"WATER BIRTH"

Arranged by:
Fadilla Kurnia Putri (1815401008)

MAJAPAHIT MOJOKERTO HIGH SCHOOL OF HEALTH SCIENCES

Midwifery OF DIPLOMA

SCHOOL YEAR 2019/2020

 ABSTRACT
Water birth is a method in which pregnant women vaginal delivery at term (term) without
complicating the street soaking in warm water. Currently, the water birth deliveries have started
much been given the many benefits to be gained. One of the advantages is helpful for mothers is
to reduce pain during childbirth. There are several other advantages of this method either for the
mother and for the baby. Water birth method also has risks and complications that need to be
considered. Childbirth water birth is very safe to do during the procedure and its phases
implemented. Noteworthy also is the policy and strategy to improve the safety and comfort in
using this method.

Keywords: Water birth, childbirth

PRELIMINARY

According to the World Health Organization (WHO) indicators of well-being of a nation is

measured from the amount of mortality during childbirth. The higher the mortality rate, the lower
the welfare of a nation (Hidayat, 2010). It is estimated that each year 300,000 mothers worldwide
die in childbirth. As many as 99% of maternal deaths occur in developing countries.
Primigravida who will face the labor tend to experience anxiety due to childbirth is a new
thing that will be experienced. With the increasing advancement in technology, action to reduce
labor pain and accelerate the delivery process began much done with the selection of one of them
is the method of delivery. Based on the media being used as labor, delivery methods are divided
into two, namely conventional methods per copy and the water birth method (water birth)
Childbirth is a normal process experienced by women. Labor is suatuproses where the baby,
placenta and membranes from the uterus of the mother. Labor is considered normal if the process
occurs at a fairly month gestation (term) without disertaiadanya complications. The delivery
process starts from the uterus to contract and cause changes in the cervix (opening and thinning)
and ends with the birth of the placenta is complete. In persalinanini process is usually
accompanied by severe pain and anxiety persalinanyang for the ibu.Namun is now developing a
delivery method that can reduce the pain of childbirth, provide comfort, and eliminate anxiety for
the mother.
Water birth is one of the alternative methods of vaginal delivery, where pregnant women at
term without complications of childbirth as the soaking in warm water (which is done in a
bathtub or pool) with the aim of cut down on the pain of contraction and provide a sense of
comfort,Konvensio nal delivery method is a method using a vaginal delivery medium as a
delivery bed, with this method of birth mothers are free to pick and choose the desired delivery
position,

Formulation of the problem

- How is the story of water birth?
- How is the labor process using the method water birth?
- What are the risk and complications of water birth?
- What are the benefits for mather and baby of water birth?
Purpose of the problem
- To know the history of water birth
- To ilustrate the labor process using the method water birth
- To know the risk and complication of water birth
- To know the benefits for mother and baby of water birth

CONTENT

A. DEFINITIONS

1. History of Water Birth

During the 1960s, researchers Soviet Igor Charkovsky do considerable research into the
safety and benefits that may be born of water in the USSR In the late 1960s, French obstetrician
Frederick Leboyer developed the practice of burying newborn baby in warm water to help ease
the transition from the womb to the outside world, and to reduce the impact of any possible birth
trauma.

Another French obstetrician, Michel Odent, said that by using warm water birth pool for
pain relief for mothers, and as a way to normalize the birth process. When some women refused
to get out of the water to complete the delivery, Odent started to research the potential
advantages for babies born under water, as well as potential problems in such births. In the late
1990s, thousands of women have given birth at Odent's birthing center at Pithiviers, and the
concept of water birth has spread to many other Western countries.

Water birth first came to the United States through couples giving birth at home, but soon
to be introduced into the medical environment a hospital and freestanding birth centers by
midwives and obstetricians. In 1991, New Hampshire began to create a protocol to give birth in
water. More than three-quarters of all National Health Service hospitals in England providing
this option for working women.

Water birth is a relatively new development introduced in Europe, French in 1803. In the
1970s, several midwives and doctors in Russia and French became interested in ways to help
baby do transition of the life inside womb to life outside as smooth as possible.

2. Definition Water Birth

Water birth (English: waterbirth) is labor or childbirth carried out in warm water. Giving
birth in water (water birth), is a method of normal vaginal childbirth in the water.

Water birth is one of the alternative methods of vaginal delivery, where pregnant women
at term without complications of childbirth as the soaking in warm water (which is done in a
bathtub or pool) with the aim of reducing the pain of contraction and provide a sense of comfort
method of conventional labor is a method of vaginal delivery using the media as a delivery bed,
with this method of birth mothers are free to pick and choose the desired delivery position.

