EBB 258 – A Hospital Waterbirth Story with Cord Avulsion featuring EBB Childbirth Class Graduate, Samantha Reisz, PhD

 

Rebecca Dekker:

Hi, everyone. On today’s podcast, we’re going to talk with Samantha Reisz about her first time birth experience on waterbirth in a hospital setting.

Welcome to the Evidence Based Birth® podcast. My name is Rebecca Dekker, and I’m a nurse with my PhD, and the founder of Evidence Based Birth®. Join me each week as we work together to get evidence based information into the hands of families and professionals around the world. As a reminder, this information is not medical advice. See ebbirth.com/disclaimer for more details.

Rebecca Dekker:

Hi, everyone, and welcome to the Evidence Based Birth® podcast. My name is Rebecca Dekker, pronouns she/her and I’ll be your host for today’s episode.

Today, I’m so excited to welcome a graduate of the EBB Childbirth Class. Before we get started, I want to make you aware of a few content notes. We will discuss complications in the third stage of labor, active management of the third phase, and umbilical cord snapping or avulsion. If there are any other detailed content or trigger warnings, we’ll post them in the description or show notes that go along with this episode.

And now, I’d like to introduce our honored guest. Samantha Reisz, pronouns she/her, is a Scholarly Assistant Professor of Human Development at Washington State University in Vancouver, Washington, just outside of the Portland, Oregon area. She completed her bachelor’s in Psychology and master’s in Infant Mental Health from Mills College in Oakland, California when she first began studying childbirth. Samantha then earned her PhD in Human Development and Family Sciences from the University of Texas at Austin, where she studied infant parent relationships and the transition to parenthood. Samantha is a passionate scholar and educator. After years of studying these topics academically, she finally was able to live her own research and she gave birth to her first child, Cody Oliver, in July of 2022. Samantha lives in Vancouver, Washington with her baby, partner, and two dogs.

Samantha, welcome to the Evidence Based Birth® podcast.

Samantha Reisz:

Thank you so much for having me. I’m so excited to be here.

Rebecca Dekker:

So tell me about your journey to finding the Evidence Based Birth® Childbirth Class. Were you familiar with EBB before you got pregnant?

Samantha Reisz:

I actually was not familiar with EBB before I got pregnant. I started studying childbirth for my master’s degree, and my master’s thesis was actually all about the subjective experience of childbirth. So it’s surprising that I hadn’t come across at your work at that point. I don’t think the podcast had been started yet. And I kind of veered away from birth and into more psychosocial aspects of the transition to parenthood in my research. But then I started getting ready to deliver myself and I hired a doula, and she recommended Evidence Based Birth® as a childbirth course. I think after watching the first video on YouTube, I was like, “Oh my God, this is amazing.” I was super on board and I’ve become very into the book, your book, and the podcast and all of the articles that you have available. So.

Rebecca Dekker:

So your doula recommended you to take the childbirth class. And how did you decide on Scarlett Lynsky’s class?

Samantha Reisz:

My doula recommended Scarlett Lynsky. She just sent me the link and said, “Scarlett does this.” She was another doula that she knew, and Scarlett was absolutely wonderful.

Rebecca Dekker:

Yeah. And Scarlett was recently featured in the EBB podcast this past December. So I encourage everyone to check out her interview about surrogacy. So tell me, what was your experience like taking the class?

Samantha Reisz:

Taking the class was very educational. I was, I guess, a little surprised at just how much I didn’t know about birth, considering that it had been a topic of my research for many years. It’s also different, I think, going through it, thinking about yourself, and really not just thinking about it hypothetically, abstractly, but like, “Oh, I’m going to do this. I’m going to do this soon, in a couple of months.” And also going through it with my partner who didn’t know most of the information. My partner’s mom actually was a labor and delivery nurse for several decades, but he still didn’t know a lot of the information. So actually going through it and talking through it together and deciding on what we wanted to do and what would work best for us.

Rebecca Dekker:

Yeah. And what are some examples of things that either you or your partner, both of you, weren’t familiar with?

Samantha Reisz:

I wasn’t really as familiar with a lot of the physiological aspects of labor and how things progress as you move through the stages of labor. And I wasn’t as familiar with a lot of the information about induction. Induction was something that he and I talked about very extensively, and whether or not we would want to have an induction. And if we did, what would be the criteria that we would feel like I’d have to meet for it? That was a big concern because I was a very late baby, and my mom and her brother were very late babies. And so I was very concerned that I was going to have to make that decision.

And also, I was told, all through my pregnancy, starting at 20 weeks on, that I had a very big baby. And I was a big baby. And on my mother’s line, everybody comes out big babies, so I was quite concerned about that. And I know the research on big babies. I listened to that podcast multiple times, but it just gets in your head. So that was something we talked about very extensively.

