Giving birth in water

Nothing can completely take away the excruciating pain of giving birth, but one can try to find ways to lessen it.

A water birth is said to be the gentlest of births. It has been professionally practised since the early 1990s in Europe, the United States and Japan.

Water is an effective and natural pain reliever, so mothers are calmer when they are in water during labour.

A newborn has what is called "mammalian dive reflex" which triggers off a swallowing reflex and closes the glottis, allowing it to swallow water but not start breathing.

As the umbilical cord is still attached and supplies oxygen to the newborn, the transition to an air environment is gradual and it can take its time getting used to breathing.

Pantai Hospital Kuala Lumpur (PHKL) is a pioneer in offering water birth services in the Klang Valley while Island Hospital is the first to offer the option in Penang. The former welcomed its first water birth baby on June 14, 2009.

RARE EXPERT

PHKL consultant obstetrician and gynaecologist Dr Choong Kuo Hsiang is an advocate of natural births. He is one of two known water birth practitioners in the country.

"There are hospitals with state-of-the-art facilities but what makes me wonder is why they don't offer water birth facilities," he says. "I learnt from the Internet and read a lot of medical journals. I have always encouraged active birth (walking, kneeling, etc) but I eventually drifted to water birth."

His interest drove the doctor to train himself to deliver babies underwater. To date, he has assisted in 35 underwater deliveries.

"Water births are not for everyone. It must be a normal pregnancy. Mothers with high blood pressure, diabetes or bleeding pregnancy are not allowed to have water births for safety reasons.

"It is great for those with back pain because they can rest during labour in the warm water in any position they are comfortable with."

Dr Choong explains the process to would-be parents in detail but he never imposes on them to try it. The decision is ultimately theirs.

"It is a natural choice for keen swimmers and divers. People with an affinity for watersports and who take to water easily are also more welcoming of the idea."

High pain threshold

HIGH PAIN THRESHOLD

Since epidural is not an option for water birth (women on epidural won't be able to move their legs around in water), Dr Choong says mothers with a lot of confidence and high pain threshold will most likely have a successful underwater delivery.

He purchased "birth pool in a box" from England that costs RM1,000 (S$400). The inflatable birth pool is highly recommended by water birth proponents and can be easily ordered online.

It's akin to a bird's nest for humans, giving comfort to mothers in labour. PHKL currently has one pool and Dr Choong plans to order more in anticipation of a growing demand for such births.

For each birth, a disposable pool liner is used for hygiene purposes. Cleaning it is also a breeze for hospital employees.

Patients get in the pool when they are 5cm dilated. They will spend about three to four hours of labour in the pool, some taking longer than others.

The water is kept at body temperature (37ºC) and is always at chest level to make sure the baby is under the water during delivery. "It is very private, with only one nurse to check on the patient. I will pop in constantly until the baby arrives," says Dr Choong.

He allows me to get in for a feel of the pool. I find it comfortable and spacious. Husbands can join their wives in the pool to give them support. "We have Starbucks here (at PHKL) so patients can send their husbands for coffee and chill in the pool as if they are at the pool," he says, chuckling as I move around in the birth pool, trying the strategically placed handles and different sitting heights. The water buoyancy will help bigger sized women move around in the pool with ease.

MINIMISING DRUGS

Water birth is not strictly drug-free, although the idea is to minimise the need for pain-relieving drugs. Patients may request for entonox (popularly known as "laughing gas") which contains 50 per cent nitrus oxide and 50 per cent oxygen.

About 40 per cent of Dr Choong's patients had asked for laughing gas when delivering their babies underwater.

The baby is caught the moment it comes out and is immediately lifted to the mother's chest, with the umbilical cord intact as opposed to immediate removal in conventional births.

This is an important bonding time between the mother and newborn. After cuddling the baby for a few minutes, the mother will be assisted to the bed (next to the pool) to deliver the placenta because blood loss is hard to gauge in water. Only then is the umbilical cord cut, usually by the father.

Through a survey on social networks, many friends balked at the idea of water birth, citing "messy" as the reason for rejection.

"The perception is not accurate, actually. The placenta is delivered on the bed so the pool is not messy - only slightly murky from the amniotic fluid," says Dr Choong as he shows me pictures of water births on his computer. He has delivered babies for more than 30 years and hopes that more medical practitioners will embrace water births and more hospitals will provide such facilities. After all, they only need to order an inflatable birth pool - hardly state-of-the-art material.

Water to water

There are two types of water births - the first is successful underwater delivery while the other is water immersion, where mothers are immersed in water and leave the pool to have a normal delivery (on the bed).

• Babies born underwater enter the world with significantly less trauma. They have a gentler transition from their mothers' wombs into the familiar surroundings of warm fluid.

• Water birth services in PHKL is between RM6,000 and RM7,000 (S$2,390 and S$2,800). It is slightly higher than the cost of normal birth, but much cheaper than a Caesarean section.

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