Monday, August 1, 2016

Malaysia - Is water birth a boon or bane?

MORE women are opting for water birth over traditional delivery methods as they believe that it is a more relaxed and less painful experience that promotes a midwife-led model of care.

Proponents of water birth also believe that it offers babies a more peaceful journey from the uterus into their mothers’ arms.

However, the question of safety and comfort pops up when it comes to selecting the preferred method of delivery.

The Health Ministry and medical experts argue that the safety of water births has not been scientifically proven and there is no evidence to suggest that the method is beneficial to mothers.

With the safety of mothers and babies in mind, the ministry, on July 13, prohibited water births from being provided as an option at private hospitals nationwide.

The decision has upset water birth proponents and would-be mothers who had been looking forward to delivering their babies via the method.

Water birth, which gained interest in the 1990s, sees the mother spending the final stages of labour in a birthing pool, with the delivery taking place either in or out of the water.

Director-general of Health Datuk Dr Noor Hisham Abdullah had said the ministry would discuss matters relating to the safety and training requirements for water births, and come up with a standard guideline for water births at hospitals.

While acknowledging that the method has its benefits, former Malaysian Medical Association president Datuk Dr N.K.S. Tharmaseelan says there is a lack of scientific evidence showing that it is a better option compared with traditional delivery methods.

“Options are always good to have, provided that there are proven results. “Most reports that laud water births are anecdotal. “Would-be mothers should be aware of all the pros and cons before opting to have a water birth,” he tells the New Sunday Times.

He says the water immersion method, on the other hand, may provide similar advantages without the potential risks associated with water birth. Water immersion is when a woman in labour is immersed in a tub of warm water only in the first stage of labour, when she experiences labour pains.

The delivery is not performed in the water, but in the conventional way.

Dr Tharmaseelan says studies have shown that water birth is associated with shorter labour, less use of analgesics, and less severe vaginal and perineal lacerations.

“The warmth of the water may induce a sedative effect that counters labour pains. “The mother is also better able to assume a comfortable position,” says the consultant obstetrician and gynaecologist.

However, he expresses concern over the safety and efficacy of underwater births for newborns, saying they have yet to be established.

“There is no convincing evidence of the benefits (of a water birth) to the neonate, but there are concerns that it could cause serious harm. “Therefore, such an option should be considered an experimental procedure and should not be performed except within an appropriately designed randomised control trial.

“The disadvantages of water births are that the perineum cannot be protected, an episiotomy cannot be performed if needed and the risk of perineal laceration is high.” Dr Tharmaseelan says newborns delivered via water births might also swallow contaminated water.

He says this may increase the risk of neonatal aspiration syndrome and neonatal asphyxia (deprivation of oxygen to newborns that lasts long enough to cause physical harm, usually to the brain).

He says continuous fetal heart rate monitoring cannot be performed underwater, which is a major concern as signs of fetal distress may be missed.

“Additionally, if the water is too hot, there is the risk of dehydration and overheating to mother and child.” Dr Tharmaseelan says it is important for parents keen on water birth to consider several factors, such as ensuring that the doctor and midwife have adequate training in handling such births, and the indemnity insurance for the doctor and hospital in the case of any eventuality.

Centres that have water birth as a delivery option should also be accredited by the Health Ministry and be equipped to handle all kinds of emergencies.

Dr Tharmaseelan says women with uncomplicated pregnancies and who had no problems during previous pregnancies or deliveries could opt for water birth. However, those who suffer complications during their pregnancies, have had complicated deliveries, including caesarean sections, and have medical conditions, such as toxaemia, hypertension, diabetes and heart problems, should deliver their babies via conventional methods.

“Women who have bleeding, infections during pregnancy and herpes should consider traditional delivery methods. “This also applies to women who are expecting twins, and those whose babies’ position is not normal or are in distress.” Obstetrician and gynaecologist Dr Michael Samy concurs with Dr Tharmaseelan’s view.

He says water births remain very controversial and are not the way forward. “Yes, water births ease labour pains as the buoyancy experienced while being in the water helps the mother relax.

“However, there is no evidence-based advantages,” says the president of the College of Obstetrics and Gynaecology at the Academy of Medicine.

He says women keen on having a water birth should have low-risk pregnancies. “Intermittent monitoring of the baby’s wellbeing must be carried out and the mother must agree to call off the water birth if fetal compromises develop.”

Tharanya Arumugam

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