M&B spoke to Barbara Harper, worldrenowned clinician, researcher, speaker and founder of Water Birth International as she began a series of seminars in Mumbai exploring waterbirth.
Barbara has been educating and training practitioners since three decades and her book, Gentle Birth Choices is required reading for midwife and doula courses. Find out how the infant brain develops and why we need to rethink birth…
HOW DID YOU DECIDE ON COMING TO INDIA WITH YOUR WORKSHOP?
I have been invited to India many times. In November 2012, I conducted workshops in Delhi, Hyderabad, Bengaluru and Kochi. That is when I met Dr Veda from Daimaa’s Natural Birth and Wellness Centre and she invited me to Mumbai. I came again on January 30 this year, on an invitation from Fortis Hospital for a grand opening of their centre in Gurgaon. Though Fortis is a normal hospital set-up, 20 doctors from fi ve of their top locations came for training on how to conduct waterbirths. Then, after a workshop at Kuala Lampur, I was back in Mumbai for this seminar.
HOW WAS YOUR EXPERIENCE IN MUMBAI?
Yesterday, we were at the Cama Hospital, talking to student nurses and midwives. Today, we are at the seminar at Holy Family Hospital, organised by Daimaa’s, where we have a selective but very involved audience consisting of obstetricians, midwives, physiotherapists and birth educators who have a vested interest in discovering how warm water can help a woman in labour. This is to be followed by a talk at Sion Hospital where I expect the reach to be much wider.
WHAT DO YOU TALK ABOUT IN THESE SEMINARS?
I don’t just talk about water birth but the whole subject of gentle birth. Water is just one option that can be chosen and I illustrate so many other things about the physiology of both mother and baby and what it takes to accept and raise a possible human. We think the baby can’t think or feel, is just a blob and it is a separate part of the mother. But it isn’t like that. The mother and baby’s connection is just like we see in the movie Avatar – they are plugged in together. The baby’s behaviour is determined by how the mother holds and accepts the baby right from the beginning of pregnancy. What I am offering is things that one can do to prepare the mother for receiving the baby right on her chest and why this is so physiologically important. I talk about how our human brains are wired and what we need to be loving, kind, empathetic, self-regulated and healthy. All these things are laid down in the pregnancy, the environment of the mother, her mental status, her emotional status, what we do to her and for her during the birth event and immediately post-partum. All this has an impact not just on her life but on the baby’s life too – especially on the baby’s life.
WHY SHOULD MOTHERS CHOOSE WATER FOR BIRTHING? IS IT ONLY TO RELIEVE PAIN OR IS THERE ANY OTHER IMPACT?
There is a huge impact. The water is her safe space. She is comfortable and it returns the control to her. People can do things to her when she is on a bed, but when she is in a tub of water, it is harder to get to her. It is her private, sacred space. It truly returns the control to her. You may ask why should women be in control when doctors know how to deliver babies? Well, babies know how to be born. They have a biological imprinting in their brains. They are wired for birth and wired to immediately go to their mother’s chest and find the breast. Just like a cat or dog or horse. We are mammals first and foremost. But we have medicalised that process and removed ourselves from our own bodies.
DOES LABOUR FEEL DIFFERENT IN WATER?
Women in water feel things more intensely –not the pain but the movement of the baby. Women tell me all the time, “I feel the baby kicking”, “I feel the baby coming out.” On the bed, you are just so consumed with the pain, the birth and the trauma of what is being done to you in the name of protection that you can’t be emotionally present. So you distance yourself from it. It’s like being raped. In fact, this kind of medicalisation or the intervention process is called birth rape in certain cultures around the world. It dehumanises the woman and separates her from her body. It gives the message that she is not good enough and her body is not capable and that only the doctor or nurse can make this birth happen. This is a generational and societal lie that has been put on women so they too feel that way. When a women is empowered with information and she understands how her body and the baby works and both of them are supported with love and comfort, including the use of warm water, the whole picture changes. And we have women who’ve said, “Why didn’t you tell me I was going to have an orgasm!” It becomes joyfi lled and love-fi lled instead of dread-filled and fear-fi lled. Water is the simplest tool that we have and it has been around for aeons. People sought warm water in many cultures – the Egyptians, Chinese, Samoans, Hawaiians, the native blacks from Ghana, etc.
