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Birth is a physiological event. In the developed countries of the world, different alternative methods are offered to help the expectant mother during childbirth.
The main purpose in different applications is to make the expectant mother feel more comfortable during labor.
Among the alternative birth methods, besides water birth, the Lamaze method (preparing the pregnant woman for birth emotionally and physically. Thus, a prepared pregnant approaches the birth with sweet excitement and joy instead of fear.), and methods such as hypnosis birth.
Alternative conceptions of birth are needed to minimize the pain and fear of birth, to encourage normal birth, to reduce cesarean rates, to contribute to the country's economy by reducing the cost, and to offer options for birth to expectant mothers.
In addition to water birth, Lamaze method (psychoprophylactic method), Epidural anesthesia, Spinal anesthesia, General anesthesia, Systemic pain relief applications during labor, Paracervical block, Local anesthesia and postpartum pain relief drugs and methods can be counted as methods to reduce pain in labor.
Hydrotherapy, that is, treatment with water, is an alternative treatment approach that has been used for many years due to its muscle relaxant and relaxing effects. The idea that this effect can be used in normal births is also very old. Aristotle (6th century BC) stated that water is the most important principle of life. Again in ancient Egypt, some selected babies were delivered in water. The first documented underwater birth occurred in France in 1803. However, this is not a planned birth. The birth of a woman who was in labor for a long time and entered a bathtub filled with hot water to relax a little, took place during this time, and this coincidence went down in history as the first woman to give birth in water.
Water birth is an alternative form of birth in which labor takes place in a pool filled with hot water at 35-37 degrees. During childbirth, the relaxing effect of hot water is used. Hot water helps start the natural aching process. The birth is largely performed by the mother, and the mother is not given any medication, painkillers, or artificial pain. After the birth begins, the baby's heartbeat and the mother's blood pressure are measured. After the birth, the expectant mother is taken out of the water for bleeding control and taken to the normal delivery table. After birth, the mother and baby are taken from the bathtub and analyzed. The purpose of these assays is to eliminate microbial factors that may arise through water.
If the water is too hot here, there may be a change in the blood circulation of the expectant mother, and a sudden drop in blood pressure and a decrease in the blood flow to the placenta may occur. This can put both the mother and the baby at risk. In addition, in case of staying in the water for a long time, the expectant mother may also experience fluid loss due to sweating.
Water eases the secretion of the endorphin hormone, which relaxes the body, and reduces the tension of birth. Since the baby is in the water in the mother's womb, it moves from one aquatic environment to another and is not shocked.
The main purpose of underwater birth is to reduce the stress of the people, to reduce the painkillers used in labor, to make the birth faster, more comfortable and relaxed, and to relax the perineum-vagina muscles as much as possible.
Physicians giving birth in water; They claim that warm water has calming and pain-relieving effects and this effect helps the pregnant woman feel more comfortable and give birth more easily.
Theoretically, the biggest advantage is; warm water relaxes the muscles, provides mental comfort, and by this means, the blood flow to the placenta increases and a less painful and shorter birth process is experienced.
Water birth shortens the birth time by 3-4 hours compared to normal birth.
Babies can easily expel the water in their lungs during water birth.
Due to the mother's increased blood circulation, more oxygen goes to the baby. This minimizes the problems associated with breastfeeding in the newborn period.
Babies do not experience birth shock as they move from the aquatic environment to the water.
Everything about the development of babies continues normally.
Kadın suya girdiğinde ağırlığının %75 ‘ini kaybeder.
It's a safe method for babies, even though everyone thinks their baby might suffocate.
Even the thought that the fetus that develops in water for 40 weeks will begin to live in a liquid environment is important for the mother-to-be in choosing a water birth.
Advantages can be divided into In Labor and Postpartum:
– Hydrotherapy has benefits in providing both hydrothermal (relaxation in the perineum, vagina and cervix) and hydrokinetic (release of endogenous oxytocin due to stimulation of the nipple by water) effects.
– It offers a method of relaxation and coping with pain by minimizing the need for medical intervention, taking into account the following basic concept:
- The relative weightlessness of the expectant mother in water creates equal pressure on all surfaces of the body in the water (as opposed to the pressure applied by the mattress under the body at the same point all the time), reducing the energy expended and supporting the mother.
- With relaxation, the expectant mother feels less pain. Less pain causes less anxiety, which lowers adrenaline levels, ensuring a constant flow of endogenous oxytocin and oxygen.
- Since there is no external pressure on the inferior vena cava vein coming out of the heart, the blood flow to the uterus will increase and more oxygen to the muscle tissue in the uterus will cause more effective contractions.
