Ministry of Health is aware that water birth has been practiced in some private hospitals in Malaysia for several years. However there are growing concerns that more women are opting for this kind of birthing method. Although the numbers are still small, it is of utmost importance that this method must be ensured to be safe for both the mother and the baby. This concern for patient safety has led the Ministry of Health’s effort to formalise a set of guidelines and audit to ensure the safety of women choosing this option of water birthing as their mode of delivery.

In 2013, the Ministry of Health convened a meeting with a group of experts in this field to review the water birth practise in both local and international setting. They concluded that there is no significant benefit of water birth over conventional birthing process. However, there are concerns of the increased risk of complications to both mother and baby who opted water birth. Furthermore, there is a significant gap in the local setting as water births are not part of the local training curricula of the advanced diploma in midwifery, nor in the training of Obstetricians and Gynaecologist in Malaysia.

Therefore, any hospital that wishes to offer water birth facilities and services need to fulfil certain criteria, among others are:

1. The mothers’ pregnancy should be a straightforward pregnancy.
2. The facility must have the ability to treat any emergency that may arise to either the mother or the baby during and after the process of labour.
3. The facility must have appropriate equipment (capable for underwater fetal monitoring) which can be used to monitor the progress of both mother and baby during the process of labour.
4. All healthcare personnel including doctors, midwives and nurses involved in the process of water birth must have adequate training in the method.
5. Necessary precautionary measures are in place to reduce the risk associated with water birth, for instance infection control measures.

These are some of the criteria, which have been proposed by the expert committee to be incorporated into the guideline for water birth in Malaysian hospital. This guideline and audit framework is currently in the final stage of formalisation and once implemented, hospital that wishes to provide water birth facilities and services may apply to the Ministry of Health. If they satisfactorily comply with the stipulated requirements, they may be allowed to provide this service. Patient safety is of paramount importance to the Ministry of Health in regulating any birthing method.

DATUK DR. NOOR HISHAM ABDULLAH

Director-General of Health Malaysia

13 July 2016