in water could be carried out on a very limited population; the model for that program has already been created in a small rural hospital in North Carolina. Within the next 25 years, it is our intent to see waterbirth become commonplace both in homebirth and in clinical settings and to have several common "problems" in labor be an indication for a waterbirth.

One of my greatest pleasures has been my ability to meet the growing need for information as more and more women ask for waterbirths. Current global estimates on the number of waterbirths that have taken place in the last 10 years has grown as we discover low-key obstetricians and midwives around the planet who love using water for labor and birth. We now believe approximately 25,000 babies have been born in water between 1984 and 1995.

In early July, two Virginia traditional midwives attended the homebirth of term twins, both born in water with breech presentations. One of the midwives said to me, as many midwives often say, "The more waterbirths I see in my practice, the less I want to do 'dry' birth." Gloria Lemay and Mary Sullivan, traditional midwives from Vancouver, British Columbia, followed the usual pattern of investigating waterbirth to becoming completely convinced of its relaxation, pain and spiritual benefits. Almost all of their clients now request waterbirths, thus Gloria and Mary have attended close to 300 births in water.

Midwives that have not embraced waterbirth, or who choose not to allow women to stay in the tub for their births, have various personal and professional reasons. Midwives have challenged me at the start of my professional workshops with statements like, "I came here to decide if I am or am not going to do waterbirths. I'll let you know at the end of the workshop." I am not convincing anyone of anything. Rather, I am simply relating the information and letting people decide based on experience and comfort level. When teaching a waterbirth workshop, I begin with these remarks, "I want to tell you three things that waterbirth is not. It is not a fad"it is here to stay. It is not part of a cult"there is never just one way or a best way to give birth, for you or your baby. Waterbirth is not for everyone" mothers and practitioners alike."

Personally, statistics don't matter; the medical establishment doesn't matter; the doubts and fears of others don't matter. What does matter is the innate wisdom women exhibit when given the opportunity to rid themselves of past or societal conditioning that inhibits and disempowers them. What does matter is the beauty of women giving birth in dignity, love and power, whether in or out of the water. And what matters is the manner in which babies are received.
I encourage women by telling them, "If water is your choice, your way, don't let someone else's attitude, fear or conditioning be an intervention to keep you from doing what is natural and normal for you." Our motto at Global Maternal/Child Health Association is, "Together, we're making a difference." It stands true for all of us concerned with keeping natural childbirth and waterbirth an option for our grandchildren and generations to come.

*Editor's Note: This article first appeared in Midwifery Today. More information about the Global Maternal/Child Health Association can be found at their website