Water births: A calmer, drug-free way of delivering your baby

Water births cost more than natural births (but less than caesarean sections) due to the facilities and dedicated staff required. — HASSAN BAHRI/The Star

Water, whether you’re in or around it, has a very soothing effect on the body.

In fact, even drinking a glass of water can calm your nerves as it triggers the parasympathetic nervous system, which is responsible for the body’s “rest and digest” response.

When it comes to giving birth, doing so in warm water provides an alternative birthing method for women who want a more comfortable and serene environment to bring a life into this world.

The first water birth was recorded in France in 1805.

As the story goes, a mother whose labour had been extremely long and difficult was helped into a warm bath.

Soon after immersing herself in the tub, her labour progressed, she started to push and eventually gave birth to her baby in the water.

In the 1970s, some French midwives and doctors started utilising this method to enable a smoother transition for the baby from the womb to the world.

French obstetrician Dr Frederick Leboyer thought babies could be affected by the way they entered the world.

With water births, he noticed that women were less traumatised, coped better with labour pain and had a shorter labour duration.

Their babies also seemed calmer.

In water births, babies are bathed in warm water as they emerge from the birth canal, and the tub environment feels similar to the enveloping warmth of the womb.

Water births have begun gaining traction in the West, although most women are still unwilling to leave the security of the hospital bed and epidurals.

In Malaysia, it is believed that retired obstetrician and gynaecologist Dr Choong Kuo Hsiang was one of the pioneers who introduced water births here about 20 years ago.

All water births were temporarily banned a few years ago by the Health Ministry.

But the ministry reversed its decision last year (2023), provided that the facilities keen on providing this service fulfil all the necessary criteria to ensure patient safety.

Water births are not provided for in government hospitals, but in the Klang Valley, there is one private hospital licensed to offer this birthing option.

Natural way, please

The majority of pregnant women who walk into consultant obstetrician and gynaecologist Dr Paul Ng’s clinic, tell him they want a natural birth.

“We discuss all birthing options with them and I gauge to see what their expectations are like because water births are not an option for all patients.

“If they cannot stand pain and discomfort, and are hoping for an epidural, then they can’t get into the water.

“The ideal candidate must be motivated to go medication- free,” says the specialist, who is among the handful of doctors here offering the water birth option.

There is no specialised course for water births and training is conducted informally by senior obstetricians based on their years of experience.

There is no age criteria for water births, but eligible women include those without medical conditions; who have an uncomplicated, singleton pregnancy at term; and whose fetus is in a non-breech position (i.e. the fetus’ bottom or feet are not resting at the cervix).

Women with larger babies and prematurely ruptured membranes are not eligible.

“Some women with previous caesarean sections may have a risk factor, so they may not fit the criteria for water birth,” he adds.

Pregnant mothers have to prepare themselves mentally, emotionally and physically for the journey ahead.

Husbands can accompany their wives as a source of support.

The couple are also allowed to make the birthing room environment more comfortable with their own aromatherapy, music, etc.

Dr Ng explains: “The staff will talk the patient through to help them manage labour symptoms and they’ll pour warm water over different body parts throughout the time she’s in the tub to bring relief.

“I’m there at the beginning of labour, at intervals and when she is pushing to bring out the baby.

“My role is more to keep an eye on the pattern of labour and progress without having to be physically present.”

Along with the patient’s husband, there is a dedicated midwife and another staff to keep the environment relaxed.

“We don’t want people rushing in and out of the room, and we ensure that the environment is not ‘medicalised’,” says Dr Ng, who carries out one to three water births a month.

How long the woman stays in the tub varies as she is allowed to get in and out, based on her comfort level.

“If they cannot stand the pain halfway through the process, and depending on how far they are in labour, we first try to support them with position adjustments.

“If this is not possible, we bring them out of the tub,” he says.

Once the baby is delivered, he allows time for the mother to hold the baby skin-to-skin and take pictures.

She is then assisted out of the tub to the bed where the doctor does the sutures while she holds the baby.

Says Dr Ng: “It’s costlier than a normal labour due to the size of the room, tub use and dedicated staff involved, but definitely cheaper than a caesarean section.

“Mothers also recover faster – it’s like going into the swimming pool and coming out refreshed.”

There are challenges with water births, although these rarely occur as the patients are carefully selected.

According to the Health Ministry, there is a higher rate of first and second degree perineal tears in water births.

But that is because women in water births are more likely to have natural tears instead of episiotomies.

The perineum is the area between the vagina and anus, which is stretched tightly as the baby is born and is prone to tearing during the process.

An episiotomy is an intentional cut in this area by the nurse or doctor to help make the birth canal wider for the baby, as well as to minimise the risk of an unpredictable, accidental tear.

Other complications include:

• Umbilical cord snap – a rare, but possible, occurrence.
• Water aspiration by baby – most babies make a complete recovery.
• Possible increase in infection risk – usually from unclean hospital water supply, hoses and/or tubs, or lack of water filters.

Profound experience

After a natural, unmedicated birth with her first child Annabelle Ng in 2021, Singaporean Grace Chen was eager to explore a water birth when she learned from her masseuse that it was available (again) here.

Chen with David at six months of age. She was eager to try a water birth for her second child. — GRACE CHEN

“When I got pregnant with Annabelle, I told my doctor I wanted to attempt going drug-free because my pregnancy was smooth and the baby’s head was down early in the pregnancy.

“It’s not that I have a high tolerance for pain – it was painful, but I was able to go through it,” shares Chen, who lives and runs a business here with her Malaysian husband.

With her second pregnancy, she wanted to try a water birth.

As she fitted all the criteria, her specialist gave her the go-ahead.

She didn’t tell anyone about it except her husband and mother, who asked her, “What’s that?”

Preparation included watching lots of water-birthing videos, and doing light stretching and strengthening exercises.

Chen’s contractions began on Jan 16 (2024), but she only got into the tub on Jan 18.

She recalls: “I could squat and get on all fours in the tub of water because I was fully supported and didn’t have to worry about falling down.

“I could move the way I wanted to instead of being confined to a bed.

“The water took the weight off my pregnant body and made me more comfortable.

“I could see my baby coming out and he could latch on immediately.

“I felt more connected, because with Annabelle, I was tired as I didn’t know what to expect.

“The first birth was like a rehearsal for the second one.”

With Annabelle, it took six hours of active birthing, but with her son David, it took four.

“The birthing option is a very personal one, so you need to decide for yourself.

“I can share my experience with others, but I wouldn’t push water birthing on everyone,” she says.

Chen was discharged on the same day as she says: “I’m not a fan of staying in hospitals, although the doctor did say I could stay another day.”

She captured her memories in her birthing diary weeks after her son was born.

She wrote: ”At 12:07am on Jan 18, 2024, David was born, weighing 3.675kg.

“I cradled him, with his umbilical cord still attached, and was transferred to the bed.

“I held my baby skin-to-skin, and my husband Andrew cut the umbilical cord after it stopped pulsing.

“There are moments in life, moments that take my breath away.

“The profound privilege of holding my freshly-birthed baby definitely ranks at the top – a life that formed and grew in me over nine months, now in my arms.”