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WATER BIRTH

Water birth is an option offered to women all over the world for childbirth.
In the 1980s, this method was introduced due to increase the demand of an alternative method of delivery, for the purpose of ‘’more suitable for the natural birth process’’ and ‘’less invasive birth management’’. Studies show that water birth is a safe and comfortable option.
The water births in low risk women delivered by experienced professionals are as safe as normal vaginal deliveries. Labouring and delivering in water is associated with a reduction in length of labour and perineal trauma for primigravidae, and a reduction in analgesia requirements for all women.
Water birth is a birth option for mothers who are not in the risk group for pregnancy and delivery and who are suitable for normal vaginal delivery. The maternal candidate spends the process after active labor pains begin in a pool filled with water that is clean, suitable for body temperature and at a temperature that can feel comfortable. In order to benefit from the advantages of water, it is possible to integrate into the classical methods of delivery. Water can be used only in the process of labor, as well as the birth labor and the birth of the baby can be completed in water.
The purpose of using water during labor is to support relaxation and pain management, to facilitate the position of the mother and to increase mobility. In our country where cesarean rates are unfortunately high, the most important reason for the choice of cesarean is the fear of not being able to bear birth pain. Research shows that the need for painkillers in water births is reduced according to birth at the standard table. With the introduction to the water, the blood supply to the uterus increases which causes the uterine contractions to be less felt and shorter the pain duration which is the 1st stage of delivery.
With the lifting power of water, the mother loses 75% of her body weight. This means more comfortable and free movement. It is shown that the baby can direct the mother to the appropriate position for his/her own descent while on his/her way to delivery. Therefore, this freedom of movement in the water facilitates the baby's birth in the path of birth. As a result, it has been shown in some studies that the second stage of labor that is phase between the full opening of the cervix and the birth of the baby is shortened.
Water can be used only at the time of labor contractions or the delivery of the baby can be completed in water. Apart from medical necessity, the mother can be exited from the water before the birth of the baby according to the wish of the mother, the birth can be completed on the table as in the traditional method. However, if the birth of the baby in the water, the birth tears of the mother due to the effect of water was less than the traditional method. It has been shown that water does not carry a risk for the safety of the baby while it is aimed at facilitating the delivery for mother. While birth in water gained popularity rapidly, opposing views arose from fear of possible problems related to the birth of the baby in the water, not the process of water use during labor. The concerns of the newborn such as taking the water to the airways or the risk of infection are discussed. However, the results of the studies have shown that there are no cases of concern with respect the specific parameters. On the contrary, it is encouraged to provide a more gentle and soft transition from water environment in the uterus to the world for newborn with the water birth.

Water birth for baby

The first and foremost question in everyone’s mind is simple: How dose the baby breathe during a waterbirth? Several factors prevent a baby inhaling water at the time of birth. These inhibitory factors are normally present in all newborns.
The baby in utero is oxygenated through the umblical cord via the placenta, but practices for future air breathing by moving his/her intercostal muscles and diaphragm in a reguler and rhythmic pattern from about ten weeks gestation on. The lung fluids that are present are produced in the lung and are similar chemically to gastric fluids. These fluids come up into the mouth and normally swallowed by the fetus. These is very little inspiration of amniotic fluid in utero.
Twenty-four to forty-eight hours before the onset of spontaneous labor, the fetus experiences a notable increase in the prostaglandin E2 from the plasenta which causes a slowing down or stopping of the fetal breathing movements. When the baby is born, the prostaglandin level is stil high and the baby’s muscles for breathing simply don’t work, thus engaging the first inhibitory response.
A second inhibitory response is the fact that babies are born experiencing acute hypoxia or lack of oxygen, it is a built-in response to the birth process. Hypoxia causes apnea and swallowing, not breathing or gasping. İf the fetus were experiencing severe and prolonged lack of oxygen, it may then gasp as soon as it was born, possibly inhaling water into the lungs. İf the baby were in trouble during the labor, there would be wide variabilities noted in the fetal heart rate, usually resulting in prolonged bradycardia, which would cause the practitioner to ask the mother to leave the bath prior to the baby’s birth.
The temperature differential is another factor thought by many to inhibit the newborn from initiating the breathing response while the water. The temperature of the water is so close to maternal temperature that it prevents any detection of change within the nexborn.
One more factor that water is a hipotonic solution and lung fluids present in the fetus are hipertonic. Even if water were to travel in past the larynx, it could not pass into lungs.
The last important inhibitory factor –the drive reflex- is associated with the larynx. The larynx is covered all over with chemoreceptors or taste buds. İn fact, the larynx has five times as many taste buds as the whole surface of the tongue. When a solution hits the back of throat and crosses the larynx, the taste buds interpret what substance it is and the glottis automatically closes; the solution is then swallowed not inhaled.
God built this automatic reflex into all newborns to help them breasfeed and it is present until about the age of six to eight months. Thus the newborn can detect what substance is in its throat. İt can differentiate between amniotic fluid, water, cow’s mil kor human milk.
All these factors combine to prevent a newborn who is born into water from taking a breath until he/she is lifted up into the air.

