Water babies
More women are choosing
to give birth in a water tub
for a drug-free labour.
LEA WEE reports
ike most women in
Singapore, housewife
Su-Lyn Tan Meyer, 36, gave
birth on a hospital bed.
This was in 2006, when she had
her first child.
Unlike most women in
Singapore, she chose to give birth
in a tub of soothing warm water
when she had her second child two
years later.
Mrs Tan Meyer has no doubt
which she would choose again,
She said: “Delivering a child in
water is so calming and peaceful,
unlike the usual image we have of
a woman in labour screaming her
head off. I felt like my baby just
swam out of me.
As with her first delivery, she
refused an epidural. But she said
she felt less pain during the last 45
minutes of her two-hour labour,
which she spent in the tub.
She said: “I was able to bob
around for a comfortable position,
from squatting to sitting.”
More women like Mrs Tan
Meyer are choosing to deliver their
babies in water, And hospitals are
responding by fitting their delivery
rooms with tubs,
The National University Hospital
(NUH) has four delivery rooms with
tubs and another four rooms in
which inflatable tubs can be
placed.
Since the first water birth there
in April 2006, the number of
requests for such deliveries has
risen from seven to more than 50
last year.
Thomson Medical Centre has
received several requests for water
births and it installed a tub in one
delivery room two years ago. There
have been five such births so far.
There have been about 10 water
births at Mount Alvernia Hospital
since it renovated a delivery room
and fitted it with a tub last year.
All in, water births make up
1 per cent or less of the total
number of births in these hospitals.
Doctors say most women who
choose water births read about it or
heard about it from friends who
gave birth that way overseas,
Caucasians used to form the
majority, but now, about six out of
10 women who ask for water births
at NUH are Asians, said Dr Chong
Yap Seng, an obstetrician
Synaccologist with the hospital.
The main reason is a desire for a
drug-free labour with minimal
medical intervention and
undertaken in the company of their
husband or doula (birth coach).
The water in the tub is kept at
35 to 37 deg C, replicating the
temperature of the amniotic fluid
that the baby was bathed in
throughout the pregnancy. It is
said that being born into a similar
environment is gentler for the
infant,
It is claimed that the warm
water relaxes the mother’s pelvic
floor muscles and makes delivery
easier. It is also said to make the
perineum, or the area between the
vagina and anus, more elastic so
that there is less need for a surgical
cut or episiotomy.
These claims have yet to be
proven, The KK Women's and
Children’s Hospital, which is the
largest maternity facility here, said
it does not offer water births
because there is a lack of good
quality data on their safety.PHOTOS: DESMOND FOO, DOREEN EN
First-time mother Doreen Eng (left
and above) gave birth in a tub last
April after 25 hours of labour
without needing pain relief.
The hospital's head of its
peripartum unit, Dr Lim May Li,
said several small clinical trials
show that while water immersion
during labour may relieve pain for
some women, it does not bring
significant medical benefits such as
reducing injury to the perineum
and improving the condition of the
baby at birth,
Dr Chee Jing Jye, medical
director of The Obstetrics &
Gynaecology Centre, added that
there are documented cases of the
. baby drowning after inhaling
water into the lungs or bleeding
after the umblical cord accidentally
broke while it was brought out of
the water. However, the specialist
in complicated pregnancies said
that this risk can be reduced if the
medical team is well-trained.
Dr Chong from NUH, who has
handled more than 60 water births,
said he has not encountered these
complications.NUH, Mount Alvernia and
Thomson Medical Centre do not
offer water births for women with
complicated pregnancies such as
twins, multiple babies and breech
babies (who are in an upright
position) or medical conditions
such as preeclampsia (high blood
pressure). Mothers who carry the
hepatitis B virus and other viruses
are also not suitable for water
births, because of the risk of
infection to others.
But NUH will allow water births
for women who have had a
caesarean section before, as well as
those with gestational diabetes and
babies due as early as 35 weeks,
A cordless waterproof foetal
monitoring device allows the staff
to monitor a baby’s heartbeat
continuously under water.
Should the baby show any signs
of distress, the woman could be
asked to leave the water and have
a conventional delivery or a
caesarean section, said Dr Chong.
He added: “We often advise
women to have realistic
expectations of water births and to
place the safety of their baby and
themselves first. They always need
a Plan B should things go wrong.”
‘When things do go right, the
feeling is euphoric, said Madam
Doreen Eng, 38, who gave birth in
water last April.
The first-time mother said: “I
felt empowered because I was able
to take the position I wanted.”
She was in labour for 25 hours
and spent the last hour in the tub.
She recalled: “I felt relaxed
when I stepped into the water. I
was able to go through my
contractions without pain relief.”
Her husband, Mr Chang Y. T.,
found the water birth a “magical
experience”.
The 41-year-old architect, who
got into a pair of swimming shorts
and into the tub with his wife,
said: “Our baby did not scream
when she came out of the water.
She just made little cooing sounds.
Tam so glad her journey into this
world had not been so traumatising
for her.”
This is the last in a series on women
and childbirth
leawee@sph.com.sy
Alternative forms of giving birth:
Page 16,What to expect in a water birth
A woman who gets the green light from her
doctor for a water birth has some homework
to do before her expected date of delivery.