Rebecca Dekker:

Yeah. So those are stories told in your family about big babies, about going past your due date and having very late term pregnancy. So knowing all that information, take us… Towards the end of your pregnancy after you’ve taken the childbirth class, what kind of birth were you planning?

Samantha Reisz:

So we were planning the waterbirth, and that was something I’d wanted to do from the beginning. And I selected my OB-GYN based on the fact that she did do waterbirths. She was one of the only people in our family medicine practice that did waterbirths. And she was actually a midwife before she went to school to become an OB-GYN, so she had a lot of experience with waterbirth. That was part of that decision.

Rebecca Dekker:

Okay. So you kind of had a magical combination of someone who has a midwife and physician training. Was this a family medicine doctor or an obstetrician gynecologist doctor?

Samantha Reisz:

She’s an obstetrician, and she works out of the family medicine clinic that I was already going to. And she apparently was also best friends with my doctor, so it all worked out really well.

Rebecca Dekker:

Okay. So it sounds like there’s a lot of collaboration there between the different kinds of providers.

Samantha Reisz:

Absolutely. I was very lucky in that sense.

Rebecca Dekker:

And you were planning a waterbirth then in the hospital with this physician?

Samantha Reisz:

Yes. Yes. This hospital did. They call it the family birthing center, but it’s the hospital. And they have a whole waterbirth program. And so they have you go through a waterbirth education course, which really just kind of takes you through the logistics of what happens when you get to the hospital, for requesting the waterbirth, what are the requirements for when you can be in the water, when you can’t, and things like that.

Rebecca Dekker:

Okay. So they actually have a whole special class for-

Samantha Reisz:

They do.

Rebecca Dekker:

Choosing that. Okay. And are the staff there then trained in supporting waterbirth?

Samantha Reisz:

Yes. And they had also said that there are some staff that are more excited and into it than others. And so depending on who’s there when you get there, if they see that, “Oh, that’s a waterbirth,” usually people who are into waterbirth will try to get on your case. I don’t know how that works from the nursing perspective, but that was what they had said.

Rebecca Dekker:

Yeah. That makes sense because speaking with midwives in particular about waterbirth, they’ll often talk about how it doesn’t necessarily make your job easier. Like my midwife, I’ll never forget her telling me, “I don’t do waterbirth because it’s easier for me. I do it because my clients want it and it makes birth easier for them.” So I thought that was an interesting perspective. It makes sense that some people might not want to deal with the body mechanics of getting down on your knees and leaning over and stuff like that.

Samantha Reisz:

Yeah, no, the whole birth team was working hard, for sure.

Rebecca Dekker:

They had to come down to your level, right?

Samantha Reisz:

Yes, they did. They needed to monitor the baby. I didn’t like the position I had to be in. It wasn’t a comfortable position for them to monitor him, so I kept having to move and it was a little challenging.

Rebecca Dekker:

Okay. So backing up just a little bit. So you’re planning a waterbirth in the hospital with your OB, and the staff there. Was there anything in particular that you wanted or did not want for your birth?

Samantha Reisz:

I didn’t want an epidural. I know the research on epidurals, and I know that anecdotes from people are not equivalent of large aggregate data, but I also had several friends who’d had failed epidurals or very different kinds of complications with epidurals. And I really wanted to feel the whole process. I believe that I evolved to birth. We’ve spent millions of years evolving into our current modern forms, and I wanted to experience that physical experience. So I didn’t want an epidural.

They did offer a nitrous oxide or laughing gas, so I did want some options for pain relief. And I did use a nitrous oxide and I found that very helpful. But I really didn’t want the epidural, and other than the nitrous oxide, I wanted minimal medical interventions, as long as that was okay from a medical perspective.

Rebecca Dekker:

Okay. So you were thinking pain management wise. You’re going to use the water. You’re going to avoid the epidural, and you’re going to use nitrous for any medication that you might need.

Samantha Reisz:

Yeah. Yeah.

Rebecca Dekker:

And what about induction? Were you worried that that might be an issue?

Samantha Reisz:

We were worried about it, and it didn’t end up being an issue because he came a few days before his due date. So that was a surprise, a happy one. We did decide that we would induce. I listened to every single EBB podcast and read every single piece of information you had about induction, natural induction, and I did everything. So I guess something worked. We did have a plan though for induction if he hadn’t arrived by his due date.

Rebecca Dekker:

Okay. So you were planning an induction on the due date, if he didn’t come by then? Or more like 41 weeks, what were you thinking?

