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Caridad Amador, Irene F. Buhigas and Asunción Aguada.
Water births continue to grow in popularity

Water births continue to grow in popularity

Six years ago, the University Hospital of Torrejón de Ardoz became a pioneer in natural methods of giving birth; since then, about a dozen others have followed suit

rubén cañizares

Tuesday, 4 July 2017, 12:52

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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).

"My daughters pulse was the same as it was during the pregnancy"

  • Elena is 32 and gave birth to her first child on March 1st. It was a girl, who they have called Anaia, and she came into the world 48 centimetres long and weighing 2.96 kilos. She is one of about 100 babies who are born in water at the University Hospital of Torrejón each year.

  • I always wanted as natural a birth as possible, with little use of analgesics, but this was my first pregnancy and I didnt know much about those things, so I had to let people guide me. Its always best to keep an open mind and listen to the professionals. They recommended giving birth in water, if I felt comfortable with the idea. I didnt even know you could do that, but I have to say that it was the right decision, she says now.

  • Elena was always clear that she didnt want an epidural. She wanted to be as aware as possible of her babys arrival in the world. During the dilation phase of labour, when her contractions were becoming painful, she decided to get into the bath to continue the process. Once in the water, she says, she realised that because the midwife wasnt intervening very much; it was physically tiring, but at the same time she felt so comfortable that she decided to stay in the bath for the expulsion stage.

  • If I had realised that it was so relaxing to be in the water, I would have got in earlier. They lowered the lighting in the room and switched on the ones in the bath, and once I was in the water I felt a lot less pain. I could move comfortably and choose the position that felt easiest. They also put a mirror in place so I could see the baby being born. It was a really lovely experience. I would definitely do it again if I have another baby, she says.

  • For Elena the babys wellbeing was the most important thing, and in the water Anaia was going to be born with very little stress, which was another reason her mother liked the idea of this method of giving birth.

  • She didnt seem to notice anything different. I was really impressed by her pulse rate. During my pregnancy it was always between 140 and 150 beats a minute, and it was the same after she was born. The highest it reached was 147, which shows she wasnt suffering at all. I was very pleased about that. When she was born her colour was good, her breathing was normal and she didnt cry at all, says Elena.

  • She moved onto a bed for the final phase of the birth. The placenta was expelled a few minutes later, out of the water. My husband, who was with me all the time, cut the umbilical cord and that was it. Our baby was born, and neither of us will ever forget that birth, she says.

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.

Its 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 childs 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. Its 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 arent 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 thats not enough. Everything has to be absolutely normal when she gets into the water. We are very cautious, says Asunción.

Constant monitoring isnt necessary in the water; it can be intermittent. Instead of continually checking the babys 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 theyre 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 arent 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 dont 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 brn in the bath, that isnt 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 isnt 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.

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