THOSE WHO HAVE CONDUCTED WATERBIRTHS IN INDIA SAY THAT EVEN WATERBIRTH COMES WITH SPECIFIC EQUIPMENT LIKE THE THERMOMETER WHICH CHECKS THE TEMPERATURE. IN FACT, THERE ARE DOS AND DON’TS ASSOCIATED WITH WATER BIRTH. WHAT DO YOU HAVE TO SAY ABOUT THIS?
You can give birth in an ocean, a river or even a puddle or paddling pool. It doesn’t have to be complicated. It is not mandatory to get equipment from abroad. I have seen births in wash basins and kiddy paddling pools and very shallow bathtubs and even in the ocean. So what I want to say is, don’t make it more complicated by medicalisation. I throw the thermometer out as the right temperature is what the woman is comfortable in. Anyhow, to be specifi c, I don’t like the water any warmer than 38 degrees centigrade since it makes the mum too hot and sweaty. So anywhere between 32 and 37 degree centigrade is recommended. And the temperature doesn’t matter for the baby as the baby is not stimulated to take a breath until its brain senses that it is in an oxygenfi lled environment.
IN INDIA, WHERE WE TAKE MANY PREVENTIVE VACCINES DUE TO EXPOSURE TO INFECTION, A PREGNANT WOMAN WOULD BE SCARED OF CONTRACTING SOME INFECTION IF SHE WAS GOING TO THE BEACH TO HAVE HER BABY, EVEN IF COMPLETE PRIVACY WAS PROVIDED TO HER. SO IS THE WAY THAT YOU ARE SUGGESTING NOT SUITABLE FOR INDIA?
Let’s get one thing straight – birth is not sterile. You should have clean water in a clean environment. Is waterbirth safe? Yes. All the research studies and randomised controlled trials say that waterbirth is as safe as any other vaginal birth method. So what we need is not bottled water but bathable or cooking water and some method to heat it. Ideally, also a dimly-lit environment because we are dealing with the same hormones that were produced when you made love and created the baby. Ask yourself what kind of environment did you want to be in when you conceived – soft light, soft music, relaxation…Whatever it took to get the baby in is the same environment we should have, even if it’s in a medical centre, to get the baby out. We must remember that medical centres are not the safest place to have babies as they are full of infection.
WHEN DOES THE BABY BEGIN TO BREATHE WHEN IT IS BORN IN WATER?
There are receptors in the face around the nose and mouth called the trigeminal nerve or the fifth cranial nerve that say to the brain, “I feel the presence of oxygen and gravity.” Those two things tell the baby that it has been born. And it starts switching over from foetal circulation. Inside the womb, it’s an aquatic mammal and outside, an airbreathing mammal. The transition through water is a continuation of the womb and so I call it ‘a womb with a view’. The baby comes out, stretches for the first time and opens its eyes, maybe makes a face but does not attempt to take a breath because it is physiologically not possible. As it moves its limbs in a swimming motion, the mother gradually picks up the baby and it starts to breathe in air. As a midwife, I don’t do anything. I only support the woman to do as her body dictates. She can move into any position with the water facilitating it.
WHICH POSITION IS MOST SUITABLE FOR BIRTH?
Babies can be born with the woman standing, squatting, kneeling, on hands and knees and they do that in or out of water. It’s a societal lie that the mother has to be on a bed with her feet up in stirrups with the doctors watching the baby coming out. Women must understand that it is their body and their job to let the baby out because the baby has been programmed neurologically, biologically and cellularly to be born and attach to a breast. Its behaviour has been pre-programmed.
THEN WHY DOES A MIDWIFE HAVE TO BE PRESENT AT ALL?
To know if things are not going right. She is listening to the baby, the heart rate and how the labour’s going.
BUT THERE IS NO INTERVENTION?
No. During an undisturbed birth, the midwife is monitoring and supporting the woman so that she can follow her and the baby’s cues.
IS BUILDING A CLOSE RELATIONSHIP BETWEEN THE WOMAN AND HER MIDWIFE NECESSARY?
It is ideal but not absolutely necessary. Many times I have walked into a room and provided comfort and safety to the woman. I have never met her before and I don’t know her name or her language. It has happened to me in China, Taiwan and Mexico. I just watch and support while the woman delivers the baby. And so we connect.
HOW IMPORTANT IS IT TO HAVE A DOCTOR OR MEDICAL CENTRE ON THE STANDBY?