Samantha Reisz:

I wanted to feel it out. My due date was on a Thursday, so I was thinking I would try to get through the weekend, and maybe on Monday, we would do a medical induction. I was going to have her sweep my membranes before that, and she was okay with me kind of feeling it out as I went.

Rebecca Dekker:

Yeah. And kind of being free to change your mind or make whatever decisions felt right to you.

Samantha Reisz:

Yeah, yeah.

Rebecca Dekker:

Yeah. So you watched, I’m assuming, or listened to all of the natural induction-

Samantha Reisz:

Yes.

Rebecca Dekker:

Methods that we’ve covered?

Samantha Reisz:

Multiple times. Yes.

Rebecca Dekker:

That’s awesome. I’m glad that was helpful for you. Do you feel like there was one in particular that helped kickstart labor?

Samantha Reisz:

I think actually the acupressure was probably helpful. And the reason I say that is, I managed to get myself in with some prenatal massage. And anybody who is pregnant, I cannot recommend prenatal massage highly enough. And the massage therapist said, “Oh, you’re pregnant. Let me not touch those spots.” And I said, “Actually, I’m pretty close to my due date. Could you do those spots?” And I’d had my partner doing the acupressure points, like in the evening while we were watching TV and stuff. But she did them and I think she was masterful.

But the first time she did it, a few days later, I went to the doctor for my checkup and I was a centimeter dilated. And then the next time she did the acupressure points, that evening, I lost my mucus plug. That was on a Friday night and then my baby arrived, or I went into labor, on Monday morning. So I do think that that made a difference.

And I also was doing everything. Almost everything that there was evidence for, I was doing. The only thing I didn’t make it to is the acupuncture appointment because I went into labor the day of the appointment.

Rebecca Dekker:

Okay. And how did labor start then?

Samantha Reisz:

Labor started at 5:00 AM. I woke up to go to the bathroom, as you do, a thousand times a night, when you’re pregnant. And I sat upright and had a huge gush. I was prepared. I was wearing period underwear because I knew that that might be something that would happen. So I ran to the bathroom and there was a whole lot of water, and it just kept coming. And eventually, I was in there for a long time and my partner was like, “Are you okay?” I said, “I’m pretty sure my water broke.”

So I labored at home until about noon, my water broke just about at 5:00 AM, almost on the dot, just being on the ball and going up and down the stairs, and we were checking in with the doula every hour or so. I did call the hospital and they said, since my water broke, they wanted me to come in immediately, which I understand about the infection risk. I was also a little nervous about kind of a clock starting once I arrived.

I stayed at home until I had a contraction. It wasn’t that painful, but it lasted for over a minute. And I could see my partner was also like, “I think it’s time we should go to the hospital.” So we put lots of towels down on the passenger seat and we went to the hospital.

Rebecca Dekker:

Okay. And when you got there, what happened next?

Samantha Reisz:

I sat in triage for two hours. That was-

Rebecca Dekker:

Oh, no.

Samantha Reisz:

That was not very fun.

Rebecca Dekker:

I think we need to do an episode on the evidence on triage, because triage is one of my pet peeves. Yeah.

Samantha Reisz:

I don’t know. It wasn’t very busy when we were there. We were one of the only families who gave birth that night. But they had me hooked up to the monitors for 20 minutes. They discovered that my OB was still doing rounds before she went to the clinic, so we waited for her. And then, I guess they were getting the whole waterbirth setup going in our room. Our doula was sitting in the waiting area. She waited there for over an hour, but she saw the tub go down the hall. So she was thinking, “Oh, maybe that one’s for us.”

The triage was just hard because it was a really uncomfortable position for me to be in. And since I was there, I felt like I was supposed to have the monitor on. But the contractions were definitely getting less comfortable at that point, at least in the position that I had to stay in. Eventually, they finally said that we could go back to the room, which was quite the relief.

Rebecca Dekker:

So when you got there, was the water ready in the tub? Or, what did you do?

Samantha Reisz:

No. No, it was empty. So their protocols were that, you could get into the water once you were in active labor. And when you were in the water, the OB had to be there.

Rebecca Dekker:

Like onsite or in the room?

Samantha Reisz:

In the room was my understanding. They wanted the OB there through the whole time that you’re in the water. The tub was just kind of there. It was a big blow up, kind of jacuzzi like tub.

So we did different exercises, and my doula came very prepared. The contractions still weren’t that bad. At that point, we were still chatting. We were talking about names. Somehow we ended up with more names on the list than we even had previously. And we had some lunch. I was very happy to know, from EBB, that it’s definitely fine to eat, and I really enjoyed that grilled cheese sandwich. That got me through the rest of my labor.

