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Water Birth

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Hanaa Kassem

on 24 May 2015

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Transcript of Water Birth

Facts About Birth
Analysis of
the current state
of maternity care
Water Birth A challenge and Growing trend in Childbirth
Presentation Objectives
- To reevaluate birth practices.

- To improve maternity care in Egypt.

- Provide sufficient evidence based information on water labor and birth (mechanism, indications, benefits, risks and guidelines and protocols).

- To encourage healthcare providers for use of water labor and water birth for low risk women.

Analysis of the current state of maternity care
-Cesarean delivery (CD) is one of the
most commonly
performed surgical procedures.

-‘A significant increase of more than
in CD was observed from 1997 to 2006.
Analysis of the current state of maternity care
-High rates of interventions
don’t improve
fetal or maternal outcomes.

published by the Canadian Institute for Health Information.

Need for change
A step toward improving maternity care
It’s clear from understanding the current state of maternity care, a
change is needed
to normalize birth and increase the women satisfaction from their birth experience.

Laboring and birthing in water is an option to reduce the necessity for medical intervention and increase maternal satisfaction.

History of
Water Birth
History of Water Birth
-Ancient cultures practiced water birth.

-There are legends that ancient Egyptians birthed selected babies underwater, they become priests and priestesses.

History of Water Birth
Chumash Indians tell stories about their women laboring and birthing in shallow water, men aid in building fires, birth huts and drum traditional songs.
History of Water Birth
-The first medical journal in France in 1803.

-In France, Dr. Frederick Le Boyer installed a labor pool in a hospital of Paris 1970’s.

Research and Evidence
Research and Evidence
Research and Evidence
Research and Evidence
Two large surveys over a four year period in England and Wales found
no difference
in outcomes for women and their newborns .
(Alderdice, Renfrew & Marchant, 1995; Gilbert & Tookey, 1999)

- A recent Canadian randomized control trial reported women experienced
less pain
after water immersion.

- The journal Pediatrics released joint statement about
negative effect
of water birth.

stated that Water immersion for labor and birth
should be available
to all clients who request it, who have been screened and who have discussed the risks and benefits with their care provider.

- It is clear
more research

is needed
into this form of care.
Which women can use a birth pool?
A joint statement produced by RCOBG & RCM stated that:

All healthy women
with uncomplicated pregnancies at term should have the
option of water birth available
to them and should be able to proceed to a water birth if they wish.’

How does the baby breath underwater?
1-a notable increase in the Prostaglandin E2 levels.
2-Hypoxia causes apnea and swallowing, not breathing or gasping.
3- The temperature differential.
4- that water is a hypotonic solution
5- The dive reflex.
Garland, D., Jones, K. (1997, June). Ibid.
Odent, M. (1998, March). Use of water during labor—updated recommendations. MIDIRS 8 (1): 68-9.
Technical Skills
Technical Skills
Technical Skills
Technical Skills
When to enter the bath in labor?
-When there is established labor pattern.

When the effect starts?
-Twenty minutes and peak around ninety minutes.
How to assess the amount of blood loss?
-How dark the water is ?
-Skin color.

What is the Temperature of the water?

What about monitoring?
-Special partogram and waterproof Doppler for FHR.

How we deliver the baby?
-Baby underwater must be exactly that: underwater.
(D. Bjarnson, personal communication, September 21, 2010).
Guidelines for Infection Control
Benefits and Contraindications
Advantage of water labor and water birth
Advantage of water labor and water birth
Advantage of water labor and water birth
Advantage of water labor and water birth

-Provides significant
pain relief

Speeds up

- Reduces blood pressure.

-Gives mother more feelings of control.


 -Conserves her

-Encourages an easier birth for mother and a
gentler welcome for baby
perineal tearing

-Reduces the need for
drugs and interventions

 -Reduces
cesarean section

Alderdice, R; Renfrew, M; & Marchant, S (1995) Labor and birth in water in England and Wales: Survey report.
British Journal of Midwifery, 3. p 375 - 382.
Balaskas, (2004) The Water Birth Book.

Contraindications for
birth in a water pool
 -Pre-term labor

 -Excessive vaginal bleeding

 -Maternal fever

-Sedation or epidural

 -Fearful Attendant
-Evidence suggests the
need for change
in the maternity care.

Dr. Hanaa Abu Elkassem
Ob/Gyn Consultant
Child Birth Educator (AAHCH)
Egypt representative of (MBFHI)
-Normal birth means
Spontaneous onset.

-The word obstetrics comes from latin word “obstare” which means
to observe.

-Caesarean deliveries should
not exceed 10–15%.
WHO & ACOG recommendations
(Tracy, Sullivan, Wang, Black & Tracy, 2007).
(dekker,2013,WHO 1996,2006)
-Childbirth has become a
highly medicalized
event .
-Michel Odent, in France, published the first medical article about waterbirth in the 20th century which was printed in the Lancet in October 1983.
-From the late 1970s until now, over
90 countries
around the world have instituted water birth policies in hospitals.
-The first hospital in the US to offer water birth was in
New Hampshire
in 1991-
1% of births
in UK are water birth.
-There were free standing birth centers, owned and operated by obstetricians in the US.
-very popular with families who choose to birth at home.

(Ba'aqeel 2009)
(Alderdice, Renfrew & Marchant, 1995; Gilbert & Tookey, 1999)
(Rush et al, 1996)
-The perinatal mortality rate for these births was
to other low risk births in the UK.
(Gilbert and Tookey 1999).
(Nuygen et al, 2002)
Water Immersion definition
Providing a depth of water which enables the mother to sit in water that
covers her belly
completely and comes
up to her breast level.

(Nikodem, VC Immersion in water in pregnancy, labour and birth. (Cochrane Review). In the Cochrane Library, issue 4, 2002. Oxford)
Effect of warm water immersion
of labor, plus significant
pain relieve

- The relation between
and the release of
from the pituitary gland.

-Relaxed woman secrete less stress hormone and more endorphins.
(Gutkowska, Antunes-Rodrigues, & McCann, 1997).
Definition and Effect
of Water Immersion
Garland, D. (Dec. 2002). Collaborative Waterbirth audit -
"Supporting Practice with audit" MIDIRS Midwifery Digest,
Vol 12, No 4, Dec 2002, pp 508-511

-The protocol is simply cleaning the tub with a
quaternary ammonium solution, and brominating agent
to for a minimum of ten minutes.

disposable liners

proper cleaning
of drain pumps, hoses, filter nets and taps .

-long shoulder length

Analysis of the current state of maternity care
-Women voices
- All healthy women with uncomplicated pregnancies at term should have the option of water birth available to them and should be able to proceed to a water birth if they wish.’
Women in Egypt deserve having Water birth
-Laboring and birthing in water is an option for better maternity care.
Thank You ...
Full transcript