With the medicalised model of birth that dominates today, we sometimes lose our perspective on this incredible milestone in the life of a woman and her family. It is possible to ensure the safe delivery of a child into this world while remaining respectful of the powerful emotional and spiritual aspects of childbirth. Every woman has the right to have her fears alleviated and both her physical and emotional needs met during childbirth. Every woman has the right to be treated with love and respect at this pivotal moment in her life.

You will often hear the statement: “As long as the baby is healthy, it doesn’t matter how it comes out,” and most of you, at some point in your pregnancy will be told that Caesarean Section is the safest way to deliver your child. Scientific research from across the globe tells us that this is not so. If you are a healthy women with an uncomplicated pregnancy, a Caesar is not the safest option and unnecessary interventions can have long-term physical and emotional effects. Internationally, countries with the lowest Caesar rates and tiered, midwife led maternity care, have the lowest infant mortality rates and best maternal outcomes in the world.

What is Active Birth?

An active birth is a normal, natural birth, without medical intervention, in which a woman follows her own instinctive responses working with her body to enable her baby to be born. If women were to labour in a relaxing, secure environment with good support and the freedom to move around, most would know instinctively what to do. Active birth enables a labouring woman to respond naturally to her birthing process and to make appropriate choices. Women are encouraged to remain mobile and upright and to adopt the position of their choice during labour and birth and unnecessary restrictions and procedures are minimised. Fundamentally it is an attitude of respect and support for the labouring woman and her family.


Waterbirth

A large number of women choosing midwife care and active birth opt for waterbirths. Below is an article by Tamzin Ingram, Unit Manager of Genesis Clinic, on the ins and outs of waterbirth.

Splashing Out at your Birth

In a world where women have grown acustomed to information and choice, birthing options other than the typical hospital scenario have become popular. Waterbirth in particular has gained much popularity in recent years and much has been said for and against it. In this article we will look at some of the core issues surrounding waterbirth and hopefully you will gain the information needed to make an informed decision with regard to your birthing options.

Benefits of a waterbirth?

The advantages of using water during labour and birth revolve around increased comfort for the labouring woman and a gentler transition for the baby from the uterus to the outside world. These advantages include:

• easier mobility so the mother can assume any position that is the most comfortable for her
• weightlessness in water
• warmth and a softening of the tissues and ligaments facilitating an easier birth and fewer tears.

Many mothers choose to labour in water because they find it soothing, are able to relax more and so experience their contractions as less intense. It has happened on more than one occasion that a mom who was labouring in water refused to get out for the birth!

Will my baby drown?

Two main things cause a baby to breathe when it is born. One is a change in temperature and the other is a change in pressure from inside the birth canal to the outside world. Both of these things are not as extreme in a waterbirth as they are in a birth outside of water. The temperature of the water is closely monitored and kept between 36 and 39 degrees celcius (body temperature) so there is no great change in temperature. Also the pressure at the bottom of a bath is greater than the pressure of air so the pressure change is not as great either. As a result, a baby born underwater will not take a breath until it comes into contact with air (ie. When baby is lifted out of the water).  The only time that this changes is if the baby is in distress in utero before the birth and for this reason no baby that is compromised is born underwater. Your caregiver will monitor this and will look out for things like meconium-stained fluid or an irregular heart rate in the baby.

Leaving a baby underwater for an extended period of time after it has been birthed is the most controversial aspect of waterbirth. The method most commonly used is for baby to be birthed "through" water as opposed to "into" water. In this method the baby is birthed and brought to the surface within one minute after birth. In my experience, once a mother has birthed her baby, she does not want to leave it floating around in the bottom of the bath anyway - she wants baby in her arms!

Why is waterbirth not available in more hospitals?

Birthing baths are not available in all maternity units and should you desire to have a waterbirth, or simply use water as a pain control method during labour, you should enquire about the availability of a bath beforehand. You should also chat to your caregiver about your wishes and find out whether they are willing to assist you in a waterbirth. Some caregivers are not trained for waterbirth and do not feel comfortable doing them.  Some hospitals do not have enough staff to allow for waterbirth. It is more labour intensive to assist a mom in a waterbirth than it is to assist a mom who has an epidural and staff shortages may prevent some units from allowing waterbirth.

Is there an increased risk of infection?

If the bath is properly cleaned before and after the birth and the water is clean (if it is clean enough to drink then it is clean enough to birth in) then there is no significant increased risk of infection to either the mother or the baby. Salt is also added to the water to act as an antiseptic and also to make the water more like body fluid so the baby is birthed from fluid into a like fluid. It is important to ensure that both the mother and the baby are healthy if they wish to have a waterbirth. It is not wise for HIV positive mothers to birth in water as it increases the risk of mother to child transmission of the disease.

When making a decision about what kind of birth is best for you, it is important to do your homework. You would not go and buy a car without looking at all the options, so why have a baby without looking at all the options? Talk to people who have had different types of births, talk to your midwife or gynae, read books, research your options on the internet. At the end of the day, knowledge is power and you deserve to have the type of birth that will best suit you, your partner and your new baby.

 By: Sr Tamzin Ingram, Unit Manager of Genesis Clinic