In principle, delivery by water birth method is not much different from the normal delivery
method on the bed, just that the water birth method of delivery is done in the water while the
usual labor performed above the bed. Another difference is in labor in bed, mothers will feel
much pain when compared to delivery using water birth method. Some say childbirth water birth
can reduce pain up to 40-70%.

This delivery method is divided into two, namely:

1. Water birth is pure, ie the water birth method in which the mother went into labor after
experiencing the place an opening 6 until childbirth occurs.

2. Water birth emulsion, namely water birth method in which the mother had only been in the
pool area until the contractions of labor (Kala I labor) ends. The birthing process is still being
done on the bed.

During the delivery process through the water birth method requires some instrumentation
essential to be prepared, among others:

1) Thermometers Treatment

2) Thermometer mother
3) Doppler waterproof
4) Gloves tangan5) Workwear (apron) 6) Nets for lifting kotoran7) Alas knee cushion, parturition
instrument set8) Shower water hangat9) Portable / permanent pool10) Towels, selimut11)
Warmer and infant resuscitation equipment

Childbirth through the water birth method is slightly different from the conventional
delivery method (above the bed), this is due to differences in vehicle delivery. Via water birth
delivery process can be summarized as follows:

During Childbirth

1. Mother took the attitude that felt safe and comfortable for him. Freedom of movement that
allows mothers taking the right position for birth. Mother came recommended to soak into the
water at the opening of the cervix 4-5 cm with baik.2 uterine contractions. Observation and
monitoring, among others:

1) Fetal Heart Rate (FHR) by doppler or fetoscope every 30 minutes during the first stage of
labor starts, and every 15 minutes during the second stage of labor. Auscultation performed
before, during, and after a contraction.
2) The thinning and opening of the cervix and fetal position. Vaginal examination (VT) can be
done in the water or the patient requested while out of the water for inspection.

3) Membranes status, if there is rupture of membranes, FHR check, and check for cord prolapse.
If meconium amniotic fluid, the patient must leave the pool.

4) The mother's vital signs are checked every hour, with the temperature every 2 hours (or as
needed). If the mother had a headache, check vital signs, teach the mother to catch his breath
during a contraction.

5) Hydration mother. Dehydration is evidenced by the presence of maternal and fetal tachycardia
and increased maternal body temperature. If signs and symptoms of dehydration occur, mothers
were given a solution. If unsuccessful pairs of infusion of Ringer's lactate (RL).

1. straining should physiologically. Mother allowed straining spontaneous, risk of oxygen and
carbon dioxide imbalance in maternal-fetal circulation decreases, and will also be tiring mother
and baby.

2. Deliveries, when possible methods of "hand off". This will minimize the stimulation.

3. The birth of a baby's head is facilitated by the presence of gentle encouragement of uterine
contractions. Gloves used a helper to deliver the baby. Chock perineum, massage, and press
gently if necessary. Mothers can control the impulse head with his hands.

4. Manipulation of the head is usually not necessary to deliver the baby because the water has the
ability to float. However, patients need to stand up to help reduce or cut and clamp the umbilical
cord loops. Minimizing stimulation reduces the risk of respiratory distress.

5. Babies should be born completely in the water. Then as soon as possible is brought to the
surface "gentle". In the child born baby's head above the water surface and the body is still in the
water to avoid hypothermia, preventing mother to child transfusion. When the baby's head is
above the water, do not soak them back.

6. When a baby is born, the baby's head is controlled with a gentle motion, face down, and
emerged from the water no more than 20 seconds. The fetus can be rested on the mother's chest
while cleaning his nose and mouth, if necessary. This treatment should be viewed also long cord
so as not to break up. Then the baby was given a blanket, and on the monitor.
The next action is:

1) Active management and psychology still be given to the mother out of the pool.

2) When the active management of the third stage, syntometrine can be given.

3) Estimate the bleeding <or> 500 ml.

4) Tailoring perineum can be delayed for at least 1 hour to eliminate water retention in the
tissues (if bleeding is not excessive).

