Now, labor is no longer the scourge of a woman, childbirth is no longer to be something scary and worrying, but it is an event that is exciting and full of happiness. Efforts in the humanization of labor by giving autonomy to the patient, involving the family as well as managing the energy is a must. Many methods are used to reduce pain and create a comfortable atmosphere in a normal delivery, one of which is Water Birth.

  

Many acknowledged that the peace, comfort and coolness can be created by the water. All this has much to recommend that in addition to create comfort and calmness during pregnancy and childbirth, water birth also has many benefits, both for the mother and the baby is born.


Actually, whether it's waterbirth? And if this is also a competence that must be mastered by midwives in Indonesia?
Waterbirth: is a process of natural childbirth who reduce pain and smooth out the delivery time of the birth of a baby. Where the bottom of the maternal body was soaked in a pool / bath that contains water with a specific body temperature. Waterbirth is an alloy of Science, Art, Skill, Humanity and Tecnology. Currently, maternity in the water has become a trend in big cities in Indonesia. If we note that there are more artists who choose waterbirth in a birth, Wanda Hamida, Oppie Andaresta and Natalie Margaretha example. In Indonesia there have been several maternity hospitals and even clinics that provide waterbirth facilities as one of its superior service. In Bali for example. There is a foundation Bumi Sehat Bali Nyuh Kuning Ubud in Bali that have been using for years waterbirth. Also in Renon, Denpasar Bali RSB Hope there is a Mother who has a gynecologist Dr. Sanjaya SpOG Hariyasa who have received certification from Barbara Harper of Australia.
Basically the water has a lot of benefit to human life than for life, water is also able to give peace and comfort for us. Just imagine what happens when we are tired and weary, then soak in warm water? Surely our bodies become more relaxed, fatigue disappear and that there is convenience. Well how about the birth mother?When the mother felt the pain, fatigue and pain, of course the mother will be more relaxed and the pain was reduced when we encourage you to soak in warm water.
So what are the benefits for both mother and baby waterbirth in addition to feeling comfortable? The question is often thrown by friends when my midwife Sharring about waterbirth.
Each method has certain advantages and disadvantages, as well as waterbirth. Alderdice, Renfrew & Marchant, (1995); Gilbert & Tookey, (1999) in his study of 4032 deliveries compared between deliveries using the waterbirth method by not using a waterbirth in the process persalinanya stated that there was no difference in outcomes between the use waterbirth with no waterbirth. Gilbert and Tookey (1999) also found there were two babies who experience aspiration, although no cause of death in these infants.
Another study conducted Burns (2001); Lenstrup et al, (1987); Rush et al, (1996); & Waldenstrom et al, (1992) states that the waterbirth able to reduce more than 80% pain and discomfort during childbirth .
As with the Ponnete Herman (1995), which states that labor with breech position (breech position) is an indication for waterbirth, and he also stated that infants with shoulder dystocia will mebih easy caring management while in the water. How? Gloria LeMay, a midwife from Canada have made the protocol or SOP for the management of care delivery with shoulder dystocia in childbirth waterbirth.
Here are some of the benefits of which can be obtained waterbirth mothers:
1. When mom soaking in water, the body becomes light allows the mother to be able to more easily move or mobilization or waterbirth able to facilitate the movement of capital & allows mothers who take these positions and when convenient delivery time mules
2. Sense of comfort and relaxation can be created when the mother's soaking in water
3. Pain and reduced pain and increased relaxation mother
4. Shorten delivery time
5. Reduce trauma to the perineum and avoid episiotomy
6. Makes the mother feel more control (which determines)
7. Impedes the energy / power mothers during childbirth
8. Mothers who give private space protected
9. Reduce the incidence of SC.
10. Soaking in water during labor reduces the pressure on the stomach, increasing the efficiency of blood circulation and oxygenation to the uterus, the muscles are also in infants.
11. Some studies suggest that babies who are born with a waterbirth has an average incidence of neonatal infection is low, and Apgar scores were significantly higher.
12. Making maternal easier (Easier birth) to welcome the birth of their baby with a more gentle (a gentler welcome for baby)
13. By putting a pool / tub in the delivery room immediately change the atmosphere so the sound is softer, calmer mothers & people around her become less stressful.