So we got into the room about 2, I’d say, and around 5, the contractions were getting a little more intense but weren’t super painful yet. And I was getting kind of tired. And I remember, my doula looked at me, she’s like, “Okay. I’ve got some more exercises for you to do.” And I was just like, “Can I take a nap?” And she said, “Okay. You can do that.” So she went to go get some food and she said, “You can take a nap, but do it with your leg up on the peanut ball.” And I said, “Okay.”

And I still don’t really understand what happens physiologically with that peanut ball, but that is when labor really got going. I did not get a nap, because once I was lying with the peanut ball, contractions got much more intense. I remember, my partner, at that point, was rubbing my back and was trying to help me through them. And I was thinking, “Oh, maybe that was one and it’ll calm down, and I can take just a little shut eye.” And that was not the case. So then, by the time the doula came back, she said, “How’s it going?” And I said, “I think it’s time for the nitrous.” She was like, “Oh. Well, that shows me that you’re definitely progressing.”

Rebecca Dekker:

Right. If you’re laying down and things are picking up, that’s a good sign.

Samantha Reisz:

Yes. Yes. We called the nurse. She brought the nitrous oxide machine. It took me a few tries to figure out how to inhale properly. And then once I did, it was definitely very helpful. And actually, it was funny because I hadn’t been drinking or anything through pregnancy, so I was like, “Woo, that was a feeling.” And then somebody had texted me, so I picked up my phone to text them back, they were like, “Oh no, she’s high texting.” I was like, “No, I just have to tell them the baby’s coming,” with my cousin or something.

Rebecca Dekker:

Yeah. Watch out. Don’t say anything you might regret later.

Samantha Reisz:

So then I think they took my phone away from me. And so at that point, things definitely were continuing to progress. And I was taking the peeing every 30 minutes very seriously. But every time I would get to the bathroom, I’d have a contraction. I’d sit down on the toilet, I’d have a contraction. I’d stand up, I’d have a contraction. So I guess that was a productive event every time it happened.

And my doctor came back around 6:00 PM, and she had come back prepared to have a conversation with me about doing things to maybe move it all along. Because she knew I didn’t want to have augmentation. I didn’t want Pitocin. So she was prepared to have that conversation with me. I was really having intense contractions at that point. It was a loud situation, and it was a lot of that low deep vocalizing. I remembered that, especially with Scarlett in our EBB class, of us having to practice what noises we would make. But she would do it too, so you felt like we could all just kind of be silly together.

Rebecca Dekker:

Yeah. It’s great when people actually participate. Because sometimes when you’re in that part of the class, nobody wants to make a noise. I’m like, “Come on, you can do it.”

Samantha Reisz:

Yeah. I think being on Zoom helped.

Rebecca Dekker:

Yeah.

Samantha Reisz:

And so she then checked me and I was, I guess, six or seven centimeters. I was much further along and she’s like, “Oh. Well, I guess I don’t have to have that conversation with you. You’re moving right along.” She left to just go home and do a couple of things, I think she had to let her dogs out, and then she came back. And the amount of time that that took was the amount of time it took them to get the tub filled up and the tub ready. So she came back and that was just about time for me to get into the tub.

Rebecca Dekker:

Did they have to check you before you got into the tub, or could they just tell from your behaviors that you were in active labor?

Samantha Reisz:

I think they could probably tell from my behaviors, but they did check me and I was okay with that. I felt like I wanted to know. Because when I arrived at triage, they did check me and I was not as far along as I thought. I was only at two centimeters, and I was very disappointed by that because it made me anxious thinking, “Oh, maybe I’m going to need some sort of augmentation or something like that.” So I did want to know how far along I was at that point.

And my doctor and I had talked previously about checks and what the protocol is and when I would be comfortable and not. And she didn’t anticipate really needing to check me again after that. I think she did once. When I wanted to start pushing, she did want to check me, just one more time, to make sure that it was okay to start pushing, at which point I informed her that I was pushing. That was happening.

Rebecca Dekker:

And you can’t stop this.

Samantha Reisz:

No. No, you can’t stop that train once it’s going.

Rebecca Dekker:

So how did it feel, getting into the tub?

Samantha Reisz:

Oh, the water felt so good. The water felt so good. I bought this cute little waterbirth outfit that never got put on. I could have cared less. If you have an outfit like that that you want to be wearing, you should put it on, before you are having really active intense contractions. Because once those start, you are not going to care at all. But the water itself was very soothing. It kind of made me feel much lighter.

My partner got in the tub with me, which my doctor was very impressed by. Apparently, she’d only had one other dad ever do that. And I, of course, had informed him that he was getting in the tub with me. That was never optional to me. I wanted him to catch the baby too, but he was scared about a slippery newborn and I think that was a little much. But he did get in the tub with me.

