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9 April 2012

Dear Editor,

We read with great interest the recent study by Carpenter and Weston,[1] who evaluated the differentiating features for respiratory distress after water birth versus air birth in term low-risk neonates. Clinical and X-ray features were assessed to determine if the disease process could be differentiated. The authors reported that the water birth babies showed greater acidosis and greater requirement for ventilation and nitric oxide treatment. They stated that the morbidity in water birth group may be attributable to water aspiration and likely to be avoidable if delivery into water is not chosen.

In a recent study, we sought to investigate the demographic and clinical features, birth complications, infection rates and rates of neonatal intensive care unit attendance of 191 water birth infants in a 5-year period.[2] The mean gestational age and birthweight of the patients were 39.2 ± 1.3 weeks and 3326 ± 409 g, respectively. Four of the patients (2%) were admitted to the neonatal intensive care unit because of respiratory distress soon after birth. Three patients required continuous positive airway pressure (CPAP), and one required supplemental oxygen. We did not observe low Apgar scores, low pH, unexplained deaths, drowning, hyponatraemia due to water intoxication, water aspiration leading to respiratory distress syndrome and respiratory failure. None of the patients required mechanical ventilation or inhaled nitric oxide for pulmonary hypertension. Meconium aspiration was not present in any patient. The chest X-rays of three patients were compatible with transient tachypnoea of newborn and one with pneumonia. Except for the patient who received antibiotic therapy because of neonatal pneumonia, infection screening tests were negative for the other three patients. CPAP requirement lasted for 1 day in three patients, but for 2 days in the patient diagnosed with congenital pneumonia. All other newborns were evaluated as healthy, observed beside their mother for 1 day and breastfed.

In conclusion, our report demonstrated that water birth is a safe, valuable and promising alternative method of delivery for the neonates when certain criteria are met, and its effect on neonatal outcomes, particularly related to respiratory complications, seems to be acceptable.

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