In November 2010, the Spanish Ministry of Health approved the ‘Strategy of Attention to Normal Birth’, a manual for clinical practitioners which encourages less intervention and medication in births.
Among other recommendations in this guide, which was produced in collaboration with the World Health Organisation, it aims to reduce the use of some procedures which have been considered normal until now, such as epidural anaesthetics, episotomies, shaving, enemas and breaking the waters. It also encourages giving birth underwater, which is quite unusual in Spain, because “immersion in warm water moderately reduces pain, facilitates relaxation and reduces the use of analgesics when carried out during the active phase of the first stage of labour (more than four centimetres dilated).”
Since then, the health service has improved its protocols and women in this country are now more aware of the possibility of water births.
“We have approximately 2,500 births a year at this hospital, and around 100 of them take place in water,” says Caridad Amador, supervisor of the Maternity unit at the University Hospital of Torrejón de Ardoz (Madrid).
This hospital has been a pioneer in this field for the past six years, because it is the only one in the Community of Madrid to provide water facilities during every stage of labour: dilation and expulsion. Since 2011, a total of 12 Spanish hospitals have introduced this method of giving birth.
“It’s much more common in central and northern Europe, especially in the UK. In Spain, we have always used many more instruments and until these new measures were introduced nobody here thought about more natural and less interventionist procedures,” says Caridad.
A woman who wants a water birth does so because it has a naturally calming effect and relieves pain. Thanks to the water temperature, which is usually around 36 to 37 degrees, there is less muscular tension and a heightened feeling of relief and relaxation, so the mother has a greater perception of her child’s arrival into the world.
However, it must be said that not all women can give birth in water. The conditions are quite strict.
“They must be women whose pregnancy has been low-risk from start to finish, for the mother and the baby. In other words, the ultrasound scans must all have been normal and she must not have suffered from any illness during the pregnancy. Also, women who have had a caesarian in the past are not allowed to have a water birth because of the risk of their scar breaking. It’s highly unlikely but it can happen, so we have to avoid that because if it occurs it is an emergency situation,” says Asunción Aguado, a midwife at the University Hospital.
Once the woman has been given permission, numerous precautions are taken during the actual birth. The foetus is constantly monitored to ensure that it is well. Sometimes the mother will be asked to come out of the water, such as if her waters break and the presence of meconium. Or some irregularity may be found during auscultation of the baby.
“If there is the slightest doubt, the baby needs monitoring extra closely and the mother needs to be on a bed for us to do that. For example, epidurals aren’t compatible with water births or with oxytocin. If oxytocin is needed during a birth it is no longer deemed to be low risk because constant monitoring is necessary. Another reason the mother has to come out of the water is if her dilation slows down. Some women have had the perfect pregnancy, but that’s not enough. Everything has to be absolutely normal when she gets into the water. We are very cautious,” says Asunción.
Constant monitoring isn’t necessary in the water; it can be intermittent. Instead of continually checking the baby’s heart rate, this is done every 15 minutes, before and after contractions, to make sure the baby is tolerating the process well.
“Scientific studies show that this type of monitoring is 100 per cent safe,” says Asunción, who also says common sense is also needed during the process of dilation. “I always say the woman has to be in labour before she can get into the water, which means that some mothers are only three to four centimetres dilated but their contraction rate is high, which means they’re ready. On the other hand there are women who are six or seven centimetres dilated but they are having hardly any contractions and the ones they have aren’t very intense. That means they are not ready to get into the water.”
Once they are in the water, there is no maximum time limit. Some women only want to spend a few minutes there, while others might take three or four hours. What is important is that the mother is comfortable, not too tired or cold, and the water should come up to her chest. After the dilation phase comes the expulsion phase, which can take place in the water or out of it.
“Not all women want both phases in the water. Some just prefer to be in the bath while they are dilating, then they don’t think there is any benefit to staying in any longer and they ask to give birth on the bed. It all depends on what the mother wants, as long as there is nothing that tells us otherwise, but most of them do give birth in the water. And it is important to note that when people say the baby could drown or swallow water if it is born in the bath, that isn’t so,” says Asunción.
What should take place out of the water is the final stage, with a small dose of oxytocin to keep bleeding to a minimum, but that isn’t always possible. “Some placentas come out really quickly and there is no time to get the mother out of the bath,” says Asunción. She also explains that donation of blood from the umbilical cord is not compatible with water births, because of the danger of infection.
And how does the baby experience the process of being born in water? Peacefully and calmly, it seems. Babies born in water seem to suffer less, with all the benefits that involves.
“The babies who are born in water suffer less stress. Obviously we have to do all the careful monitoring beforehand, but in reality this is a safe method for the mother and the baby. These babies hardly cry, and their foetal pulse is very similar to during pregnancy. Mother and baby both feel very well indeed,” says Irene F. Buhigas, a gynaecologist at the Torrejón hospital in Madrid.