- Slight vasodilation (vasodilation) occurs in water; This situation slightly lowers the blood pressure of the expectant mother and slightly raises her pulse. As a result, the amount of oxygen going to the uterus and fetus increases.
- It allows the expectant mother to take a position that can assist fetal descent during labor.
It offers the woman giving birth in a more flexible and lower risk environment compared to the delivery table.
.By accelerating the normal physiological process of labor; It makes this action to be thought of as a state of well-being rather than being seen as a disease.
. It helps the expectant mother to control her own birth process.
. It provides a smoother transition of the newborn to a new world.
- First of all, the expectant mother should have stated her desire for hydrotherapy and given consent to the person who will give birth.
-Mother-to-be should not have recurrent, untreated vaginal, urinary tract and skin infections.
-The vital signs of the mother and fetus should be within normal limits and the baby should have a reactive NST before entering hot water.
-The vital signs of the mother and fetus should be monitored intermittently while in hot water.
We do not recommend it to those who will be mothers for the first time and those in the risk pregnancy group. In the first deliveries, controlled incisions are made to open the tears properly. We recommend water birth for the 2nd or 3rd birth, as this cannot be done while in water.
Moreover;
-Fever of the expectant mother is higher than 38 degrees Celsius or there is a suspicion of infection in the mother-to-be
-Amnionitis (infection of the placental membranes), premature urination of the mother
– Fetal distress (trouble for the baby in the womb)
- Any situation where it is not appropriate to listen to the fetal heartbeat and continuous electronic fetal heartbeat monitoring is required.
– In High Risk Pregnancies (Mother's diseases such as heart, diabetes, asthma, etc.)
– Excessive vaginal bleeding
– Amniotic fluid contaminated by fecal material (dark meconium, etc.)
– Positive HIV (Aids test) status
– Malpresentation (differences in the baby's entrance into the canal)
– Dark particulate meconium (to a degree that may require perineal aspiration)
– Water birth is not recommended in cases where the gestational age is less than 36 weeks, which is confirmed by first trimester USG.
Since water birth has not become widespread all over the world, scientific research and articles on the subject are extremely limited. The number of comparative studies is also very limited and the available data are not sufficient to reach a consensus. There is conflicting information on the subject.
It is a disadvantage that the heartbeat of the baby cannot be monitored with the fetal monitor (NST) during the "tram", that is, the pain act of the pregnant. While some studies suggest that more and more serious birth canal tears occur in the mother during water birth, there are also studies reporting the opposite. Similarly, when water birth and normal birth were compared, contradictory information was obtained from a small number of studies in terms of parameters such as duration of labor and need for painkillers.
Infant mortality rate in water births is 1.2 per thousand and is not statistically different from normal birth.
The hypothesis of those who advocate water birth is that warm water will relax the muscles and provide mental comfort, and thus, the blood flow to the placenta will increase, resulting in a less painful and shorter birth process. However, the temperature of the water becomes important here. The ideal temperature for water is 37 degrees. If the water is warmer, there may be a change in the blood circulation of the expectant mother, and a sudden drop in blood pressure and a decrease in the blood flow to the placenta may occur, which may put both the mother and the baby at unnecessary risk. In addition, in case of staying in the water for a long time, the expectant mother may experience fluid loss due to sweating. On the other hand, it is very difficult to monitor the baby with a cardiotocograph while the expectant mother is in water during labor. Special monitor devices are required for this. If the labor is not monitored, there may be a risk of oxygen deprivation, as the decrease in the heart sounds of the baby will not be noticed.
Another risk associated with water birth is an increased chance of infection. Blood and feces mixed with water during labor pose a risk to both mother and baby. Although the feces of the mother in the water are taken out of the water, the water is never clean.
Suda doğum sırasında karşılaşılan ve önceden kestirilemeyen bir başka risk de kordon kopmasıdır. Özellikle bebeğin göbek kordonunun kısa olması durumunda aniden su yüzüne çıkan bebeğin kordonu kopabilir ve bebek kan kaybedebilir. Yapılan bir çalışmada suda doğum sonrası bebeklerin %14’ünün kordon kopması nedeni ile yoğun bakıma alındığı ve hatta bir bebeğe kan verilmesi gerektiği saptanmıştır.
This risk can be reduced by not keeping the pool where the birth will take place too deep or not pulling the baby up until fully born.
In terms of breathing, water birth does not increase the risk of drowning or swallowing water.
As a result…
Although there are no superior advantages or disadvantages to each other in terms of benefit or harm in many studies on the subject comparing normal birth and water birth, water birth is an "alternative birth method" preferred by many couples, especially in recent years. became like that.
The experience of the physician, the hospital conditions and the views of the couples should be considered in this regard and the decision should be shaped accordingly.