Baby’s first breath

What initiates the breath in the newborn? As soon as the newborn senses a change in the environment from the water into the air, a complex chain og chemical, hormonal and physical responses initiate the baby’s first breath. The reflex to begin breating is only initiated after innervations of the trigeminal nerves in the face. It means it is needed that baby’s face must be exposed to the air for the first breath.
It is estimated that there have been well over 150,000 waterbirths worldwide between 1985 and 1999. There are no valid reports of infant deaths due to water aspiration or inhalation. In the last century, more interventions have been added to the delivery process by bringing births to hospitals in developed countries. The aim of water birth is to produce a less risky, more flexible alternative to the woman who is going to give birth and to give a more gentle transition to the external environment for the baby. In the same time, the aim is strengthening the idea of normal, physiological and natural birth, instead of seeing the birth as a disease.
Women may choose their own methods of birth within the limits of medical compliance. With such a method, the mother who wants to complete the delivery in the water after the period of pain is aware of the fact that the baby and herself is the lead role, despite the fact that the birth team is always close. The most important thing that makes water birth different is that it is an experience where the woman feels the feeling of becoming a mother and feels the most intense. Because of the birth process is under the control of the mother, except for the cases requiring intervention at the birth in the water, the birth gives the woman the pleasure of achievement and the birth experience.
In conclusion, the studies have shown that the use of water during labor or the completion of birth in water is safe and comfortable for both mother and baby in women who have no particular risk in pregnancy and delivery. Water birth is a special process and pleasure experience for women who prefer this method.

Some studies in the world

The study of Cochrane Pregnancy and Childbirth Group which was conducted in 2004 and 2009 and 8 randomized controlled trials involving 2938 pregnant women was found to be significantly less painful in the first phase of labor. There was no difference in apgar score, rate of neonatal infection and admission to newborn unit in infants. (1)
In 2009, 11 randomized controlled trials were evaluated in Cochrane review, which included 3146 women by Cluett and Burns. When compared with the traditional method of delivery, it has been shown that there is a significant decrease in the application of pain relief methods (epidural) in the first stage of delivery. There was no difference in intervented birth and cesarean rates or infection or perineal injury in the mother. There was no increased negative effect on the newborn such as apgar score, neonatal infection and neonatal infection. (2)
The results of Thöni, Mussner and Ploner’s research on 2625 water birth between 1997 and 2009 support the medical advantages of water birth. There was a decrease in episiotomy rates, shortening of pain in primipar and a significant decrease in pain relief requirement. For the newborn, there was no increase in the risk of infection in the water birth by compared to the traditional method. (3)
Alderdice et al. with Gilbert and Tookey's two major studies in England, including a 4-year period, included maternal and neonatal results after birth in water and only immersion during pain in water. The researchers did not see any difference in the results of mother and newborn when they compared the delivery of pregnant women who were not in the high risk group and who use water 4693 and did not use water 4032. Between 1994 and 1996, they examined the negative consequences of approximately 4000 births in water. 1500 consultant pediatric physicians were studied for 5 deaths among water-born infants and none of the 5 deaths were found to be water-dependent. Admission rates to special care units were slightly lower in infants born to water. (4,5,6) This study is important to address concerns about the safety of birth in water. The study of Geissbuhler and Eberhart on 7508 births was published in 2000 and it was shown that there was no statistical increase in infection rates in infants born to water. There was no aspiration in infants following birth in water and no drowning or death in infants. (7)
Other researchers reported similar results. (Burns 2001; Lenstrup et al., 1987; Rush et al., 1996; & Waldenstrom et al., 1992).
In the literature, there are several reports on the negative effects of water entry for babies, especially in pediatric journals. It was said that ‘’the likelihood of getting water into the airways at water birth should be evaluated (Nuygen et al., 2002)’’ . The decisions of the authors on the negative effects of water birth should be reviewed carefully. There are several methodological problems in this case study and the results are incompatible with the findings of very large studies. Of course, further research is needed in this issue, but every thought should be carefully evaluated, but not non-medical and non-scientific.

REFERENCES

Nikodem VC. İmmersion in water in pregnancy, labor anr birth (Cohrane review). The Cohrane library. İssue 2 Oxford, U.K. 2004
Culett ER. İmmersion in water in pregnancy labor and birth. Cohrane database Syst Rev. 2009.
Minerva Ginecol. 2010 Jun;62(3):203-11. Reparto di Ginecologia e Ostetricia, Ospedale di Vipiteno, Bolzano, Italy.
Alderdice, F., Renfrew, M., Marchant, S., Ashurst, H., Hughes, P., Gerridge, G., and Garcia, J. (July 1995). Labour and birth in water in England and Wales: survey report. British Journal of Midwifery, 3:7:375-382Andersen, B. Gyhagen, M. Nielsen, TF (1996 Sept) Warm bath during labour. Effects on labour duration and maternal and fetal infectious morbidity. Journal of Obstetrics and Gynaecology, Vol 16, No 5, pp 326-33 Alderdice, F., R., Mary, Marchant, S., Ashurst, H., Hughes, P., Gerridge, G., and Garcia, J. (April 1995). Labour and birth in water in England and Wales. British Journal of Medicine, 310: 837.
Gilbert, Ruth E., Tookey, Pat A. (1999) Perinatal mortality and morbidity among babies delivered in water: surveillance study and postal survey. British Medical Journal;319:483-487 (21 August) Geissbuhler V, Eberhard J. Waterbirth a comparative study. A prospective study on more than 2000 waterbirts. Fetal Diagn.Ther. 2000,15-291-300.
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