"Water birth" reduces pain and provides a comfortable birth

Dr. Hakam Çoker / Gynecologist

"Water Birth", which has a pain-relieving feature at birth, is one of the most popular birth choices in recent years! It has become a very common practice in our country and in the world

• History of birth in water

Although it has been the fact of water birth since ancient times in all cultures, it was not widely discussed and applied scientifically until 1980 -1990s. In 1805, water birth was mentioned for the first time in a French magazine. In 1980, water birth was documented for the first time in America. The pain relieving effect of water during childbirth and the fact that the expectant mother can move easily has made water birth very popular. Subsequently, the use of water at birth gradually increased.

• How does water birth take place?

As with births on land, the baby slowly takes off its head in the water. It also happens that he opens his eyes at this moment. Since oxygen continues to come through the cord, the baby is not trying to breathe. At this stage, our midwife definitely supports the mother so that she does not remove the baby quickly with a sudden push. The baby is then taken out of the water in a calm manner, placed on the mother's lap, and a warm towel is covered. Since it is a soft transition, the reflex cries of the baby also occur gradually, and some babies do not cry at all. The cord is cut with a delay of 1-15 minutes, depending on the family's request. The placenta usually separates after the mother is taken out of the pool.

• Aquatic Birth and Water Birth are separate things

Birth in water is a term that includes all births where water is used during prenatal contractions and / or birth. However, basically water birth should be examined by dividing into two;

1 Water birth: In the first stage of birth (1st stage), the mother enters the water pool before the baby is born and benefits from the relaxing and pain-reducing effect of water. It leaves the pool at any stage and the birth takes place on land.

We call this the use of water at birth.

2 Birth to water: The mother enters the pool especially in the last stages of birth, if there is no problem until birth, she will not go out and the baby is born into the water.

• The ideal time to enter the water at birth?

After the regular uterine contractions begin, delivery is divided into three main parts;

1 Opening period: The period from the beginning of the birth waves to the opening of the cervix sufficient to allow the baby to pass. There are 3 classical stages: slow, fast and transition period.

2 Birth: After the cervix reaches full opening, it is the process that continues until the birth of the baby by advancing through the vaginal canal.

3 Delivery of the placenta: It is the time between the separation of the placenta after the baby's emergence.

Birth in water is generally used for 3 different situations that are involved in the birth process. Which of these 3 possibilities will be chosen is entirely up to the preference of the pregnant woman (inner voice), provided that the doctor does not see any reservations. However, if water birth is aimed and everything is fine, the ideal is to go into the pool a few hours before birth.

• It has advantages, no downsides!

Its biggest advantage is its pain relief feature. Therefore, another name of the birthing pool is aquadural. Those who are first introduced to this pain relief feature may even think that their contractions have stopped. We also observe this effect in births. Other advantages include shortening the duration of labor, less perineal damage, reduced cesarean rates, reduced rate of intervention, ability to use the desired position at birth, and increased satisfaction with the birth.

Contrary to popular belief, there is no proven disadvantage in correctly selected pregnant women. This includes infection rates. In other words, today's data do not show us the disadvantages of pregnant women using the birth pool.

There is also a baby issue. There is no increase in infection rates in the baby. In correct follow-up, water swallowing, loss of baby, unwanted problems in the baby are not more common when compared to terrestrial births. An increasing frequency of adverse neonatal consequences of immersion in water during the second stage of labor was not detected in the 2009 Cochrane review.

• We don't have enough evidence!

Since there is no positive or negative evidence about the birth to water for both mother and baby, the decision is left to the family. In the ACOG 2016 publication, he concludes his final sentences as follows: “There is not enough evidence available regarding the benefits and risks of immersion in water at the second stage of birth and at the exit of the baby. Although major neonatal complications have been recorded, a large population-scale study has yet to be conducted. Therefore, until such data are obtained, ACOG's recommendation is to give birth in bed, not in water. ACOG believes that well-designed future studies on the benefits and risks of water birth that will affect the mother and baby should be supported. Moreover, according to ACOG, despite the comments in this article, a woman can request a water birth at the second stage of delivery, including the baby's exit. "

In other words, since there is no great evidence of benefit, doctors have to recommend terrestrial birth to families in a legal sense. However, there is no evidence for the risks. For this reason, ACOG stated that the wishes of families wishing to have a water birth should be respected. In this case, it should be the duty of families who want water birth to take the responsibility of their decisions after the right training and to investigate the hospitals and teams where they can reach these demands.

• Who cannot give birth in water?

First of all, we can say that it is not suitable for risky pregnancies. Not suitable for water birth;

* Pregnant women with very high blood pressure,

* Pregnancies before 37th week (premature) or after 42nd week (over term),

* Obesity-obesity (due to large baby and limited mobility)

* Twin pregnancies

* Rectal arrivals (Baby entering the birth canal with her butt)

* The incoming amniotic fluid is meconium (baby's first stool). Because this may be a sign that the baby is getting too little oxygen depending on the degree of the condition.

* Pregnancies that are estimated to be larger babies, that is, over 4500 grams,

* Pregnant women with herpes or similar viral infections in the genital area (due to the possibility of water contamination).

Apart from these, all low risk pregnant women are suitable candidates for the use of water at birth or for birth to water.

• Some hospitals have this opportunity

Unfortunately, not every hospital in the pool, I can say that this number up to 10 in all of Turkey. But their numbers are increasing. It does not bring an additional cost to the hospital expenses as it is thought. Additional payments may be received for the disposable pool cover in plastic pool use or for the maintenance of fixed pools. These also vary depending on the hospital.

• Hygiene concerns are unfounded

This issue is one of the biggest obstacles to water birth. We can almost say it is a myth. However, there is no evidence in any of the evidence studies that the infection rates have increased compared to terrestrial births. ACOG (American College of Obstetricians an Gynecologists / American College of Obstetricians and Gynecologists) argues in its 2016 publication that there is no evidence of an adverse effect for the mother in women who enter the water during childbirth and the exit of the baby. I think it is time for both doctors and pregnant women to quit this fear. We have not seen an additional infection rate in our own births, nor did we encounter any situation that is against hygiene.

If you want to give birth in water…

The first requirement is maternity education! It is not something to be done without education. Afterwards, the appropriate hospital and team selection is required. I say a team, because one-to-one support is again a must for water birth. We prepare every pregnant woman for the birth with a team of birth psychologist, midwife or doula, doctor, and we work together during birth. Now, the number of doctors and birth supporters in water birth is increasing. Researching these people could be the starting point.