Waterbirth - Overview

Water birth is beyond the physical aspect of water, it is an attitude to care, an attitude which believes in the normal physiology of labour and the ability to deliver with minimum medical intervention in low risk labouring women. Its an attitude both of the medical personnel as well as the woman in labour.

Who can offer water birth?
Practitioners who have a track record of high percentage of normal vaginal deliveries, who have the experience and patience to let women labour at their own pace, who can provide one to one care and support ,monitoring constantly both the mother and baby, and if required, have the infrastructure to safely and quickly intervene when required.

We at ALFA offer WATER POOL for pain relief and delivery under water. We have an experienced obstetrician as the lead member of the team, nurses and support staff available at most times.

Water is known to be relaxing, rejuvenating. A warm bath at the end of the day refreshes.

Michel Odent in 1960s used this medium to give pain relief in labour, one of his patients was so comfortable there, that for delivery, she refused to get out of the bath tub and delivered a calm baby under water.

This accidental under water delivery made him do extensive research and he came to the conclusion that water is safe for both mother and baby. This is subsequently found out to be true by thousands of mothers all over the world.

The advantage for mother is:
Deep Water immersion causes buoyancy which makes her movements in water very easy, very comfortable, she has her own private space, reduced pain perception inhibits stress hormones release, releases positive endorphins which reduces blood pressure. redistribution of blood causes better uterine perfusion, makes contractions more efficient and leads to a shorter labour

For the baby: baby is in amniotic fluid in utero, delivers in a similar liquid medium so the transition to land/air is gentler and are born calmer. Since the mother has had no pharmacological pain relief, the baby suckles better, lactation is successfully established bonding is better.

Babies do not breathe under water in normal circumstances because of various factors.

The prostaglandin E2 SURGE which occurs 24 hours prior to the onset of labour, inhibits fetal breathing movement, and hence babies do not breathe under water.

The dense taste buds in the larynx recognizes fluid at the back of the throat, closes the glottis, thus causing swallowing in stead of aspiration into the lungs.

Healthy babies have a relative hypoxia at birth which cause swallowing reflex, not gasping.

Guidelines are adhered to in selecting the patient who can and who cannot labour under water, protocols are strictly followed in monitoring the baby and mother ,to ensure safety of both.

Thus, water is now being successfully used in Europe, Thailand, Phillipines, Mexico, North America as a pain reliever, its even nicknamed “acquadural” and in the U.K. it has become mandatory in all public hospitals to offer water as an option for labour and delivery.

In India too, some hospitals and Birth Centres in Delhi, Mumbai and Goa offer water birth facilities.

We at ALFA are geared for water birth and hope to give a satisfying experience during the stressful period of labour.

Please go through our FAQ section on water birth for more information.

Contact us for specific queries at :9731703120

MY JOURNEY TO WATER BIRTH

Obstetrics was a very exciting thing for us young doctors in the 1980s .One delivers babies, whichever way, natural way or by Caesarean, very dynamic, unlike the other branches of medicine.

This sparked a passion to learn more about this phenomenon of childbirth. After studying and working in Mumbai, India, as a postgraduate, I ventured to the U.K. for obtaining the membership of the Royal College of Obstetrics and Gynaecology and to gain more experience in the subject.

In U.K., midwives look after the normal labouring mums, obstetricians are called only if labours are not progressing as expected. Senior house officers become the link between the two streams. Thus, as a SHO,I had a good grasp of the normal and the abnormal.

Once I was on call for 5 days at a stretch, during the Christmas and New Year period,{I was collecting days off for the vacation to India},in a unit which delivered average 10 babies a day with a 25% Caesarean Section rate, there was not a single Caesarean. My seniors remarked at the feat.

After passing the postgraduate examination and obtaining the membership of the RCOG,I returned to India, in 1992, I started practising as an obstetrician in Bangalore, balancing a young family and profession.

Bringing technology from the West to the knowledge and art of obstetrics resulted in a high percentage of normal vaginal deliveries, this gave me immense satisfaction.

Pain management in labour was still not satisfactory at this juncture, morphine derivatives did not take the pain away and depressed the baby while epidural would sometimes cause fetal heart changes and a higher rate of forceps delivery.

Water was already being used by some obstetricians in France and US for pain relief in early nineties, midwives in UK were already doing home water births but not mainstream yet. Research papers slowly started appearing, in the midwives journals, which showed a reduced pain perception, reqirement for analgesia was diminished, shorter labour, less perineal trauma.

Mums who had babies both on land and water swore by their positive experience in water, the word spread, with the advent of internet, it became a movement.

My own “would be mums” started enquiring about water births and this propelled me to go for it.

After a long search for places who would take in an obstetrician for training {water birth is done in midwife led units where they have their own midwifery students for mentoring}, I finally managed to convince Queen Charlotte’s, the Mecca of Obstetrics in London, to take me in. This was April 2011.

These were exciting two weeks, when I had first hand exposure to the Dos and Don’ts of water birth and returned home to put it in practice in our own unique Indian scenario.

On my return, finding the right pool for delivery was a task. Portable imported ones were available but permanent plugged in pool was advised, more user friendly, less cumbersome, can be made deeper for better benefits of deep water immersion and last but not least, is easier to clean and maintain.

It took a frustrating four months for the made to order fabricated pool to be delivere, around which, we at ALFA then modified our infrastructure to be able to have a steady supply of warm water at a temperature of 37 C at all times.

We then also installed ENTONOX-a combination of Oxygen and Nitrous oxide gases to provide pain relief in labour. This is a PATIENT CONTROLLED self administered analgesic. It does not reach the baby, and gets washed out of the lungs within minutes of stopping inhalation. In some mums, it helps relieve pain if they need something more than warm water immersion for pain relief.

We finally launched our water birth facility on 20/11/11, and our first mum was admitted that same night and had a water birth on 21/11/11.

How do we do it?
Non intervention is the cornerstone of water birth.
Correct diagnosis of labour , letting them labour at their own pace, closely monitoring the fetus with an under water Doppler, identifying the low risk mum in uncomplicated pregnancy, immersing her in water only when she gets into the active phase of dilatation, supporting her throughout labour while closely monitoring the fetus, having mum’s chosen family members to be with her when in the pool, making her comfortable in water by showing her the different positions, making her bear down at the right time after full dilatation , letting her deliver in whatever position she chooses, whatever position she feels comfortable, either squatting, on her knees or sideways, supporting the perineum gently, no- touch technique to deliver the baby, maintaining the water temperature at 37 C, all ensures the baby comes out in good condition and preventing bad perineal tears in the mother.

Waiting for cervix to be very favourable after ensuring well being of the fetus in mums who have crossed their dates, artificial rupture of membranes as the means for induction includes many mums who would have been otherwise excluded from water ,we can offer water for a large number of our would be mums.

We have started water births recently, but the non interventional philosophy has been ingrained in our practice for years, we have fine tuned it over a period of time, moving on to water birth is for us a natural evolution.