So I spent a lot of the time with my arms around his neck, just kind of hanging in a squatting position and screaming into his ear or into the nitrous oxide mask. And it actually helped me be able to be in a squatting position, which really surprised me because I hate squats with burning fiery passion. I hate them so much. And I spent almost the whole time I was in the tub squatting. That was the position that my body wanted to be in. I think that was just the position where I felt the most open.

Rebecca Dekker:

Yeah. And I would think that being in the water, you’re more buoyant.

Samantha Reisz:

Yes.

Rebecca Dekker:

So maybe a squat isn’t as uncomfortable as it is on land.

Samantha Reisz:

Yes. I think that is definitely part of it.

Rebecca Dekker:

So what happened next?

Samantha Reisz:

I was in the water. I think I kind of really lost track of time. My eyes were closed for most of that time. Occasionally, I’d open them just to see something or get oriented, but then I was just kind of back in the zone of what was happening with my body. And people were putting cool washcloths on my forehead. I remember too, I had a saline lock, which was also a whole conversation. I didn’t really want one, but my doctor had said she wouldn’t force me to have one, but she felt a lot more comfortable if I did have one. So after much discussion, I did decide to get one. And there was this plastic thing that they put over it, and it didn’t seal fully, so water kept getting under it. Saran wrap would’ve worked a lot better.

That kept bothering me, so eventually, I just kept taking it off and they were trying to put it back on. I remember someone saying, “I don’t think she cares at all.” And I did not care at all. And I just remember going back and forth between… I kind of reached a hand out and my partner said, when I reached my hand out, if I had the nitrous oxide mask on already, he knew I wanted a hand to squeeze. If I didn’t have the mask, he knew that that’s what I wanted. And so I was really lucky of having… I really felt like I had the golden ticket that you talk about. My partner, we were on the same page. He was really on board with what I needed. He’s really good at reading my body language. And my doula was fantastic. The doctor was great. The nurse who was attending was so wonderful.

We also had music playing. We just had the Beatles going, and so people were singing along to it and my doctor kept saying like, “Oh, this is my favorite song.” And then the next one would come on and she’d say, “Oh, this is my favorite Beatles song.” So that was just a really nice environment.

Then I felt the need to start pushing. And I remember kind of hearing a conversation, where my doula was saying, “Yeah, she’s sounding a lot more grunty,” and say, “Oh yeah, I think she might be getting ready to push.” And I guess I was at nine and a half centimeters at that point, because they did a check, and wanted me to try to hold off pushing. And that was the most powerful sensation I’ve ever had. I don’t know that there was really holding off on the pushing, but I did.

So I started pushing. I knew that pushing could last a long time. And everybody kept saying, “Oh, just one more push. Just one more just like that,” which made me think that, “Oh, maybe the baby’s really close.” But they were just lying to me. It wasn’t just one more push. So I was very frustrated by that. So eventually, I heard their voices getting more and more excited. So then I was like, “Oh, okay. Maybe it’s actually there.” There was just a lot of back and forth of they wanted to check the baby’s heart rate every 15 minutes, so I’d have to get out of the squatting position and move into a position that was better for them to check the baby. My body was just doing what it was doing, and it was not interested in the position that they wanted me in to check the baby. I know that then there was a mirror they were putting into the water, I guess, to try to see the baby’s head.

And eventually, the doctor did say, “You know, you can reach down and you should be able to touch his head. He’s not quite there yet.” I remember just saying, “Can you just pull him out? Is he close enough yet?” And eventually, he was close enough and I finally pushed him out. And it was right at the end of the song, All You Need Is Love.

Rebecca Dekker:

Aw.

Samantha Reisz:

Which was, yeah, I don’t know. The universe worked out really well for that, right there. And he came out with his hand up next to his head. So I didn’t just have to push a head out, I had to push a head plus his hand and arm out all at the same time. I remember, I reached down and I pulled him up, and that was when the complications started. My partner said it went from beautiful to Jaws in about three seconds, because when I pulled him up and then the cord snapped.

Although I do remember, when he came out, it was the most intense sense of relief I’ve ever… Wow. I knew that it would be like that, but my goodness. I will-

Rebecca Dekker:

Three seconds of like, “Wow, this is amazing.”

Samantha Reisz:

Slippery little thing.

Rebecca Dekker:

Yeah.

Samantha Reisz:

It was five seconds, I don’t know. But then suddenly, I was very disoriented. I was very out of it. But suddenly, somebody was taking the baby and they were saying, “We have to get her out.” And I apparently tried to get out of the tub, not where the step stool was, but at a different point, so I remember the doctor saying, “Somebody help me with the mother.” So people were kind of supporting me to get me out and onto the bed and feet up in stirrups.

