Gynaecologist, Dr. Fatima Poonawala on benefits & risks of Water Birth

Here is the transcript of our interview with Dr. Fatima Poonawala, Obstetrician and Gynaecologist, in Bangalore. Please note that the transcript has been edited for clarity and brevity and is not verbatim.

Water birth embraces the philosophy of non intervention in a normal pregnancy. When a labour is straightforward, it gets into an automatic mode. It ends in a normal vaginal birth, where the mother pushes and births her own baby with minimal medical interference.

So what exactly is water birth?

Water birth is a birthing process in which the mother’s body is totally immersed in warm water upto the abdomen in the presence of medically trained personnel.

Benefits for the mother:

• It provides natural pain relief in any and all stages of labour.
• Immersion causes buoyancy (weightlessness), which makes it easier for the mother to change positions from sitting to kneeling to squatting.
• Warm water makes the uterine contractions more efficient and shortens labour. It softens the perineum, thus preventing severe perineal tears.
• Water birth, by nature, avoids the complications associated with pharmacological pain killers such as Epidural. An anaesthetic used to induce loss of sensation below the waist, Epidural is known to cause increased operative deliveries in the form of forceps and C Sections. It also compromises early breast feeding.

Benefits for the newborn:

• The most important benefit is that the mother has not been given any pharmacological pain killers, which may pass on to the baby through the placenta. The pain killers make the baby sleepy and sedated.
• The baby is alert at birth, suckles, cries and remains active. These are very vital in establishing successful lactation and breast feeding. Thereby the ills of top feeding are avoided.

Procedure:

• First a few tests are conducted to check if the mother is fit for a water birth and the foetus is healthy.
• At the time of birth, the mother is surrounded by her own chosen attendants—her husband, friends, family members.
• When the mother is ready for birthing, the midwife/obstetrician patiently waits for her to labour at her own pace.
• When the mother is half dilated (at least 5 cm), she is immersed in deep warm water, making sure that she is comfortable in any position. The whole abdomen of the labouring woman should be submerged in water for maximum benefit. A normal bath tub is 18 inches, but buoyancy is better in a deeper tub. Therefore, depth of 31 inches and above is recommended.
• With an underwater hand held foetal monitor, the care provider checks that the mother and baby remain healthy from time to time.
• When the mother is fully dilated, she has an urge to push. As soon as the head is seen through the hand held mirror, she is encouraged to push. The care provider, patiently, with masterly inactivity, waits for the head to slowly emerge. She stays ready to help the mother, catch the baby gently underwater and lift it to the surface.
• Once the baby is born, there is no hurry to cut the umbilical cord. The care provider waits for the family to celebrate, and cuts the cord only when it stops pulsating. The mother is then brought out of the water to remove the placenta in case it hasn’t already been expelled and to examine and suture the perineum.

What are the risks involved?

While there are several benefits of water birthing that are also certain risks. We’ll discuss how they can be avoided and what sort of care must be taken.

• Drowning of the baby due to water aspiration: During its tenure in the uterus, the baby naturally swims in the bag of amniotic fluid. It has in built reflexes that prevent it from breathing and taking in fluid. This is called dive reflex, which is active when the delivery occurs under water. Only if the baby is deprived of oxygen at birth, it starts breathing prematurely underwater and then has a risk of aspiration. Therefore the tests before birthing and rigorous monitoring of the foetal heart under water is mandatory.
• Distress due to hot water: 
The temperature of water should not be more than 38 degree centigrade, as the baby may suffer from distress if hotter than this.
• Infection: Warm water is a potential medium for causing infection to the mother and baby. It is extremely imperative to follow a strict protocol and clean the pool after every use. If the sterilisation process is followed it has been conclusively shown after quality research that water labour and water birth colonises the baby but does not cause infection.
• Snapping of the umbilical cord: The cord can snap at birth due to the pull of bringing the baby out of the water. It can be prevented by being gentle and aware, constantly checking and reducing the column of water just before birth. These guidelines are incorporated into the bible of every water birth practitioner.

What must you keep in mind when selecting a place and a caregiver for water birth?

Water birth requires 1:1 intensive involvement of the caregiver. The practitioner has to be available during the entire duration of labour. Obstetricians who have a busy practice and attend to many hospitals find it difficult to offer their services. Practitioners who are competent in normal vaginal deliveries, who have a track record of high percentage of normal vaginal deliveries, are trained in water birth, and have an attitude to care, are best geared to offer water birth.

Under what circumstances is water birth not ideal?

• When the mother is heavy with a BMI of more than 25, it is strenuous to make her get in and out of water.
• If the mother has medical conditions like heart disease or high blood pressure, it necessitates close monitoring. This is logistically tough underwater. In such cases water birth is best avoided.
• Foetal heart irregularity and meconium stained liquor require electronic foetal monitoring, which is again logistically difficult underwater.
• During the course of water labour, if at any stage, there is a perceived maternal or foetal distress, water should be abandoned and the mother should be brought out of water for land birth.

Medico-legal beliefs that every birth is a potential for complications has led to medical interventions routinely. This belief contradicts water birth, which accentuates normalcy. Overall, water birth empowers the woman to be in charge of her own labour and decision making. It puts the birthing process back into the woman’s power. So much so that in some countries like Venezuela, it has become a human rights issue.

For more details you can visit the website: www.alfaclinic.net

If you have undergone water birth, do let us know about your experience and your opinion. We hope to bring to you more information on similar topics. And as always, we look forward to your feedback.