If the mother wants to ensure that no matter how the birth goes, a live baby is the result, and is not willing to take any risk whatsoever or take responsibility for that outcome, then she can place herself in a centre like Daimaa’s which has an Operation Theatre in it for emergencies. Homebirth in a city like Mumbai, anyway we look at it, is diffi cult. You can be close to a centre but the traffic here cannot be predicted. So, I think it’s safer from the perspective of a mother who wants a live baby to place herself within at most, half an hour drive away from a centre where a C-section can be performed. Having said that, I must also say that the Caesarean rate when I was practising as midwife was two per cent. The national average in United States today is 35 per cent, Mexico is 68 per cent, China is 60 per cent and in urban centres in India it would probably be between 60 and 80 per cent.
EVEN IN A MEDICAL FACILITY, CAN WATER BE OFFERED FOR ADDED BENEFITS?
Water makes birth easier. You have smiling mothers. Within a one month period in 1982, there was a water birth in every continent. After my first daughter was born in a traditional hospital set-up, I had my two sons at home in water. I pushed for educating providers in nursing and medical schools so that waterbirth can be offered to women and they can find out more about it. But what happened in the UK was amazing – one can have a waterbirth in every single NHS hospital. Every lady has a choice and it was the women who had asked for it and made it happen.
HOW CAN WE BEGIN TO EMPOWER WOMEN NOT ONLY IN URBAN CENTRES BUT THROUGHOUT OUR COUNTRY?
It has to start with prenatal education in middle or high school at the age of 12 or 13 years.
WHAT SHOULD THIS PRENATAL EDUCATION INCLUDE?
It should include more than just the process of birth. The physiology, anatomy, human brain development and why we need gentle birth. If I gave you a proposal before you have babies that I have this process that can guarantee you that when your baby is three years old he will be loving, empathetic, kind, eat all vegetables, go to sleep when you ask, express love, receive love, be talented and artistic, would you be interested in finding out more about the programme? The prenatal programme would involve understanding your body because it’s better to get people prior to conception understand the infl uences on conception.
HOW WILL YOUR APPROACH MAKE A DIFFERENCE?
The principle is that we are spiritual beings seeking a physical experience and that the baby has only one opportunity to be born. There are major infl uences on personality and character development that form in pregnancy, the birth event and the very first hours. The title of my next book, ‘Embracing the miracle: How pregnancy, birth and the first hour infl uence human potential’ talks about this. If a woman knows all this and still chooses a medical birth then she will have to live with the consequences which include increasing violence on the planet, ADHD, Asperger’s and skyrocketing autism rates, child suicides and medication for fi ve and six year olds. We never had this kind of wholesale medicalisation of childbirth at any time in our past. We are at a very desperate crossroads right now and it can go even further. This affects health not just in the short-term or infancy. If we want a healthier society, we need to pay attention to what happens during pregnancy, birth and the first few hours.
HOW WAS THE RESPONSE TO YOUR WORKSHOP IN INDIA?
One of the doctors from Jaipur told me, “Your workshop has changed the way I view birth for good, forever.” My message is simple and non-threatening. One cannot be held responsible if one is not aware of the latest scientifi c developments in epigenetics and infl uence of emotions on growth and brain development of the foetus. We have lots of research-based evidence and need to accept this gift. Fortis Hospital called me back to train their doctors in humanistic and gentle maternity care because it is clearly evident that we can create a different society in one generation. A gentle birth leads to a gentle earth. M&B
“I learned that water birth is so much simpler than I had been used to doing it. Its also best for VBAC mums, mums with borderline high blood pressure and even breech babies. I unlearned that water has to be a certain temperature before the mum can get in. I used to worry about infection but Barbara has given ample proven research that now I no longer feel the need to get tonnes of distilled water. Care providers can also set-up their waterbirthing centres with a pump, geyser and ozonator which will clean water with oxygen and kill germs.” – Lina Duncan, seminar participant and doula
A GOOD START
“This workshop turns an ob/gyn 180 degrees around. We know the technicalities but this approach gives dignity to the woman. At Cama Hospital, we had mostly nurses and midwives in attendance and at the Holy Family event, there were nodal people participating. There were 250 postgraduate students, doctors, nurses attending the talk at Sion Hospital. Senior faculty at Sion Hospital knew about waterbirth but shrugged it off as non-viable in their set-up. Now we may see dissertations
coming up in this topic. However, a lot of evidence-based practices and hand-holding is required before the concept of gentle birth finds its place in India.” – Dr Veda Simons, organiser, obstetrician, founder of Daimaa’s Birth Centre, Mumbai
Words Subarna Ghosh
Visuals Gireesh Sharma