The gynecologist agreed, a study on the safety of water birth, both the mother and baby safety
needs to be done. This is a guarantee for mothers who choose this method was safe for his
choice. So far, research has yet befall the unfortunate case of mothers who gave birth in the
water. Often, stories circulated only anecdotal based on experience mother or medical staff who
experience it. Instead, a number of studies to inform the birth in water is worth doing
(Danuatmaja, 2008), which are:

1. A study in Liverpool, England compared 100 women who gave birth in water with 100
mothers who gave birth on land. The results mentioned, babies born in the same water healthy
and good condition with the babies born in the land. None of the 100 infants that require special
handling.

2. Two years later, an article in the British Medical Journal said the chances of a baby is born is
problematic and should be treated in the ICU as large among infants born in the water and on
land. So, the cause of problems is not a matter where the baby was born. In the same article
mentioned, the case of the five infants who died in childbirth in the water due to the following
matters. One infant died of women giving birth at home without assistance, one baby died before
she went into labor pool. Two babies died as a result of problems in the body's organs, and only
the baby died from an infection in the mother's womb during pregnancy.

3. A number of studies in Southend, England, in the period from 1989 to 1994 resulted in the
discovery that water birth is safe to do all the mothers of professional medical assistance and
help to master the technique of water birth. Although there are cases of two babies who died
from drowning and take in water, this is because the baby is too late removed from the water
after the delivery is over. Delays reportedly reached an hour.

4. Studies show that water birth tend to speed up the overall process of childbirth. A study says,
the water makes the second stage or stages of labor and delivery push faster up to 90 minutes.
Delivery time is becoming shorter again on the second delivery.

5. Two other important studies concluded, the use of a pool of water significantly reduce the use
of painkillers and reduce the use of delivery tools, such as forceps. Research also mentioned,
water birth reduces perineal tears. But this applies only for mothers who give birth the first time.

In the method of delivery water birth, expectant mothers will be fed into a pool of warm water at
the time of entering into the sixth openings. The goal is that the skin of the vagina become
thinner and more elastic so it will be easier to be stretched when the baby's head out through the
vagina, even said if labor goes well then do not need to have to tear the perineum (vaginal lips.
In addition, the warm water in the pool will also give a sense of comfortable, calm and relaxed,
in a relaxed state of this body will release endorphins (a kind of morphine that was formed by the
body itself) to reduce pain. the warm water is also able to inhibit impulses - impulses nerves that
conduct pain, thus making labor is not so heavy ,

In the water delivery in this, the husband also has a very important role in the smooth delivery, is
to perform massage on her back which aims to provide a sense of relaxed and comfortable to the
mother during labor performed in the pond. Water birth deliveries this method lasts
approximately 1-2 hours after the opening of the sixth where the usual delivery takes up to 8
hours.

Then after the baby is born then the doctor will pick up the baby to be breastfed surface of the
water for the first time. Most mothers sometimes feel worried about their baby will choke, but
actually it will not happen because when the baby is outside, the baby is still breathing through
the placenta - placenta and the umbilical cord is still connected to the mother's abdomen, so it
would not be a problem for infants who was born in the water.
4. The instrument used in water birth

Water birth delivery method has also been widely applied in some hospitals and health centers in
Indonesia such as Jakarta and Bali. Some of the equipment needed in the water birth is a plastic
tub large enough (diameter 2 meter) with a bump - bump underneath so that the mother does not
degenerate during labor progresses. The water level in the pond should also be arranged so as to
be above the navel well when mom sitting, squatting or lying down. Delivery position can be as
free as possible can while seated, facing backward or up to comfort the mother.

It is also necessary water heater and a thermometer to keep the water temperature to keep the
temperature of 37ºC. It is intended that the baby does not feel the difference between the extreme
temperatures in the stomach with the outside, and so the baby does not experience hypothermia.
Warmer water temperatures also cause the baby immediately after birth in the water will not cry,
because the baby was still in the womb due to the water temperature is still warm. The water
used is also sterile distilled water and does not contain bacteria that will not cause infection if
swallowed.

5. Things that should be considered in the delivery of water birthMelahirkan in water is also no
limit and some medical considerations. Here are some criteria for expectant mothers who are not
allowed to do a water birth: 1. Mothers who have a narrow pelvis,

2. The baby was born breech or transverse

3. Mothers who are under medical treatment

4. Women who have herpes because the herpes virus is not dead in the water and can be
transmitted to babies born.

Preparation for water delivery:

1. There is a willingness and confidence to give birth in the water

2. Following pregnancy exercise during pregnancy, so that the delivery process went smoothly

3. Make sure the pool that will be used in childbirth is a pool that meet the standard for a water
birth, and ensure cleanliness and sterility of the pond.

