MEASURES TAKEN BY MOTHER AND BABY

1. Saiswapna
II /VI PHARM.D
WATER BIRTH:
Water birth is the process of giving birth in a tub of warm water. Some women choose to
labor in the water and get out for delivery. Other women decide to stay in the water for the
delivery as well. The theory behind water birth is that since the baby has already been in the
amniotic fluid sac for nine months, birthing in a similar environment is gentler for the baby
and less stressful for the mother.
Benefits for Mother:
Warm water is soothing, comforting, relaxing.
In the later stages of labor, the water has been shown to increase the woman’s energy.
The effect of buoyancy lessens a mother’s body weight, allowing free movement and new
positioning.
Buoyancy promotes more efficient uterine contractions and improved blood circulation
resulting in better oxygenation of the uterine muscles, less pain for the mother, and more
oxygen for the baby.
Immersion in water often helps lower high blood pressure caused by anxiety.
The water seems to reduce stress-related hormones, allowing the mother’s body to produce
endorphins which serve as pain-inhibitors.
Water causes the perineum to become more elastic and relaxed, reducing the incidence and
severity of tearing and the need for an episiotomy and stitches.
As the laboring woman relaxes physically, she is able to relax mentally with greater ability to
focus on the birth process.
Since the water provides a greater sense of privacy, it can reduce inhibitions, anxiety, and
fears.
Benefits for Baby:
Provides an environment similar to the amniotic sac.
Eases the stress of birth, thus increasing reassurance and sense of security.

2. risks to the mother and baby
Over the last 30 years, as water birth has grown in popularity, there has been
very little research regarding the risks of water birth. Some studies in Europe
have shown similar perinatal mortality rates between water births and
conventional births.1
According to an article written by the Royal College of Obstetricians and
Gynecologists, theremight be a theoretical risk of water embolism, which
occurs when water enters the mother’s bloodstream.2 Though the British
Medical Journalis 95% confidentin the safety of water births, they see a
possiblerisk of water aspiration.
If the baby is experiencing stress in the birth canal or if the umbilical cord
becomes kinked or twisted, the baby might gasp for air with the possibility of
inhaling water.3
This would be a rareoccurrencebecause babies do not normally inhale until
they are exposed to air. They continue to receive oxygen through the umbilical
cord until they startto breathe on their own or until the cord is cut. The final
potential risk is that the umbilical cord could snap as the baby is broughtto the
surfaceof the water. This can be prevented by using caution when lifting the
baby up to the mother’s chest.
situations are not ideal for water birth:
If you have Herpes: Herpes transfers easily in water, so you should discuss this risk
thoroughly with your healthcare provider.
If your baby is breech: Although water birth has been done with bottom or feet first
presentations, you should discuss this risk thoroughly with your healthcare provider.

3. If you have been diagnosed with one of the following: excessive bleeding or maternal
infection.
If you are having multiples: Although water births have been successful around the world
with twin births, you should discuss this risk thoroughly with your doctor.
If preterm labor is expected: If a baby is pre-term (two weeks or more prior to due date),
water birth is not recommended.
If there is severe meconium: Mild to moderate meconium is fairly normal. Since meconium
floats to the surface in a tub, your health care provider will watch for it and remove it
immediately, or help you out of the tub. Meconium usually washes off the face of the baby
and even comes out of the nose and mouth while the baby is still under water. If the water
is stained and birth is imminent, the woman can lift her pelvis out of the water to birth the
infant.
If you have toxemia or preeclampsia: You should thoroughly discuss this risk with your
healthcare provider.
preparation for a water birth:
First check with your healthcare provider. They may already be equipped for water birth
with a special tub or might know of a location in your area that is equipped for this.
If you plan to give birth at a hospital, make sure their policies permit water birth. Increasing
numbers of hospitals are welcoming parents who desire water birth.
You can rent a birthing tub online for about $350. Be sure to ask if the cost includes shipping
both ways and what extras they offer to make your birth experience more enjoyable. Check
with your insurance company to see if they will reimburse the cost of the rental.
Contact a local birth center to see if they offer a water birth option.
What Temperature Should The Water Be For a Water Birth? The water temperature ought
to be within 35C – 38C, depending on your preference. Adjust the temperature to your
comfort. If the water is too cold, you will lose body heat trying to keep warm, you will
become tense if you’re shivering and it’s thought that cold women don’t birth their
placentas well. If the water is too hot you’ll feel drowsy, overheated, become dehydrated
and as it dilates all your blood vessels. Your blood pressure will drop which can make you
feel faint and you’ll have a greater tendency to bleed after the birth. If you just want
localised heat, say on your back; use wet, hot nappies or hot packs whilst kneeling in the
water. Use a cold washer if needed on your face, have a fan blow on you (turn it off for the
birth) and suck ice.