And I remember my partner was then right next to me and he was saying, “Do you hear him? Do you hear him crying? He’s crying. He’s so perfect.” And I was just kind of like, “What is going on? I don’t really know.” But they got him cleaned up pretty quickly. Then I heard somebody say, “Oh, Dad, would you like to cut the cord?” And I guess it really ended up being a little trim on the cord, because then Jeff left to do that and my doula was right there on the other side of me.

And then they brought the baby and they put him right on my chest. And Jeff was right there next to me. But once they put the baby on my chest, I was like, “Oh, his name is Cody.” And I don’t think there’s anything my partner and I have ever discussed more than the name of the baby. The list only got longer. We wanted a short list, it just got longer. But they put him on my chest and I knew his name immediately.

So it was kind of, up here, we were having this beautiful bonding family moment. And then down there, there was this whole other situation happening that I didn’t really know or really understand what was going on until afterwards.

Rebecca Dekker:

So what was going on? What were the care providers working on?

Samantha Reisz:

So they were working to get the placenta out ASAP. I guess it was kind of pulled it out, which was an interesting sensation. But they needed to get the placenta out ASAP, because I guess it was just the cord had snapped. When I pulled him up, that had snapped the cord. And also I think, because his hand was up, and I think the cord was maybe tangled up with his arm somehow. So between those things, the cord snapped and so I was just bleeding out. And I lost a fair amount of blood, so it actually was really, really, really good that I had the saline lock in, because my doctor’s big fear was that, if I suddenly would need blood, they wouldn’t be able to get it in if I was losing blood and my veins had collapsed or something. So that ended up being a really good thing to have.

Rebecca Dekker:

So did they give you fluids or anything in that moment or not?

Samantha Reisz:

They gave me… It’s a little bit of a blur. They gave me Pitocin. And I remember your whole podcast about the use of Pitocin for management of postpartum bleeding. So they gave me Pitocin. I think they may have given me something else too, to help with the bleeding. I think once the placenta was out, then most of the bleeding stopped. I did have a second degree tear. My doctor was concerned it was a third degree tear, so she had somebody else come in and consult, which was really scary, the idea that I might have torn all the way up to my cervix. But I didn’t. It was just a second degree tear. Just a second degree tear. And so she was working on stitching me up, which there was a lot of numbing. I asked for more numbing stuff a couple of times, and it’s good to be numb when all that’s happening.

Rebecca Dekker:

And it sounds like the nuchal hand, the hand up by the head, might have contributed to both the cord snapping, which we can talk about more in a little bit, but especially the tear that you experienced?

Samantha Reisz:

Yeah. Yeah, I think so, because there’s more to push out than just the head. And he did not have a small head. So.

Rebecca Dekker:

So how did your recovery go in the next couple of hours after that experience?

Samantha Reisz:

The recovery was okay. There was a lot of coming in and pressing on my abdomen, so that more and more blood would come out. They did that a lot. I think that it might have been more than for somebody who didn’t have such a tear, had lost so much blood. I remember, they did get me up to go pee. And somehow, in the amount of time that that took, they cleaned up everything in the room, which apparently, there was blood all over the floor. It apparently really looked like a horror scene, according to my partner, my doula. But, they got the bed changed. They got everything done, so that I was able to come back and not see a horror scene. I don’t know. There was a lot of numbing stuff that was involved, so those first few hours weren’t too bad.

Those ice diaper things, those are magical. Those are amazing. And I was really just kind of high on the baby. He was so magical and perfect, and I just couldn’t stop staring at him and holding him and looking at him. I was just so happy he was there.

Rebecca Dekker:

And he was doing okay despite-?

Samantha Reisz:

Yeah. Yeah, he was doing good. Yeah, it did make me sad because one of the things we’d also talked about was the delayed cord clamping and making sure that he was able to get all of his blood from the placenta, and he got none of the blood from his placenta.

Rebecca Dekker:

Yeah. He got immediate, for sure. He’s immediately snapped and immediately clamped probably as soon as they could get their hands on him. Yeah.

Samantha Reisz:

Yeah. But he was very, very healthy from the get-go and high Apgar scores, and he latched really well immediately. My doula had said it was one of the best immediate latches she’d seen. So he was just perfect.

Rebecca Dekker:

And you didn’t need any blood transfusions or anything like that?

Samantha Reisz:

No. I did not end up needing any blood transfusions. There was, I forget what it was called, but there was another drug that they gave me, that was administered. Maybe it started with an R. It was administered over the course of several hours through the IV, to help with the, I think, with the bleeding and the blood loss. And I didn’t lose quite enough blood to need a blood transfusion though.

