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By Heather Pieterse - 2005, Birth Right - Private Midwife, RN, RM, Psych & Comm Health (Pr No: 8829195)
WHAT HAPPENS WHEN BABY IS BORN?
The baby will be born with very little assistance i.e. hand on perineum. As the baby glides out into the water it will be gently, but immediately, lifted up onto the mother's chest.
Baby will gradually take a nice breath and start crying this sometimes takes a few seconds. Remember all the while the cord is still pulsating and supplying Baby with all the necessary oxygen requirements.
Once baby is on mommy's chest, its face may be wiped if there is a lot of mucous.
The baby must be kept warm so it should either be submerged in the water (shoulders under) or a warm towel must be placed over baby to keep him/her warm.
(this is possibly the most important part of the birth keeping baby warm)
The cord will continue to pulsate and only be cut once the mother asks or it stops pulsating. Baby can remain in the water with mommy as long as it is warm this can be anything from 15 minutes to virtually an hour.
Once mommy or baby is ready to be taken out of the water, the baby will be taken by the back-up midwife who will wrap and dry baby and hand him/her over to daddy.
Once mommy has been helped out of the bath into a comfortable bed mom and baby will be reunited. The baby shouldn't leave the room or have any medical procedures performed such as weighing, injections etc until mom, dad and baby have had a chance to be together. (Unless medication intervention is necessary)
Having a waterbirth is becoming increasingly popular as women are reading more about it, hearing about it from friend's personal experience and fantastically - it is becoming more available.
Question commonly asked by most is:
Won't the baby drown?
No. The baby only starts to breathe once it receives stimulation i.e. cool air on its skin. The baby is born into warm water (body temperature) and therefore doesn't receive any stimuli to encourage breathing.
Isn't it very dirty?
Absolutely not, in my opinion it is a far cleaner birth that a dry or land birth. With little intervention and unnecessary procedures there is very little vaginal discharge/bleeding etc prior to the birth. If tearing occurs (which I must add is very seldom), there is a little blood discharged. Once the placenta detaches after the birth there is a gush of blood.
Does the midwife have to be in the water too?
Definitely not! We work from the side of the pool. Your partner may enter the water if he chooses though.
Is it true that waterbirth babies are more intelligent?
I don't believe so and I personally haven't read any documented proof of such findings.
RISKS AND REALITIES
Benefits of using water in labour and waterbirth:
· Helps relax a tense stressed mom in labour
· Helps speed up the labour process due to the above reason
· Decreases the need for medical intervention and augmentation of labour.
· Makes the labour more personal and private (it is easier to create a quiet space around you) a dimly lit quiet room/water vs. bright noisy labour ward.
· Research has shown that a woman using water in labour feels more in control of her labour and more satisfied with her birthing experience.
· It is far easier to move around in water than out of it good for active birth.
· Fewer incidents of needing episiotomies and fewer serious tears occur when using water.
· Babies tend to experience less stress and have a better oxygen supply if the mom is less stressed.
· The use of warm water in labour helps reduce the need for synthetic pain relief in labour which ultimately is better for baby.
· Baby is left with the mom immediately after the birth no unnecessary intervention this enhances the bonding process.
Other Tips:
· Your midwife will:
o know You (through monthly check-ups),
o observe everything carefully for signs
o and listen to gut feelings
· Rather be safe than sorry listen to your midwife - if she is concerned get out!
· Your midwife should always carry all necessary emergency equipment with her / set up / check emergency equipment on arrival to home/labour ward. (Suction, oxygen, drugs to stop bleeding, IV equipment)
IT IS ESSENTIAL TO HAVE A VERY GOOD TRUST RELATIONSHIP WITH YOUR MIDWIFE!
Foetal Heart monitoring :
It is recommended that your midwife should follow the American College of Obstetrics and Gynaecology guidelines:
Listen to the baby's heart for:
1. 1 full minute every 15 - 30 minutes in active 1 st stage
2. Every 5 minutes in 2 nd stage (or after every /every alternate contraction)
She will listen after contractions for decelerations and from time to time during contractions.
A Waterproof foetal Doppler will be used for this purpose as the heart can be listened to in the water and the woman doesn't have to change position or leave the bath.
It is very encouraging/motivating for woman in labour to hear the heart beat
Vaginal examination :
· This can be easily performed in water no need for woman to get out
· Kept to minimal ideally. Your midwife will use other observations to monitor progress - body language, breathing, contractions etc
· If labour is progressing well it is not necessary to do routine vaginal examinations.
(Being submerged in water is actually a very good deterrent against internal examination and other interference)
GENERAL GUIDELINES
Informed decision by parents :
- Discuss pros and con's of waterbirth with your caregiver.
- Ensure you involve your partner in the decision making process.
- Be flexible being too rigid about birth preference can lead to great disappointment allow your body to naturally find its own pace and place (you may not feel like water in the end?).
- The midwife should also be flexible!!
Questions to ask / consider :
- Why do you want a waterbirth?
- What have you heard about waterbirth?
- Has your desired birth venue got facilities for waterbirth and do they actually do waterbirths?
(Some hospitals in Pretoria openly tell their patients wanting waterbirths that the bath is used for pain relief before the epidural????)
- Bath availability-what if someone is using the bath when you are admitted?
Who can have a waterbirth :
- If you are 37 weeks gestation or more.
- If your pregnancy is considered low risk pregnancy.
- Normal progressing labour with no contra-indications - such as a baby in distress etc
Who is going to assist with the waterbirth? .
(RCOG recommends the attendant should be experienced in doing waterbirths).
- Good idea to have 2 midwives at the birth 1 for baby, 1 for mother.
- Aim: not just to give birth in water but rather to experience the comfort/pain relief/trust relationship with attendant/environment.
- Encourage partner participation he can assist you in a squatting position, he can enter the water if he desires, he can assist with the actual birth/lifting baby out of the water.
Other tips when planning a waterbirth:
- Choose your caregiver very carefully as we sometimes see cases where a waterbirth is promised by a caregiver who really has no intention of doing it and this can be very traumatic for you - to suddenly be faced with this knowledge only a week before your due date.
Questions to ask to ascertain whether your caregiver is really the one you want to do your birth:
- How often do they do waterbirths?
- Who assists through labour ( back-up midwife ) and are they supportive of water for pain relief?
- How often are waterbirths done in your facility of choice?
- What is the procedure after the baby is born?
o Is baby left with you or taken out immediately?
o Is the cord left to pulsate?
o Where is the placenta delivered?
o How is the baby's heart monitored in labour?
o When would you be asked to leave the water?
o When can you enter the water?
(All these questions will help you establish whether you feel you have the right caregiver for the birth you plan).
When to get out of water :
- If there are any concerns about mother - hypotension/ dehydrated/ decreased energy/fainting/bleeding.
- Changes in foetal heart rate or sudden meconium stained liquor.
- If your midwife suggests you get out due to:
o Large for date' babies where she is concerned about shoulders being to big or possibly becoming stuck
o If water becomes too soiled need clean water for baby.
o Maternal request - for sedation/epidural.
o For instrument births!!!!!
o Midwifes gut feeling
LAST NOTE FROM THE MIDWIFE:
To see a mother's face as she holds her newborn on her chest and slowly absorbs I've done it!
At the end of the day we want to know that we have assisted a woman to have a satisfying, safe birth experience . It is the ultimate satisfaction to know that she got the birth she dreamed of!
Good luck in the planning of your birth I hope this info is of value to you!
For more information about Natural Birth see www.earthbabies.co.za.
