Letter to the Editor: Disappointed by Mayo decision on water births
To the Editor:
Hello Waukon! I did not expect to be writing again so soon, but here we are. As some background about myself I grew up in Osage, Iowa, studied medicine at the University of Iowa, and eventually landed here in Waukon where I work for the Mayo-Franciscan organization based in La Crosse, Wisconsin. When I arrived three years ago, Waukon had a well established reputation for providing expecting mothers with the option of laboring and giving birth in a birthing tub; a so-called “water birth.” This was a new technique to me as it is not part of usual family medicine training. In order to better understand it I talked to patients who had experienced labor and delivery in and out of the water and attended deliveries that one of my partners performed using the birthing tub. With my wife becoming a water birth enthusiast I even managed to catch my second son in the tub with my partner’s guidance. In taking time to understand this technique I have come to appreciate its advantages in low-risk births.
In April of 2014 the American College of Obstetricians and Gynecologists (ACOG) and American Academy of Pediatrics (AAP) released a joint statement regarding immersion in water during labor and delivery. It concluded that laboring in water is safe and that delivering in water has not been established as safe and thus should be considered an experimental procedure that only should be performed within the context of an appropriately designed clinical trial with informed consent. This was concerning to me as small town doctors generally do not have the time and resources to organize clinical trials, however, our leadership in La Crosse stepped up to the challenge and began to organize the trial that would allow Mayo-Franciscan providers to contribute to the medical field’s understanding of water births.
Unfortunately, despite specifically recommending clinical trials, it seems the AAP considers water birth to be inappropriate to do clinical trials on. Mayo Clinic in Rochester has thus decreed that, due to safety concerns, Mayo-Franciscan providers will no longer be able to perform water births. I can only say that I am disappointed.
I am disappointed that the AAP is apparently too gutless to allow the studies that they specifically recommend. The doctors who were to be involved are experienced, serious clinicians who were very excited to have the opportunity to contribute to medical knowledge. This is a missed opportunity.
I am disappointed that Mayo Rochester is citing safety as the reason for forcing providers to stop doing water births. From my understanding of the decision making process, medico legal concerns are a much more likely reason. As far as safety goes, many basic obstetric interventions done in the interest of patient comfort cause uncommon but serious complications. I know patients who have gotten bacterial meningitis from an epidural and who stopped breathing when giving IV pain medications, yet we offer these interventions to almost every laboring woman who comes to the hospital.
I am disappointed at the angst that Mayo Rochester’s decision is causing patients in Waukon. Many women now have to re-evaluate how and where they are going to deliver. Some will choose to give birth at home. While giving birth at home can be comfortable, few people have resources like resuscitation equipment, a blood bank, and multiple trained nursing staff in their home. These are very useful when an emergency occurs. I hope that the AAP and Mayo Rochester contemplated this when considering the safety of the patient.
Finally, I am disappointed that an organization that has achieved the international fame and clout of Mayo Clinic in Rochester has failed to support its rural doctors in the Mayo-Franciscan network. I do not know the providers who offer water birth in La Crosse and Tomah, Wisconsin, but I do know my partners here in Waukon. They are not only some of the greatest doctors that Mayo Clinic has but also some of its greatest people. They are not big-wig administrators; they do not lecture at renowned universities, file patents, write textbook chapters, or publish in famous journals. They are far too busy taking care of my family, friends, and neighbors.
Disappointed but always optimistic,
Benjamin W. Ross, MD
Waukon