Rebecca Dekker:

Well, let’s talk about the cord snapping. Do you have any questions about that complication? It is one of the potential risks of waterbirth, so what questions do you have for me?

Samantha Reisz:

I am very curious about it generally. It wasn’t something that was on my radar. My doctor had experienced that happening before, and she and I debriefed afterwards. She was trying to figure out what that might be associated with, because it had only happened to her with a waterbirth. So I’m very curious what you might know about it. Because like I said, it wasn’t on my radar at all.

Rebecca Dekker:

So the first time I wrote the research about waterbirth, there were only two studies at the time on this topic. And so what we’re talking about is umbilical cord, when it tears, it’s also called a snap, a rupture or avulsion. So sometimes, you hear it called cord snapping or cord avulsion, but basically, the cord rips apart.

And in 2014, there was a study where they had reviewed all of the published cases that had ever happened. And they estimated that it occurs about three out of every 1,000 waterbirths. And this was in 2014. And out of all of those cases that had ever been published about, about 23% of them led to a NICU admission and 13% led to the need for a newborn blood transfusion. But there were zero cases of long-term harmful effects.

Since then, there have been two new studies. So the first one was published in 2020 by a researcher named Sidebottom, et al. And this was looking at all the electronic health records from eight hospitals that were doing waterbirth. And they compared water immersion in the first stage of labor, water immersion in the second stage. And they also documented whether or not the delivery occurred in the water. And then they had comparison groups as well.

And out of all of the people who were in the water during the second stage of labor, there were about 384 people, three of them experienced a cord avulsion, which was a 0.8%. And the three infants who it happened to did not have any bad outcomes. They didn’t have to be admitted to the NICU. They didn’t have excessive blood loss. And all three cases occurred in the first year of this five-year study where they were studying waterbirth. And so after those three cases, the staff were educated in ways to prevent cord snapping. And then there were zero cases over the next four years.

The next study is probably the most important study that’s ever been published on waterbirth, and that is as Bovbjerg, et al, published in 2022. This was a study of 17,530 waterbirths, with a matched cohort of what we call land births, so giving birth outside of the water. And this is the largest observational study, or study ever, on waterbirths. So they examined all these low-risk waterbirths, and then they matched them with people who were extremely similar, who gave birth on land. And they looked at so many different health outcomes. And they only found two negative health outcomes associated with waterbirth. Everything else was either neutral or favored waterbirth.

So the two negative outcomes were an increased odds of having a uterine infection, which was very rare, and the increased odds of an umbilical cord snap. So it happened in 0.57% of waterbirths and 0.37% of land births. So it was statistically significantly higher in the waterbirth group, but it does happen in land births as well. But it is slightly more likely to happen in a waterbirth.

So when you’re looking at how to prevent this, because I talked about how in that one research study, they were like, “Well, we educated everyone and so we were able to prevent it.” The first study that I mentioned from 2014 was by Schafer, et al. They actually, in addition to summarizing all the research, they also basically suggested guidelines for how to prevent it and how to manage it. So I’m going to read a direct quote from their study. So Schafer wrote, “There may be a strong instinct to bring the newborn above the surface of the water immediately after birth. This can translate into rapid core traction over a distance greater than in land-based birth without respect for cord length or tension.”

In other words, with waterbirths, you’re more likely to quickly lift the baby up to your chest, and this might cause the cord to snap, especially if it’s an abnormally short cord or, like in your case, where the cord might have been wrapped around the hand or whatever.

So the other thing that Schafer says is that, the signs of a cord snapping or cord avulsion in a waterbirth, which you witnessed some of these, include a dramatic change in the color of water to a deep red color very quickly, a snapping sound, a sudden release of cord tension, visualizing the cord snapping, or signs of the newborn going into shock. And it’s possible that the water can make it difficult to visualize when a cord has snapped.

So the management of it is pretty simple. You need to immediately clamp the newborn’s end of the umbilical cord and assess the baby for signs of shock. And if the newborn has any abnormal signs, if it’s born at home or in a birth center, they should be transferred to the hospital. But they talk about how it’s important for providers and nurses who are doing waterbirths to recognize the potential that this could happen. I mean, this could happen in a land birth as well, but it’s slightly more common in a waterbirth. So being familiar with the signs, having a cord clamp with an easy reach in case it’s needed quickly.

And then in terms of prevention, they talk about teaching your clients to bring the baby to the surface gently and avoid excessively pulling on the cord. It’s really interesting in the United States, in terms of waterbirth culture, there is this culture where you got to get the baby out as soon as possible out of the water. But you can actually watch videos of waterbirths from European countries, and they do it totally differently. They do it very slowly, which can, as an American, when I’m watching those videos, I’m like, “Ah, I can’t watch this,” because culturally, we just don’t do that here. But just being gentle with the surfacing.

