KUALA LUMPUR - Dr Nor Amelia Mohd Fauzi knew that an epidural would never be an option for her during labour as she suffered from scoliosis (curvature of spine).
"There are other pain relief medications such as entonox and pethidine but they can make you feel drowsy. So I looked for alternatives. A midwife suggested water birth."
Then a medical senior house officer in Ireland, Dr Nor Amelia did her research. "The more I read about water births, the more I was convinced that it was the way I want to deliver my baby - gentle, natural, and relaxing." The doctor from Kelantan explains that there is a lower risk of tearing and episiotomy due to water-aided stretching of the perineal muscles.
"I also suffered from symphysis pubic dysfunction (pelvic pain) during my pregnancy, so I feared that with the conventional birth position, my pelvic condition would worsen. So, this was another reason to choose a water birth - mobility and freedom!"
She says the procedure was not a matter of convenience for doctors, but what was convenient and comfortable for her.
"I decided on a water birth when I was eight months pregnant after I came back from Ireland. I was worried that Dr Choong might not agree since it was a late decision but he assured me that it was never too late to decide on a water birth as long as I fully understood the method and implications."
She received mixed reactions on her choice but her husband and family supported the decision. The first question many people asked "Could a baby drown in water?".
"Babies live in water in-utero, and newborns will only breathe when two things happen - when the oxygen flow from placenta is stopped when the cord is cut, and when the baby is in direct contact with air."
Being a doctor made it is easier for her to understand the mechanism and explain it to curious family members and friends. She notes that many, including doctors are still sceptical about underwater delivery.
Surprisingly, even in the maternity hospital she used to work at, the special tub provided for water birth is very rarely used due to lack of demand and availability of experienced doctors.
"One would expect that awareness regarding water births is high, but apparently it is not so here," she says.
16 hours of labour
Two-month-old Wan Mohd Faris is Dr Nor Amelia's first child, so she had quite a prolonged labour (about 16 hours). "I decided to get into the pool when I was about 6cm dilated. The midwife was with me all the time. The baby's heart rate is carefully monitored every hour."
Relaxed and calm in the warm water, she fell asleep between contractions.
"The water was so soothing. I could still feel the pain, but it was less when I was in the pool due to the relaxing effect of the warm water. I changed my position frequently - squatting and sitting, but I found kneeling the most comfortable position. I changed it to upright position during the final pushing stage."
Her husband, Wan Mohd Firdaus Wan Mohd Fuaad, was in the pool with her for over seven hours.
"He massaged my back during contractions. It was only us in the pool. Dr Choong and the midwife were very supportive throughout the process. Nobody told me when to 'push' or to 'stop pushing'. I felt I was in control," she says. Faris was caught when he came out underwater and was immediately put on his mother's chest for a few minutes before they both got out of the pool and were helped to the bed.
Only then did Firdaus cut the umbilical cord.
"Firdaus was so supportive throughout. Not all husbands voluntarily get into the pool with their wives. Many just settle for taking pictures and holding their partners from outside the pool," says Dr Choong. "Nor Amelia made me watch water births on YouTube for hundreds of times!" exclaims Firdaus, adding that he only got out of the pool to perform prayers.
Asked whether she'd do a water birth again, Dr Nor Amelia, who was the first doctor to do water birth in PHKL, did not hesitate. "Yes, of course, I will do it again. I would encourage my friends and family too, if they want to go for something gentle and natural. It tremendously helped me face giving birth with back pain," she says.
She advises would-be mothers to do research on water births before making a decision.
"You can always use the water as immersion for pain relief, or in conjunction with other pain relievers like entonox and pethidine. After all, we do not need to be a purist."
She points out that would-be mothers should anticipate that they may need to get out of the pool and deliver on "land" due to various reasons, not least the baby and mother's safety.