4. Prepare complete data, such as laboratory tests as a prerequisite in the implementation of labor
in air.Bagi mothers, should consult a gynecologist during pregnancy to be able to know what
delivery methods are most appropriate.

6.Tahap water birth

Water birth process has the same steps as a normal delivery. Only the mother soaking in warm
water, making the circulation of the blood vessels so much the better. The result will also affect
the uterine contractions that become more effective and better. So that the travel time in the
delivery process is shorter than in normal childbirth.

Following stages:

• Mothers get into the water when they give birth, the mother experienced the opening of the
latent and active phases. When the active phase of the opening has reached 5cm, new mothers
can get into a pool of water. In this phase usually takes a short time, about 1-2 hours to wait for
the birth of the baby.

• relaxed attitude, usually as soon as the mother goes into a pool of water will feel comfortable
and the pain disappeared. Mom can sit relaxed and can focus more on delivery. It can also be
another position such as menungging.

• straining as contraction. In the water, straining to be lighter, do not use a strong force that
usually make more painful. Water will block pain stimuli. So, the pain that is not passed, it will
disappear by itself. Plus the ability of the buoyancy of the water will ease during straining.
Straining to the rhythm of the arrival of a contraction. Babies who came out also do not need the
help of a hand or other manipulation, but it looks a bit sluggish out. Contraction would speed up
the opening of the uterus and speed up the delivery process. Moreover, with the mother soaking
in water, the walls of the vagina are more relaxed, more elastic, making it easier and faster to
open. It also causes no need for stitches after childbirth, except when there is a tear.

• Appointment of a baby. After exiting the baby's legs and the whole body, then the baby is
removed. Splattered blood that comes out is not going anywhere, but settles in the bottom of the
pool, as well as the placenta bayi.Kontraksi good uterus causing bleeding that occurs too little.

 profit

a. for Mom

-Reduce labor pain

Water birth is a normal birth in warm water, where with the use of warm water, women who feel
the pain reduction. Warm water also reduces the release of stress hormones, so that mothers
secrete endorphins which function as inhibitors of pain. According to a study comparing water
birth in a conventional manner showing a water birth can reduce the use of analgesics, whereas
in the conventional labor, analgesics are given to reduce pain, especially in the first stage of
labor.

- Shortening Kala I Childbirth

Some studies show that water birth shortening effect on the first stage of labor. Recent studies
have shown a shortening of the first stage of labor is limited to primigravidae. In this case the
mother feel more relaxed, comfortable, decreased blood pressure, and reduce perineal trauma.

-Reduce action episiotomy

A report showed that perineal become more flexible while in the warm water, which is caused by
warm water can increase blood flow to the perineum can stretch more easily. This can reduce the
occurrence of perineal trauma. It is said that women who do a water birth, the ratio of 1.5 times
more likely to experience perineal laceration, but 5 times more rarely do episiotomy. Differences
due to the difficulty in reaching the perineum mother while in the water, resulting in tears or
perineal trauma, but it protects the mother of episiotomy

Baby
With this method of water birth, babies are born in an environment where conditions are roughly
the same as intrauterine conditions. This is certainly a very good impact on bayi.8 There are
several theories that by reducing stress or pressure during childbirth will reduce complications
may occur in infants. Warm water conditions make the baby does not feel extreme temperature
differences with amniotic fluid, so as to facilitate the transition from the birth canal to the outside
world and the baby becomes a shock. Another advantage gained is reducing the possibility of
trauma to the baby's head as a result of the birth canal. This is because when the mother soaking
in warm water, the muscles around the pelvis mothers become more relaxed, perineum and vulva
become more flexible when stretched,

 Risks and Complications

Maternal

-Infection

There's objection that water birth is causing a risk for the water used is not sterile and dirt are
removed the mother when the mother straining. However, a literature states that the infection can
be the only mother who ringan.3 This infection can be prevented with good control and
supervision of the cleanliness of the pool and the water used during childbirth water birth.
Certain infections will die immediately upon contact with warm water.

-Pendarahan postpartum

There is a study that says that there is the risk of postpartum hemorrhage with this waterbirth. Its
prevalence is more common in women who primigravida.3 Doctors and nurses also said that
water birth can reduce the amount of blood lost. This is because the warm water surrounding the
mother, can lower blood pressure in the mother.