And then, some people actually don’t consider cord snapping to be an emergency as long as you have a skilled provider, because if the provider responds promptly, you can avoid complications. So basically, by clamping the cord immediately and assessing the baby and cord thoroughly.

So does that kind of help give you more information about what happened?

Samantha Reisz:

Yeah, absolutely. Absolutely. That makes a lot of sense, because I did pull him up right away. And my doctor also thought that the height of the water might influence that feeling of needing to pull them up above the water. So she was thinking that she might want to have the water in the tub be lower in the future for other waterbirths.

Rebecca Dekker:

Yeah. That’s actually another recommendation in the Schafer article. They recommend, before the pushing phase, of lowering the water level a little bit, so that you don’t have to feel like you have to bring the baby all the way up to the top of your chest, but instead they can be on your abdomen.

Samantha Reisz:

Yeah. Yeah. So she said that I would be her kind of case control if I deliver in the water again like that.

And the other thing that also stands out is that, having a really skilled provider, because my partner had said he had that moment of, “Oh no. Is she going to bleed out right now?” But then everybody snapped into action and he was really, really impressed with how quickly everything happened then to help Cody and to help me. And he was just really impressed by the doctor and then the whole medical team that was there.

Rebecca Dekker:

Yeah, it’s amazing. And it sounds like they knew what they were doing and they were trained and experienced. Sometimes I talk with people who are like, “Well, I want a waterbirth. My hospital doesn’t allow it. But what if I accidentally on purpose have the baby in the water?” And I’ve talked with them, “I mean, that is a possibility to just refuse to get out of the tub or to not tell them that you’re about to have the baby and just give birth. But, if a complication occurs, have the staff trained in how to handle it in the water? Because most midwives who attend home births and birth center births are very trained and experienced in how to handle a complication in the water. But some staff might panic if they’ve never been trained in how to deal with those things.”

But I also think it’s important for hospital staff to all be trained in waterbirth, because if you have tubs in your facility, you can give birth on accident in the water. Like you said, sometimes this train can’t be stopped, right? And so to me, it seems that hospitals have a responsibility to know how to handle complications in the water. And they can be handled safely, as your team demonstrated.

Samantha Reisz:

Yeah.

Rebecca Dekker:

Well, thank you so much, Samantha, for sharing your story. Do you have any words of advice or wisdom for any of our listeners who might be entering birth or parenthood soon?

Samantha Reisz:

I think being familiar with the research really, really helps, so listen to all of the podcasts and read the EBB articles. I found that to be really, really helpful. I operate better when I know what all of the different possibilities and options are, and I would always come to my doctor’s appointments with a list of questions, that she eventually was just joking, she’s like, “All right. Get that list out.” And we would go through everything. And I talked through it all with my partner as well.

And I also made a point of really thinking through and talking through things that I didn’t necessarily want to happen. I listened to podcasts about emergency C-sections and things like that so that I would feel as prepared as you can be if something happened that wasn’t what I was hoping for, rather than just only listening to like, “Oh, these waterbirths that all went so well.” But actually listening to people’s stories and people’s birth stories about all the different options and possibilities of ways that things could go, I think those were the things that prepared me the most for the birth. Also, doulas are amazing and wonderful, and if that’s something that you can have, I highly, highly recommend having a doula.

Rebecca Dekker:

Yeah. Those are all great recommendations. For the list of questions, it can be intimidating to ask questions, and I often will teach family and friends and students, “When you’re going to an office visit, just bring a sticky note and write three things. And I want you to have three questions or topics of conversation to talk with your doctor or midwife about, because you need to get in the habit of asking questions. Even if it’s something little, it gets you more comfortable. You’re paying for their time. You’re the customer, so you should be able to ask questions in the time you have.”

So, Samantha, thank you so much for coming on and sharing your story. It was wonderful and beautiful to hear that you and your partner and Cody are doing well, and that you had, overall, a smooth, easy, empowering experience. And thank you for being part of our community and being a podcast listener who became a podcast guest.

Samantha Reisz:

Yes. Yes, I know. It was very exciting. I was so excited to come on the podcast and to have this conversation with you.

Rebecca Dekker:

All right, everyone, thank you so much for listening to our episode with Samantha. We do have evidence on waterbirth. You can check out at evidencebasedbirth.com/waterbirth, and we’ll make sure to put all of the references and links to the studies I mentioned in the blog article that goes along with this episode. Thanks, everyone, again, and we’ll see you next week. Bye.

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