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The Informed Parent

What’s Up Doc?

by John H. Samson, M.D., F.A.A.P.
Published on Dec. 01, 2014


By Sarah C. Hugh, M.D., Nikolaus E. Wolter, M.D., Evan J. Propst, M.D., MSc, Karen A. Gordon, PhD., Sharon  I. Cushing, M.D., MSc, and Blake C. Papsiin, M.D., MSc.

PEDIATRICS Vol. 133, Nu. 4, April 2014

This article raises concern about a device that is becoming very popular. It presents data that suggests the machines may be damaging to infant hearing and auditory development.

Most importantly recommendations are offered for families to encourage safer ISM use. These are:

a)   Place the ISM as far away as possible from the infant and never in the crib or on a crib rail.

b)   Play the ISM at a low volume.

c)   Operate the ISM for a short duration of time.  



American Academy of Pediatrics Committee on Fetus and Newborn and American College of Obstetricians and Gynecologists Committee on Obstetric Practice

PEDIATRICS 2014, 133: 758-761

I am going to reprint the summary of this clinical report by the Academy because I want all potential participants to have a clear picture of this delivery technique before they launch into it.


“Immersion in water during the first stage of labor may be appealing to some and may be associated with decreased pain or use of anesthesia and decreased duration of labor; however, there is no evidence that immersion during the first stage of labor otherwise improves perinatal outcomes. Immersion therapy during the first stage of labor should not prevent or inhibit other elements of care, including appropriate maternal and fetal monitoring.

In contrast, the safety and efficacy of immersion in water during the second stage of labor have not been established, and immersion in water during the second stage of labor has not been associated with maternal or fetal benefit. Given these facts and case reports of rare but serious adverse effects in the newborn, the practice of immersion in the second stage of labor (underwater delivery) should be considered an experimental procedure that only should be performed within the context of an appropriately designed clinical trial with informed consent.  

Although not the focus of specific trials, facilities that plan to offer immersion in the first stage of labor need to establish rigorous protocols for candidate selection, maintenance and cleaning of tubs and immersion pools, infection control procedures, monitoring of mothers and fetuses at appropriate intervals while immersed, and protocols for moving women from tubs if urgent maternal or fetal concerns develop.”

I want to thank members of the American Academy of Pediatrics Committee on Fetus and Newborn  2012 -2013 for presenting this report in a clear and succinct fashion. 

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