Water births: a naked emperor.

Abstract

In Hans Christian Andersen's sartorial tale of a vain emperor,1 it takes a child's vision to bring clarity to an awkward situation. Despite knowing the naked truth, the people scold the child for speaking out and actively ignore the issues raised by his challenge. In a sense, water births, the birthing of an infant underwater, are much like the emperor's new clothes in that some people believe what they wish to serve their own purpose while actively ignoring the facts at hand and admonishing those who question their opinions. Despite an absence of supporting evidence, proponents of water births claim benefits and disregard concerns while continuing to fail to subject this approach to the rigors of scientific inquiry. This desire to ignore the facts may be particularly prevalent among individuals who prefer nontraditional delivery techniques. In a 1989 editorial in the Journal of Nurse-Midwifery , Elder2 compelled readers to put aside concerns about a lack of research and data, essentially to feel little need for this information when considering alternative practices, but instead to seek a “balanced perspective” against such “rigorous analysis.” Elder wrote: “If one claims something is a fact, how should the claim be supported? Indeed, must it be supported?” She offered that nurse midwives, among the majority of proponents of alternative childbirth methods, should be “pioneers,” taking pride in offering unproven alternatives. By advocating for this approach, she validated the long-recognized gap that separates practitioners of evidence-based medicine from practitioners who accept unproven alternatives as a basis for practice. In the current era of natural and alternative medicine, practices such as water births continue to be introduced without validation of their equality or superiority to standard obstetrical practice and despite some clear potential risks. In such a model, good alternative birthing practices cannot be differentiated …