She is encouraged to create a birth plan on
what she wants her baby’s birth to be like,
said midwife Deborah Fox from the National
University Hospital.
Often, women who ask for water births
already have some idea of the kind of
experience they want.
Said Ms Fox: “They do not want to be
offered pain-relief medication unless they ask
for it. They want a quiet environment,
skin-to-skin contact with their babies after
they are born and to breastfeed them.”
The couple will get a preview of the bath
tub where the birth will take place.
The oval-shaped tubs at the National
University Hospital, for instance, come in two
sizes: to accommodate only the woman or to
fit in her husband as well. The cost of using
these tubs ranges from $200 at Thomson
Medical Centre to $500 at Mount Alvernia
Hospital.
During the preview, the couple will be
introduced to the equipment used in the birth:
a floating water thermometer to make sure the
water is maintained at 35 to 37 deg C; a
waterproof torch and a mirror for the doctor
to examine the woman; and a waterproof
cordless foetal heartbeat monitoring machine.
These are available at NUH and Mount
Alvernia Hospital.
‘Most women will go on to sign up for
So a a
‘PHOTO: MOUNT ALVERNIA HOSPITAL
For water births, the water in the tub is kept at
35 to 37 deg C, replicating the temperature of
the amniotic fluid that the baby was bathed in
throughout the pregnancy.
natural childbirth classes offered by private
companies. Some couples may also attend
classes on hypnobirthing and other relaxation
techniques (see page 16).
The women are also encouraged to engage
a doula or birth coach.
Ms Fox said: “Studies show that continuous
emotional and physical support in labour
raises a woman's chance of having a drug-free
vaginal birth. She is also more satisfied with
the birth process, and is able to breastfeed and
bond better with the baby.”
During labour, the woman may choose to
squat on a stool, stand on a mat or sit on an
exercise ball.
The delivery room also comes with other
features to keep the woman calm and relaxed.
These include dim lighting, music,
aromatherapy and a microwave oven to warm
up heat packs so that they can be applied to
soothe aching muscles,
When her contractions become stronger,
she may choose to step into the water tub.
Said Ms Fox: “She can wear anything she
likes in the tub. Most choose to wear a bikini
top, a large T-shirt or nothing at all.”
She goes into the water with a cordless
foetal monitoring machine, if available,
around her waist. Otherwise, the baby's
heartbeat will be monitored with a hand-held
Doppler machine.
‘At Mount Alvernia Hospital, women are
usually not allowed to stay in the water for
more than two hours.
Said the hospital’s assistant director of
nursing for maternity services, Ms Susan Kok:
“We need to change the water every now and
then to keep its temperature consistent.”
This also helps to keep the water clean as it
may get murky from accidental faecal or othei
types of discharge.
Once the baby is lifted out of the water, she
is passed to the mother who may start
breastfeeding. The umbilical cord may be
clamped and cut by the father. A short while
later, the woman has to get out of the water
and deliver her placenta on the bed.
Ms Kok explained: “This will allow us to
monitor her blood loss more easily.”
Bleeding after delivery is a major cause of
maternal mortality.Altemative forms of giving birth
HYNOBIRTH
WHAT: Simple self-hypnosis,
breathing, relaxation and visualisation
techniques to help women cope with
labour pains.
WHO: Women having any kind of
birth, from a caesarean section toa
water birth. The techniques are often
taught to both the woman and her
partner,
WHERE: Parentlink (tel: 6535-4626,
website: www.parentlink.org), Four
Trimesters (tel: 9475-1585, website:
www.facebook.com/fourtrimesters) and
Baby Bliss (tel: 9838-6205 (SMS),
‘website: www.babybliss.sg).
FEE: From about $500.
DOULA-ASSISTED BIRTH
WHAT: A doula or birth coach
provides continuous emotional support
for the woman during labour. She also
meets the woman before and after
labour to give her information or
emotional help.
WHO: Women due for any kind of
birth.
WHERE: ParentLink, Four Trimester,
Baby Bliss and Tranquil Beginnings
(tel: 9146-8640/6522-6543, website:
tranquilbeginnings.comsg).
FEE: From $900 to $3,000.
HOME BIRTH
WHAT: The baby is delivered at the
woman's home by a doctor and a
midwife or doula. The foetal heart rate
is monitored with a hand-held Doppler
ST PHOTO: CAROUNE CHA
Ata hypnobirt class at Parentink,
les Cooper uses a head massager on
ME wf, Mrs a eek \-Cooper. It is
believed that this will help her body
release endorphins, which provides
natural pain relief.
machine and the suturing of any
vaginal tears is done under local
anaesthesia by the doctor.
WHO: Typically for women with
normal low-risk pregnancies.
WHERE: Some doctors in private
practice may provide this service.
FEE: About $6,000, including the
rental fees for the oxygen tank and
‘other equipment, doctor's charges and
the charges of the doula or midwife,
Home births are not covered by
Medisave.
Sources: Di Bustamante from ParentLink,
Ginny Phang from Four Trimesters, Dr Lai
Fon-Min from Camden Medical Centre