More women are choosing to give birth in a water tub for a drug-free labour. LEA WEE reports
Like most women in Singapore, housewife Su-Lyn Tan Meyer, 36, gave birth on a hospital bed. This was in 2006, when she had her first child. Unlike most women in Singapore, she chose to give birth in a tub of soothing warm water when she had her second child two years later. Mrs Tan Meyer has no doubt which she would choose again. She said: “Delivering a child in water is so calming and peaceful, unlike the usual image we have of a woman in labour screaming her head off. I felt like my baby just swam out of me.” As with her first delivery, she refused an epidural. But she said she felt less pain during the last 45 minutes of her two-hour labour, which she spent in the tub. She said: “I was able to bob around for a comfortable position, from squatting to sitting.”
More women like Mrs Tan Meyer are choosing to deliver their babies in water. And hospitals are responding by fitting their delivery rooms with tubs. The National University Hospital (NUH) has four delivery rooms with tubs and another four rooms in which inflatable tubs can be placed. Since the first water birth there in April 2006, the number of requests for such deliveries has risen from seven to more than 50 last year.
Thomson Medical Centre has received several requests for water births and it installed a tub in one delivery room two years ago. There have been five such births so far. There have been about 10 water births at Mount Alvernia Hospital since it renovated a delivery room and fitted it with a tub last year. All in, water births make up 1 per cent or less of the total number of births in these hospitals. Doctors say most women who choose water births read about it orheard about it from friends who gave birth that way overseas. Caucasians used to form the majority, but now, about six out of 10 women who ask for water births at NUH are Asians, said Dr Chong Yap Seng, an obstetrician gynaecologist with the hospital.
The main reason is a desire for a drug-free labour with minimal medical intervention and undertaken in the company of their husband or doula (birth coach). The water in the tub is kept at 35 to 37 deg C, replicating the temperature of the amniotic fluid that the baby was bathed in throughout the pregnancy. It is said that being born into a similar environment is gentler for the infant. It is claimed that the warm water relaxes the mother’s pelvic floor muscles and makes delivery easier. It is also said to make theperineum, or the area between the vagina and anus, more elastic so that there is less need for a surgical cut or episiotomy. These claims have yet to be proven.
The KK Women’s and Children’s Hospital, which is the largest maternity facility here, said it does not offer water births because there is a lack of good quality data on their safety. The hospital’s head of its peripartum unit, Dr Lim May Li, said several small clinical trials show that while water immersion during labour may relieve pain for some women, it does not bring significant medical benefits such as reducing injury to the perineum and improving the condition of the baby at birth.
Dr Chee Jing Jye, medical director of The Obstetrics & Gynaecology Centre, added that there are documented cases of the baby drowning after inhaling water into the lungs or bleeding after the umblical cord accidentally broke while it was brought out of the water. However, the specialist in complicated pregnancies said that this risk can be reduced if the medical team is well-trained.
Dr Chong from NUH, who has handled more than 60 water births, said he has not encountered these complications NUH, Mount Alvernia and Thomson Medical Centre do not offer water births for women with complicated pregnancies such as twins, multiple babies and breech babies (who are in an upright position) or medical conditions such as preeclampsia (high blood pressure). Mothers who carry the hepatitis B virus and other viruses are also not suitable for water births, because of the risk of infection to others. But NUH will allow water births for women who have had a caesarean section before, as well as those with gestational diabetes and babies due as early as 35 weeks.
A cordless waterproof foetal monitoring device allows the staff to monitor a baby’s heartbeat continuously under water. Should the baby show any signs of distress, the woman could be asked to leave the water and have a conventional delivery or a caesarean section, said Dr Chong. He added: “We often advise women to have realistic expectations of water births and to place the safety of their baby and themselves first. They always need a Plan B should things go wrong.” When things do go right, the feeling is euphoric, said Madam Doreen Eng, 38, who gave birth in water last April. The first-time mother said: “I felt empowered because I was able to take the position I wanted.” She was in labour for 25 hours and spent the last hour in the tub. She recalled: “I felt relaxed when I stepped into the water. I was able to go through my contractions without pain relief.” Her husband, Mr Chang Y. T., found the water birth a “magical experience”. The 41-year-old architect, who got into a pair of swimming shorts and into the tub with his wife, said: “Our baby did not scream when she came out of the water. She just made little cooing sounds. I am so glad her journey into this world had not been so traumatizing for her.”
What to expect in a water birth
A woman who gets the green light from her doctor for a water birth has some homework to do before her expected date of delivery. She is encouraged to create a birth plan on what she wants her baby’s birth to be like, said midwife Deborah Fox from the National University Hospital. Often, women who ask for water births already have some idea of the kind of experience they want. Said Ms Fox: “They do not want to be offered pain-relief medication unless they ask for it. They want a quiet environment, skin-to-skin contact with their babies after they are born and to breastfeed them.”
The couple will get a preview of the bath tub where the birth will take place. The oval-shaped tubs at the National University Hospital, for instance, come in two sizes: to accommodate only the woman or to fit in her husband as well. The cost of using these tubs ranges from $200 at Thomson Medical Centre to $500 at Mount Alvernia Hospital.
During the preview, the couple will be introduced to the equipment used in the birth:a floating water thermometer to make sure the water is maintained at 35 to 37 deg C; a waterproof torch and a mirror for the doctor to examine the woman; and a waterproof cordless foetal heartbeat monitoring machine. These are available at NUH and Mount Alvernia Hospital.
Most women will go on to sign up for natural childbirth classes offered by private companies. Some couples may also attend classes on hypnobirthing and other relaxation techniques. The women are also encouraged to engage a doula or birth coach. Ms Fox said: “Studies show that continuous emotional and physical support in labour raises a woman's chance of having a drug-free vaginal birth. She is also more satisfied with the birth process, and is able to breastfeed and bond better with the baby.”
During labour, the woman may choose to squat on a stool, stand on a mat or sit on an exercise ball. The delivery room also comes with other features to keep the woman calm and relaxed. These include dim lighting, music, aromatherapy and a microwave oven to warm up heat packs so that they can be applied to soothe aching muscles. When her contractions become stronger, she may choose to step into the water tub.
Said Ms Fox: “She can wear anything she likes in the tub. Most choose to wear a bikini top, a large T-shirt or nothing at all.” She goes into the water with a cordless foetal monitoring machine, if available, around her waist. Otherwise, the baby’s heartbeat will be monitored with a hand-held Doppler machine.
At Mount Alvernia Hospital, women are usually not allowed to stay in the water for more than two hours. Said the hospital’s assistant director of nursing for maternity services, Ms Susan Kok: “We need to change the water every now and then to keep its temperature consistent.” This also helps to keep the water clean as it may get murky from accidental faecal or other types of discharge.
Once the baby is lifted out of the water, she is passed to the mother who may start breastfeeding. The umbilical cord may be clamped and cut by the father. A short while later, the woman has to get out of the water and deliver her placenta on the bed. Ms Kok explained: “This will allow us to monitor her blood loss more easily.” Bleeding after delivery is a major cause of maternal mortality.