“Although the numbers are still small, it is of utmost importance that this method be assured safe for both the mother and the baby,” Health Ministry director-general Noor Hisham Abdullah said.

He said concern for patient safety had led the ministry to formalise a set of guidelines and audit to ensure the safety of women choosing 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 water birth practices in both local and international settings.

Noor Hisham said the experts concluded that there was no significant benefit in water birthing over conventional birthing processes.

He said, however, there were concerns of the increased risk of complications to both mother and baby during water births.

Noor Hisham said there was a significant gap in the local setting as water births were not part of the local training curricula of the advanced diploma in midwifery, nor in the training of Obstetricians and Gynaecologists in Malaysia.

Therefore, he said, any hospital that wished to offer water birth facilities and services needed to fulfil certain criteria first. Among the criteria are:

• The mothers’ pregnancy should be a straightforward pregnancy.
• 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.
• The facility must have appropriate equipment (capable underwater fetal monitoring) which can be used to monitor the progress of both mother and baby during the process of labour.
• All healthcare personnel, including doctors, midwives and nurses, involved in the process of water births must have adequate training in the method.
• Necessary precautionary measures are in place to reduce the risks associated with water births, for instance infection control measures.

The Health DG said some of the above criteria had been proposed by the expert committee to be incorporated into the guidelines for water births in Malaysian hospitals.

He said this guideline and audit framework was currently in the final stages of formalisation and once implemented, hospitals that wished to provide water birth facilities and services may apply to the Ministry of Health for permission. If they satisfactorily comply with the stipulated requirements, they may be allowed to provide water birth services.