4. What to Eat and Drink:
Drink to thirst. Ask your partner to remind you to drink at least 300mls of water every
couple of hours to avoid dehydration, which can result in fatigue and a poorly functioning
uterus. Eating and drinking during labour has been shown to reduce the total length of
labour by as much as 90 minutes. Eat light, easily digested food.
How Long Should The Baby Stay Under Water:
Discuss with your birth attendants ahead of time. Many people feel comfortable with the
time that it takes the mother to reach down and pick the baby up herself (called rapid
immersion). Any longer than that is not necessary. Remember that the great benefits of
water are achieved as soon as the infant is born into the warm water. How Does The Baby
Breathe During a Water Birth? The baby doesn’t breathe until after its face leaves the water
and its skin comes into contact with the air or it is stimulated. Until then, the baby receives
oxygen through its umbilical cord, as it has done during the 9 months of pregnancy.
Sometimes the babies are so calmat birth it can appear that they aren’t breathing at all but
they just aren’t crying. Their heartbeat will be normal and when you gently rub their back,
blow on their face or open their mouth with your finger they will gasp.
The Many Benefits Of Water For Labour And/Or Birth Greater comfort and mobility. The
mother has much greater ease and freedom to move spontaneously and to change position
to aid in descent of the baby. Reduction of pressure on the abdomen. Buoyancy promotes
more efficient uterine contractions and better blood circulation, resulting in better
oxygenation of the uterine muscles, less pain for the mother and more oxygen for the baby.
Helps mother to conserve her energy. Immersion reduces opposition to gravity; supporting
the mothers weight so that her energy can be used to cope with the contractions Promotes
deeper relaxation. As a woman relaxes deeply in water, her hormones are released and she
starts progressing faster with more rhythm: labour becomes more efficient. Water relaxes
the pelvic floor muscles, as it softens the vagina, vulva and perineum leading to fewer
injuries to these tissues. Water minimises the pain so effectively for most women that it
reduces or eliminates the need for analgesia. If analgesiais required it is in lower doses and
is potentiated by the effect of the water. Immersion is more safe and effective than an
epidural. Water stimulates the touch and temperature nerve fibres in the skin. It blocks
impulses from the pain fibres, known as the ‘Gate Theory of Pain’. Facilitates a dysfunctional
labour. Water can be an effective way to stimulate dilation of the cervix when the mother
has difficulty progressing into the active stage of labour. Water can reduce the need for
drugs to artificially stimulate labour. Often, simply getting into the tub will result in dramatic
and rapid progress to full dilation within an hour or two. Lowering of blood pressure. When

