PATIENT PREPARATION FOR LABOR IN WATER
In the development of modern obstetrics the most important thing to be performed is the humanization of the labor and birth process. This is an approach focused on the family, patient autonomy and pain management. This effort is essential for fetal and neonate safety.
The Royal College of Gynecologist and Obstetricians published guidelines, protocols were agreed upon, to prevent complications that are not predictable.2, 3 Thus guidelines are absolutely needed by the service provider of water birth. Guidelines or protocols are a main reference when formulating a basic approach to the patient and her family.
Some of the existing research indicates that being in the water during labor and childbirth provides a significant advantage in birth outcomes. Each maternity unit should have a policy of water birth, including guidelines for patient preparation including information about water birth. Service providers should be required to provide guidance on the process of childbirth to mother and family.2, 3,4,5,6
Understanding the risk factors that will be experienced by the mother and the baby is important, so that the prospective mother is completely ready to do the water birth. Labor protocol is a matter that absolutely must be upheld to prevent risks and complications during labor.6 Considering risk for the baby is important. However, the majority of medical experts believe that this situation is very rare, because babies will not breathe until the baby is exposed to air.7, 8
In 1999, Gilbert, et al published their research in 1996 by taking a sample of 4032 infants born in the water. This study concluded that the prenatal mortality is not significantly higher than the risk of conventional childbirth.9
In the protocol designed for water birth, the Australian Government also asserts that all health workers involved are responsible for any information given to women candidates in each provider’s water birth techniques. Data, which is provided, should be accurate and up to date .10 Patients have many birth choices to consider making informed consent important when choosing water birth. 7,8,9
In general, preparing the mother for waterbirth does not differ much than preparing the mother for conventional birth. A conducive environment for the prospective mother during water birth strongly supports the success of this program. The role of the assisting family is important as well in the preparation of childbirth. 11
PATIENT SELECTION
Water birth is generally given to the term pregnant woman with no complications.10, 12
Confinement terms for water birth:
1. Low-risk pregnancy 2. No vaginal, urine, or skin infection 3. Vital sign within normal limits and infants CTG normal (baseline, variability, acceleration) 4. Warm water is used for relaxation and pain management after cervix dilatation of 4-5 cm or more. 5. Patients cooperative with birth attendant instruction, including a possible exit from the pool if necessary.
Criteria / Indications 10, 13.14
1. It is a mother”s choice 2. Normal pregnancy > / 37 weeks 3. Single fetus with head presentation 4. No use of drugs-sedative 5. Spontaneous broken membranes < 24 hours 6. Non-clinical criteria such as staff and equipment 7. No pregnancy complications such as pre-eclampsia, uncontrolled blood sugar level, etc. 8. Normal heart rate 9. Clear amniotic fluid 10. Spontaneous childbirthing or after using misoprostol or pitocin 11. There is no bleeding. It is difficult to assess the loss of blood in water birth due to the lack of attendant experience in water birth. If that be the case, some service providers may prefer to deliver the placenta outside of the pool.
Contraindications 10,13,16
1. Infection that can be transmitted through the skin and blood.
2. Febrile mother or other evidence of infection.
3. Herpes genitalis. Herpes is very easily transmitted through water.
4. Abnormal fetal heartbeat.
5. Abnormal vaginal bleeding.
6. HIV, Hepatitis.
7. Macrosomia.
8. Meconium. A light or medium meconium can be said normal in childbirth. However if thick meconium appears in the water, the attendant should clear or help the patient out from water birth pool.
9. Breech presentation of the baby.
Perawatan selama kehamilan itu penting bunda… karena kehamilan memerlukan persialan baik fisisk, mental maupun spiritual. 
Kenaikan BB yg harus dicapai < 18,5 (kurus) è 12.5-18 kg 18,5-25 (N) è 11.5-16 kg 25-27 (gemuk) è 7-11.5 kg >27 (Obesitas) è Max 7 kg
