Stones From a Glass House: In Reply

Abstract

In Reply .— I appreciate the comments of King and Carr in regards to my commentary on water birth.1 It is regrettable that they illustrate the points of my commentary by missing them entirely. The discerning reader will note that their comments reflect little of my commentary or its intent. They change the focus away from my invitation to provide legitimacy to alternative birthing practices that currently do not enjoy it. They did not provide substantive examples of what I may have missed or how my concern for a lack of evidence to support the claims of water-birth proponents may be misguided. To understand the unique position and perspective that medical and midwifery providers of alternative birthing practices fill, it is important to place it in the context in which it dwells. The series of articles that appeared in the Journal of Nurse-Midwifery in 1989,2 describing alternative birthing practices and the attitudes of their practitioners, provide precisely that, in their own words. This “dated” information remains as relevant today as it did then and does not suffer from having aged. It is the environment from which King and Carr write, and it is that milieu that I think threatens to fail them and their constituency in regards to immersion in childbirth. The review from the Cochrane Library entitled “Immersion in Water in Pregnancy, Labour and Birth” (an update of the review cited by King and Carr) was not available to me as I wrote my commentary.3 Closer examination of this review gives pause to any claim of clinical significance. Although the conclusion of the meta-analysis is encouraging, the insurmountable limitations they note bar any certainty in claim to the truth on immersion. The review's authors note the same methodologic issues as I did. They note that the nature …