5. anxiety is causing high blood pressure, immersion in water often helps relieve it. The effect
is heightened if the room is darkened. Change of consciousness. Immersion helps relive
anxiety and promote relaxation. Water encourages women to let go and focus inward as
labour progresses Easier breathing. Moisture in the air makes it easier to breathe without
the mouth becoming dry and is helpful for women with asthma. Also decreases the
tendency to hyperventilate. Facilitates the second stage of labour. Many women are less
inhibited in the water. Many women experience rapid second stages, with the baby
emerging minutes after the body begins pushing, also known as the foetus ejection reflex.
(see Odent, The Nature of Birth and Breastfeeding) It reduces the ‘ick’ factor for some
women and encourages both parents to touch the baby whilst birthing Being in the tub
reduces the possibility of intervention by birth attendants. Their visibility is reduced and
they cannot touch the perineum or baby as it emerges unless the mother chooses to let
them. The ability for birth attendants to intrude is reduced. They are less likely to interfere
with the actual birthing without the womans consent and willingness to move and allow
access. Skin to skin time is facilitated. Initial breast contact is also easier to initiate as the
woman is already naked. The cord continues to pulse strongly for an extended period,
resulting in baby receiving his full blood volume. Birth in water is wholly a somehow softer,
more gentle experience. –
Positions of water birth:
Squatting – this is a good position for many women to give birth in, and it's especially easy in
the water because the water supports so much of your weight and makes it easier to stay in
a squat. You can also lean against the side of the tub to give yourself more support.
It's a good position for the mother to reach down and bring up her baby herself.
Sitting – The mom sits on the bottom of the tub, legs out or pulled up in a sort of semi-
squat. Normally she's leaning against the side of the tub. Moms in this position will often
rise up a little during pushing contractions.
Kneeling – This can be on knees, or on one knee with the other up in a sort of modified
squat. This is a very stable position that also allows you to be the one to pull your baby up.
Hands and Knees – this is a favorite position out of water and it works well in the water, too.
The water completely supports the mother's body and it's a great position for a mom that
wants to roll her hips during contractions. It's best to have an attendant waiting to catch the

6. baby if using this position, but if the attendant doesn't catch the baby it's OK – mom can
move back to a squat or kneeling as soon as baby is born and bring the baby up.
A consensus exists in the literature from theoretical, qualitative, empirical and
observational
research that intrapartum supportconsists of four key categories:
1. Emotional support, includes presence, demonstrating an effective caring attitude,
positive and calming verbal expressions and non-verbal expressions, distraction,

7. use of humour.end comfort measures, including environmental control,
encouragement of different positions and mobilisation, touch, massage,
application of hot and cold packs, hygiene, hydrotherapy, promotion of urinary
elimination and nourishment.
3. Information and advice, includes listening to women’s views, instruction on
breathing and relaxation, information about routines, procedures and progress.
4. Advocacy, includes protecting the client, assisting the client to make informed choices,
being the client’s voice when required and conflict resolution.
Midwifes role during water birth:
1.essure the temp of the water is suitable for water birth or not
2.helps you get in and out of the pool
3.checking your temp ,pulse and blood pressure are within the normal ranges or not
4.keep a check on how often your contractions are coming and encourage you to empty
your bladder
5.mointor the baby’s condition

8. Contraindications to water birth:
Previous obstreic history-
*post pattern haemmorage in excess of 1 litre
*caesarean section delivery when the womens labour and birth cannot be monitored
electronically
*shoulder dystocia
Medical history:
*insulin dependent diabetes
*active herpes
*known hiv positive
*alcohol or drug missuse
*any pre existing medical condition that may effect the women labour risk
Mobility or skeletal problems that may prevent leaving the birthing pool when necessary
History of water birth:
Giving birth in water (rather than labouring in it) is a relatively recent development in the
western world. The first water birth that we know about in Europe was in 1805 in France. A
mother whose labour had been extremely long and difficult was helped into a warm bath.
Soon after immersing herself in the tub, her labour progressed, she started to push, and
gave birth to her baby in the water.
In the 1960s, the Russian water birth pioneer Igor Tjarkovsky experimented with babies
being born into cold rather than warm water. His thinking was that this would help protect
the baby's brain and enhance the baby's cognitive abilities. Understandably, this approach
to water birth didn’t last long!

