Your Voice

Not yet an acceptable option

Thank you for Dr. Shuman's well-written piece on water births. (Nov 2006)

My general position has been that of your colleague, who stated, "why would one do such a thing?" My concern has been a claim of benefits with only anecdotal proof, or under-powered studies of limited design, with morbidity and mortality unique to the procedure, which are entirely avoidable. That avoidable morbidity and mortality with no known benefit is what brings me to conclude it is not yet an acceptable option. I was pleased to see the AAP take this position.

When a personal agenda overwhelms the welfare of an infant, I take umbrage with persistence with the agenda despite the available knowledge. If one posits that even one significant avoidable neonatal morbidity or mortality is unacceptable, I ask, "why would one do such a thing?" As an advocate for infants and their families, I don't feel the procedure has a place in childbirth at this time. In the meantime, centers that persist are running with scissors.

Ken Schroeter, DOAssistant Professor of PediatricsUniversity of Vermont College of MedicineNeonatal-Perinatal MedicineBurlington, Vt.

Pediatric Advocacy

As the editor of Contemporary Pediatrics, I was surprised that you let a "chance" slip by .... I am writing about pediatric advocacy. I feel that most pediatricians will never design a better car seat or argue for improved funding in the Senate; most advocacy will be when we demand good care for children. This care must be based in science, reason, and common sense. When care is offered to children that is outside science, reason, and common sense, we MUST stand firm. Just saying No is not enough. We must act against the forces that are acting to the detriment of these children.

In the November 2006 article by Andrew Schuman, "When parents-to-be ask about water birth," all of the right words were in the article, but I fear that the article fell far short of where we as an academic community should stand. I was surprised that so many water births are still occurring in the civilized world. Eighty two hospitals and 97 birthing centers in the US! Where are the community pediatricians? Where are the regional neonatal groups? Where are the hospitals' credentials committees? (By the way, saw my first underwater birth in Michigan in 1980. I was shocked as a medical student; I am appalled as a PICU physician that the practice persists. First breath physiology is well studied and understood.) The 2005 AAP position statement: "Water birth is an experimental procedure that should not be performed except in the context of a randomized clinical trial" still allows for possible interpretation that the procedure may have merit .... It does NOT. No reputable IRB would ever allow such a non-physiologic study to be done on this vulnerable population. I do not know the reason why the ACOG and AAP have not taken stronger stances on this practice. I have. Water births are a non-physiologic practice outside science, nature, and reason. They should be stopped.

Kevin Ragosta, DOAssociate Professor of PediatricsUpstate Medical UniversitySyracuse, N.Y.