Neonatal b.Bagi

-Infection

The risk of infection at birth with a water birth method is very rare, but should still be taken into
account. Some reports indicate that water birth is a potential cause of infection of babies
(neonatal). Most infection caused by Pseudomonas aeruginosa. This bacterium is usually found
in tap air.10Berdasarkan report, infections due to these bacteria found in the ear swab and the
umbilicus of newborns with this water birth method.

Air -Aspirasi

There are various criticisms regarding this water birth, where there is a risk of water ingress into
the baby's breathing. This risk can be avoided by raising the baby as soon as possible to the
surface of the water. However, the appointment of a baby that is too fast, can cause rapid pull the
cord that goes beyond the length of the cord itself.

-Hipoksia Ischemic Encephalopathy

Generally the cord continuously provide oxygenated blood while baby filled her lungs with air
for the first time. Delay clamping and cutting the umbilical cord is very beneficial for the baby.
If the cuts are too fast, can cause the risk of hypoxia. There are some reports that babies born by
water birth may cause hypoxic ischemic encephalopathy. Reported hypoxia occurs in women
who gave birth for 7 hours in a pool of water.

-Hiponatremia

Hyponatremia occurs because baby breathe amounts of water are in the pool of water. The water
will be quickly absorbed pass through the lungs and taken toward the circulation, which would
later lead to the dilution of intravascular and excess fluid. Bebeapa experts suggested that a pool
of water where water birth water is added the salt to be isotonic atmosphere, so as to prevent
dilution and hyponatremia.

 contraindications

-persalinan pre-term

-adanya vaginal bleeding that much

-adanya maternal fever or suspected infection in the mother

-kondisi-condition that requires monitoring of fetal heart rate

-infeksi that can be transmitted through blood and skin

-using a sedative or epidural

abnormal heart -denyut

b.Kontroversi

-Mekonium

The presence of meconium should be evaluated and is one reason for the mother to leave the
pool. Some practices with a water birth, only limit on their meconium much.

- HIV, Hepatitis A, B, and C

Some evidence suggests that the HIV virus is vulnerable to warm water and can not live in that
neighborhood. Cleaning all equipment properly after birth need to be implemented. As for
hepatitis is still no source that can be used as a reference.

-Herpes

Some practices that provide waterbirth will cover the lesions first, especially if the lesion is
severe. But some are choosing better performing delivery by cesarean section.

- breech and multiple

According to the research in Surrey H.Hospital in Ostend, Belgium, stated that a breech birth
may be indication for delivery by water birth. Their experience is the reduced gravity in water
and the presence of power floats, it can create a good environment for a breech birth.

-Induksi or augmentation

Today many hospitals practice in dealing with the delivery process using Misoprostol or Pitocin.
Some even use the infusion of Pitocin to give birth in the water, as long as the fetal heart rate can
be monitored continuously.

-VBAC

At present, there remains controversy about normal vaginal delivery after a previous cesarean
section surgery. Some hospitals do not allow these women to give birth in the water because they
do not provide the tools for continuous fetal monitoring.
-Distosia shoulder or macrosomia

Currently, dystocia with a narrow pelvis, more often occurred due to the mother or service
providers try to push the baby before the baby rotates perfectly. We recommend that you wait a
few contractions, with a head that has been hanging out towards the water, and will allow the
baby to rotate perfectly.

According to the study, changes in the position that in water is easier to do than in bed.

• Temperature of water at the time of delivery

Some practices prohibit waterbirth mother to start soaking in the water when the water
temperature is lower than body temperature, because the baby will be able to breathe in the water
due to a temperature difference. There is research that says that water with a temperature lower
than body temperature can increase the activity of the muscles of the baby.

-placenta in water

Things that can be troublesome is the inability to assess blood loss. Currently, delivery of the
placenta is said to be safe and to blood loss can be estimated by evaluating the color and
determining where the bleeding occurred. Cutting and clamping the umbilical cord is
recommended not to do in the water.

CONCLUSION

Water birth is a method in which pregnant women vaginal delivery at term (term) without
complicating the street soaking in warm water. Water birth gives many advantages both to the
mother and her baby alone. One of the advantages that greatly assist the mother is to reduce pain
during childbirth. Water birth is also mempunyairisikodan complications that must be considered
for the safety of mother and baby.
 Water birth deliveries this method, should pay attention to indications and
contraindications, childbirth water birth is very safe to do during the procedure and its phases
implemented. Noteworthy is the policy and strategy to improve the safety and comfort in using
this method. And lastly, this method should be carried out by relief workers either a doctor or
midwife who are competent and have experience in handling labor with this water birth method.

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