9. Next, in the 1970s, some midwives and doctors in France became interested in ways of
helping babies make the transition from life in the womb (uterus) to life outside as smoothly
as possible, by using warm water.
Their concern was that modern maternity care, with all of its interventions, was making
birth traumatic for babies. Some doctors, including French obstetrician Frederick Leboyer,
thought babies could be affected for life by the way they came into the world.
Leboyer's approach was to use a warm bath for the newborn baby a short time after the
birth, after a period of skin-to-skin with the mother and a natural third stage. Leboyer's
work influenced our next water-birth champion, the French obstetrician Michel Odent, who
installed birth pools in each room at the birth unit where he worked in France.
Odent noticed that as well as helping women cope with the pain of childbirth, being
immersed in water seemed to help labour progress. He found that water births also seemed
to offer babies a more peaceful journey from the womb into their mums' arms. Babies are
bathed in warm water as they emerge from the birth canal, and the pool environment feels
similar to the enveloping warmth of the womb.
Doctors and midwives noted how calmbabies were after they had been born in water. They
cried less than babies born in air. They appeared more relaxed and were eager to have eye
contact with their mums and to breastfeed.
Pioneers, such as Odent, thought that babies may feel more comfortable being born into
water because of our aquatic past. Many evolutionists now support what's called the
"aquatic ape theory ", based on the idea that we had a long period in our evolution when
we lived by the waterside. This explains why our babies are born with a subcutaneous layer
of fat, the ability to swimat birth, and the reflex that prevents babies from breathing when
they are born into water.
During the 1980s and 1990s, interest in water birth grew in the UK, Europe and Canada.
More water birth-champions emerged in the form of the obstetrician Michael Rosenthal,
registered nurse and childbirth educator Barbara Harper in the US, plus midwife and
educator Dianne Garland in the UK. These pioneers helped increase confidence in birth pool

10. practice by sharing their experiences of and promoting the use of water, and making sure
guidelines for labour and birth in water were safe.
Evidence fIn a meta-analysis, researchers combine data from multiple studies to get
stronger evidence. Cochrane researchers combined 11 randomized trials on water
immersion during labor and during birth (Cluett & Burns 2009). Eight of these trials only
studied water immersion during the first stage of labor (before the pushing phase). The
Cochrane reviewers found evidence that laboring in water reduces the use of epidurals and
spinals for pain relief. They also found that laboring in water shortened the first stage of
labor by an average of 32 minutes. There was no evidence of harm to the mother or baby
from laboring in water.
Randomized Controlled Trials on Waterbirth
There have been five randomized trials on waterbirth, and so far they show that waterbirth
holds several potential benefits for mothers including lower pain scores, less use of pain
medication, less use of artificial oxytocin, shorter labors, a higher rate of normal vaginal
birth, a higher rate of intact perineum, less use of episiotomy, and greater satisfaction with
the birth. As we noted previously, those benefits could be due, at least in part, to water
immersion before the birth. Three of the trials in the Cochrane review (mentioned above)
looked at the effects of actually giving birth in the water. One of these trials was an
unpublished student thesis from South Africa (Nikodem 1999). In this study, 60 people were
randomly assigned (like flipping a coin) to waterbirth and 60 people to land birth. There was
no water labor—participants assigned to waterbirth entered the pool at the start of the
pushing phase. The researchers found that the waterbirth group was more satisfied with
their birth experience (78% vs. 58%) and that the pain was less than they expected it to be
(57% vs. 28%). They found no difference in overall trauma to the birth canal between
groups. The researchers defined trauma to the birth canal as injury to the vaginal wall, labial
tears, or perineal tears. The other two waterbirth trials included in the Cochrane review
took place in the United Kingdom (U.K.) and Iran (Woodward & Kelly 2004; Chaichian et al.
2009). In the trial from the U.K., only 10 out of 40 people who were assigned to the
waterbirth group actually gave birth in the water. Since people didn’t stay in their assigned
groups, it is not possible to draw any conclusions from this study. The trial from Iran
included 53 people assigned to waterbirth and 53 people assigned to land birth (Chaichian
et al. 2009). Everyone who was assigned to the waterbirth group gave birth in the water.
The researchers didn’t find any differences in newborn outcomes, but they found quite a
few differences in maternal health outcomes between groups. Compared to the people
randomly assigned to give birth on land, those assigned to give birth in the water had a
higher rate of normal vaginal birth (100% vs. 79.2%), a shorter active phase of labor (cervix