Meanwhile, below is a shortage of waterbirth method:
1. Reduce the strength and frequency of uterine contractions, especially when used before the active phase.
2. The possibility of aspiration in infants
3. Hypothermia might happen if the water used is cold water
4. Estimated volume of bleeding and treatment of bleeding in third stage is difficult when the mother is still in the water
5. In theory, women have a risk for embolism occurs water
Then how the criteria are recommended for pool water?
1. Waterbirth should be used in women who have no risk or high risk of complications during pregnancy.
2. Mothers should begin to enter the water during the active phase in the process of labor.

Here are contraindicated for waterbirth:
1. Premature birth
2. Mothers who suffer from infectious diseases such as HIV, Hepatitis B and hepatitis C.
Recommendations for the use of waterbirth method:
1. Midwives should discuss the advantages and disadvantages of waterbirth to the patient.
2. Vital signs and fetal heart rate should in normal circumstances.
3. Fetal heart rate should always be monitored when the mother is in the water.
4. Maintain and monitor the water temperature around 36 to 37.5 º C to prevent hypo or hyperthermia.
5. Maternal temperature should also be monitored. And mothers must get out of the water when their body temperature exceeds 37 º C.
6. Waterbirth in the room in such a way that sets close to where the alternative delivery.
7. As much as possible the water kept clean of slime and dirt, so it is not easy to contamination.
8. Babies should be born until the complete absence of air to contact. Because of differences in air pressure and temperature can stimulate the baby to breathe and the heightens the risk of aspiration of water.
9. Intensive care for the baby to avoid hypothermia.
10. Water should be issued at the time, spending the third stage of the placenta or the management of the mother bleeding to find out accurately.
11. Ponds that are used in hospitals should be disposible or cleaned with chlorine to kill pathogenic bacteria.
And the questions that must be asked in addition to the above questions is whether the baby from drowning or aspiration, and how the baby breathe?
Keep in mind that there are several factors that can prevent the baby breathing in water. Baby while still in the womb get oxygen supply through the placenta and cord pusat.tapu practically breathes through the air has been prepared from fetuses aged 10 weeks through the intercostal muscles and diaphragm movement.24-28 hours prior to spontaneous labor, there are increased levels of placental prostatglandin which causes a decrease or stop the movement of breathing (Fetal Breathing Movements / FBM). With the cessation of movement of the diaphragm and intercostal muscles, the blood flow of many vital organizational and flow in the brain. And when the baby is born, prostatglandin levels are still high and the muscles to pernafasanpun not work. And the baby will breathe when there is a stimulus or stimuli that is the difference in air pressure. So when the baby is still in the water, the baby not breathing. The baby will breathe after head raised and out of the water for it then possible for the aspirations of very small infants.
Then the extent of the authority of a midwife in a waterbirth?
As a midwife most important is how to make mothers feel comfortable, these tasks can be performed in a waterbirth midwife:1. Ensure good condition of the mother & baby. 2. Detecting changes with rapid & appropriate, to prevent complications. 3. Taking action with fast & precise: either standalone, collaboration or referral 4. Facilitates comfort for the mother & husband / family, maintaining privacy. 5. Preparing the supporting environment, avoid contamination, infection prevention, stable water temperature, 6. Preparing since ante natal mothers, mental & physical 7. Competently prepared. 8. Teamwork is a solid or a glue 9. Accurately document the care And most importantly of all is: 1. Delivery should be competent helper 2. À evidence based practice is safe, beneficial. 3. Mothers need to prepare physically, mentally & environment 4. The presence of informed choice & connsent informed. 5. Security is the mother & baby kingpin (security for the helper & institutional) As a midwife, of course we can not "close your eyes and ears closed" with all the science and new technologies surrounding the health of mother and child, because it is our fundamental duty.Phenomenon that is present demands from the public on midwives competence, including competence in the delivery assistance in water (waterbirth). Well .... are you ready?