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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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