11. dilates more rapidly) (114 minutes vs. 186 minutes), a shorter third stage of labor (birthing
the placenta) (6 minutes vs. 7.3 minutes), less use of artificial oxytocin (0% vs. 94.3%), less
use of any pain medications (3.8% vs. 100%), a 23% lower rate of episiotomy (a surgical cut
to the area of tissue between the vagina and rectum, called the perineum), and a 12%
higher rate of perineal tears. They didn’t find any differences between groups in the length
of the pushing phase of labor or the rate of breastfeeding. Since the 2009 Cochrane review,
two more randomized trials have come out on waterbirth—one from Iran and one from
China (Ghasemi et al. 2013; Gayiti et al. 2015). The 2013 Iranian trial randomly assigned 100
people to waterbirth and 100 people to land birth, making it the largest randomized trial
ever done on waterbirth. In the end, 83 people ended up staying in the waterbirth group
and 88 people stayed in the land birth group; it’s not clear why people left the study. This
study was published in Persian, not English, but we were able to get some of the details
thanks to our volunteer translators (Personal correspondence, Clausen and Basati, 2017).
The study found that fewer people in the waterbirth group had Cesareans compared to
people in the land birth group (5% versus 16%). People in the waterbirth group also
reported less pain with labor compared to the land birth group, but they do not give any
details on how pain was measured. There was less meconium (baby’s first stool) in the
mother’s amniotic fluid with waterbirth (2% versus 24%) and also fewer low Apgar scores
with waterbirth compared to land birth. An Apgar score is a test of how well the baby is
doing at birth. A low Apgar score means that the baby may require more medical assistance.
The trial from China randomly assigned 60 people to waterbirth and 60 people to land birth.
Everyone who was randomly assigned to the waterbirth group gave birth in the water. The
researchers didn’t find any differences in newborn health outcomes between groups, but
they found a few differences in maternal outcomes. Compared to the land birth group, the
waterbirth group had a higher rate of intact perineum (25% vs. 8%). The waterbirth group
also had a much lower rate of episiotomy (2% vs. 20%) and lower pain scores. The total
length of labor was also shorter in the waterbirth group by an average of 50 minutes. They
did not find any difference in the amount of lost blood between groups.or water birth
Baby careafter water birth:
Have a basket in each room
A basket is really handy for keeping baby’s things and it lets you save space and
clean fast. You are able to get things off the floor and store it where you can find
them, which will help you in cleaning the baby’s room and maintaining their toys
quickly. This also allows you to be efficient when doing a full home clean-up.
Keep household cleaning products handy

12. Make sure that all adults at home knows where the disinfectant and sanitizing spray
are to wipe down a dirty spot as soon as they see one.
Get on their level
From our point of view, it’s pretty easy for us adults to look at decently clean floor
and judge it to be clean enough. However, your little kids are going to be spending
quite a bit of its time on those floors, and you’re going to want them to be spotless in
order to help keep your baby safe from bacteria and viruses. Turn to Dettol
disinfectant multi-use hygiene liquid to keep your floor safe and sparkling, without
leaving behind any harsh or harmful residues
REFERENCES;
WWW.American pregnancyorg.com
WWW.belly belly.com
WWW.natural brithhand babycare.com
WWW.baby centerco.uk.com
WWW.evidence basedbirth.com
WWW.detol coin.com