Breast Examination

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

nst

You can find older posts regarding ASEAN politics and economics news at SBC blog, and older posts regarding health and healthcare at IIMS blog. I thank you.

Cambodia - Daily Habits for Healthy Genitalia

Genital care is an important issue for women, as allowing small problems to go untreated can have an impact on reproductive health. Dr. Ty Sovannaroth, from Mearda Maternity, has more than 10 years of experience working in the fields of obstetrics, gynecology, ultrasound and infertility treatment. She advises women to adopt good hygiene habits in order to prevent reproductive health problems.

YT : What are the most common genital health problems experienced by women?

Dr. Sovannaroth: The problems that I encounter most often in my health consultation room – and I believe this is true at other clinics – are leucorrhea, and vaginal itching resulting from fungal infections. Vaginal discharge is not abnormal; most of the cases I encounter are in the “normal” category. Only about 30 percent of cases stem from problems requiring serious treatment. Some clinics will offer medicine to women in cases of normal leucorrhea, but the condition will continue regardless. 

YT :  What symptoms of leucorrhea should women look out for?

Dr. Sovannaroth: Normally occurring leucorrhea [discharge] has no bad smell, is not particularly greenish and is not accompanied by pubic tenderness or fever. The symptoms can vary. Some women experience leucorrhea more than others, and this can be an annoyance. More serious forms of leucorrhea are accompanied by symptoms such as itching inside the vagina and cloudy discharge.

YT :  What should a woman do if she sees signs of leucorrhea?

Dr. Sovannaroth: Women should not try to assess their leucorrhea condition themselves. They need to visit a health consultation room so the symptoms can be analyzed. Certain infection can cause inflammation of the cervix, which can affect the uterine membrane and cause other problems later in life. I always advise patients who come to see me about the importance of good living habits. In general, relying solely on medical treatment [after the fact] cannot keep us free of illness forever.

Leucorrhea can result from stress. Stress alters a woman’s hormonal balance and weakens the immune system. A good way to release stress is to exercise. Women can get sufficient exercise by walking for up to 30 minutes every morning and evening.

Avoid wearing tight clothes; the genital area needs a ventilated environment. Wearing jeans that are too tight, for example, can lead to fungal growth.

You should wear underwear made from soft, thin fabric that allows air to flow through. If your underwear is often moist due to normal leucorrhea then you should change your underwear often.

When swimming, avoid staying in the pool for too long.

Clean the genital area using clean water every time you use the restroom. Using the hand to scrub the area is not necessary; rinsing with water is enough. Some people clean their genital area using lime juice or salt water; that is the wrong way to do it and can cause the vagina to swell.

Consult your doctor before buying a feminine wash to ensure you choose a product that is right for your condition. If you think it’s time for a genital cleaning, this should be done by a doctor.

YT :  What is a good daily vaginal care routine for women in normal health?

Dr. Sovannaroth: Women in normal health can clean the vaginal area with clean water, normal water, or warm water; do not use hot water. If you are feeling unhygienic during your menstrual period, use a feminine wash during your period. Or you can use it daily, twice a day, morning and evening. A good feminine wash to use should have a pH level of 4 to 4.5.

Va Sonyka

Khmer Times

You can find older posts regarding ASEAN politics and economics news at SBC blog, and older posts regarding health and healthcare at IIMS blog. I thank you.