Pregnancy
Water birth is catching on in Indian metros but how safe is it?
Birth Village/ Aimie Sonia Natasha Coelho, Alfred M. Augusty

The water is set to 36 degrees Celsius, after which the mother gently enters the pool. The mother breathes deeply and relaxes. No, this is not a jacuzzi, but an alternative approach to labour and delivery known as water birth.

Leading this new approach are Bloom Fertility and Healthcare in Chennai founded by Dr.Kavitha Gautham, and Kochi based Birth Village, co-founded by Priyanka Idicula.

Water birth is a process by which the expectant mother sits in a pool of warm water during the labour process with the baby being delivered underwater. While some women choose to go through labour in the water and get out for delivery, other women decide to stay in the water for the delivery as well.

Does water birth help with labour?

Why go in for water birth? Sandhya* says, “I wanted my child to have a slow transition from the water environment in the mother to the air environment after delivery and this was one of the reasons I opted for this method.” 

Dr Jayashree Jayakrishnan, doula and lactation consultant at Bloom says, “The whole labour process is psychological. Labour pain in water birth is generally reduced to some extent and does gives comfort. It varies for everyone. While I have seen a mother rolling in the pool with pain, some stayed calm doing breathing exercises.”

In addition to labour pains, conventional labour delivery also involves routine interventions which can be painful to the mother, like episiotomy (a surgical cut made near the vagina) and labour augmentation, where medicine is given to increase the strength of contractions.

This has made some pregnant women to opt for a natural way of dealing with their pregnancy, and water birth is slowly becoming popular as an alternative.

Srimathi S based out of Bengaluru, went in for a conventional delivery for her first child.She had a natural delivery in her 37th week, but had to deal with the pain from the episiotomy for one month.

When she conceived again, the couple was looking for alternative. Srimathi shifted her base to Kochi along with her family. Recalling her experience at Birth Village, Srimathi says, “I started to get pains in the evening when we were in a mall, however, I wasn’t sure that I was actually into labour. At night, we went to the birthing centre. On reaching, they just felt my abdomen and checked the heartbeat of the baby. Half an hour later, I went inside the pool, was in a squatting position and I felt immediate reduction in my pain.I was free to listen to my favourite songs. I just followed my instincts, pushed four times and my baby was out. The best part was while my husband was holding me, my 5-year-old son was beside me videographing the baby's delivery.”

Image courtesy: Birth Village; Aswathi Sasankan Nambiar and Rohith Nair

Who is eligible for water birthing?

Says Priyanka, director and co-founder of Birth Village, “Ideally, if a woman chooses to birth in water, she should enter the pool when the dilation is 6-7 cms, the reason being entry into pool earlier on may slow down the onset of labour. During labour the water should be between 32º C and 36º C. For delivery, the water should be between 36º C and 37º C.”

Speaking on the parameters of women who can go in for water birth, Dr Kavitha stresses that it is very important for the woman to be medically and physically fit with an uncomplicated pregnancy.

Priyanka says, “The healthy woman should have completed 37 weeks of gestation. We don’t recommend mothers to opt for water birth in the case of twins, or if the baby is not oriented head-first.”

Aarthy M, mother of an eleven-month-old son was very firm on her decision of water birth right from the start till the end. She had completed full term and her labour lasted for 36 hours after the water bag breaking. She got herself admitted at Bloom around 3am and by next evening, intense pain had started.

She recalls, “The moment my pains were intense, I entered the pool and it made me feel relaxed in a couple of minutes. I finally delivered my baby the next noon. Only after the baby’s head came out, we realised the delay was due to the fact that the cord was around the baby. They immediately detangled the cord and my baby came out. The labour pain was bearable and I only shouted with pain when the stitches of my first grade tear was being done. I was really happy that my labour was without any injections to fasten my labour and no episiotomy was done.”

What are the risks of water birth?

Dr Priya Chandrashekar, pediatrician and consultant at Indira Child Care and Apollo Children’s Hospital, says, “Although the baby comes out in a familiar environment, the quality and the source of the water here in Chennai is unknown. There are rare chances of the baby swallowing water and thereby getting infected. However the warm water soothes the mother and that will reduce her physical and hormonal stress. A stress free mother’s child will always be healthier than children whose mothers are under stress.”

As per evidence based research conducted by the American Congress of Obstetricians and Gynaecologists (ACOG), there are rare possibilities of dehydration of the mother, chances of slipping while getting into or outside the tub and of overheating or loss of body heat of the baby.

Considering water birth is still not very well known in India, experts give one-on-one attention to their patients and explain the practice in detail.

Dr Jayashree, who has handled 17 successful water birth cases in the last one year adds, “We are very open with the couple about the pros and cons of water birth that is mentioned by the ACOG. We leave them to decide if they want to go for it. We give them a consent form stating all the possible risks.”

How practical is water birth in India?

Although water birth is a completely natural method without external medical intervention during the labour process which many women are favouring these days, it has a long way to go.

Dr Uma Ram, gynaecologist and director of Seethapathy Clinic, Chennai says,”We need to have a large and ready supply of water that needs to be clean and a lot of disposable equipment for the monitoring and managing of the delivery. In reality, in India, even in the city of Chennai, we are buying water to run our hospitals and this amount of water used per birth would be an unrealistic dream if the demand increases. Further adequate training of doctors and midwives is needed with good protocols in place before it is offered to women more widely.”

Priyanka also opines the need for more certified midwives to care for women on a one to one basis. Commenting on the future of water birth, she concludes, “We do feel that water birth may be offered to women but it does not solve the basic issues in maternity care like privacy, dignity in labor. We need more women to aware of the human rights in childbirth. In India again, we have a long route to travel as far as this concerned and without that really taking off, water birth will still remain a Youtube wonder in our country.”

*Name changed on request