The Ministry of Health has recently issued an order to suspend waterbirths in Pantai Hospital Kuala Lumpur (PHKL).

PHKL has been conducting waterbirths  since 2009 with successful outcomes for mother and baby for the past 7 years.  It has been adhering to strict safety guidelines and hundreds of mothers and babies have benefited from this birth option.  During this time the Ministry of Health has been fully aware that water births have been offered.

This unprecedented decision by the Ministry of Health to suspend waterbirth in PHKL after so many successful births has shocked and upset many mothers who had planned and are planning to choose this option for their births.

It is crucial to realize that these birthing options are recognized by the UK Royal College of Obstetricians and Gynecologists and the Royal College of Midwives in their joint statement: “Immersion in Water During Labour and Birth”, which states that: “All healthy women with uncomplicated pregnancies at term should have the option of water birth available to them and should be able to proceed to a water birth if they wish.”

Denying our nation of this choice is counter-productive to the progress of maternity care in Malaysia.  Furthermore, this action by the Ministry of Health could push the public to move towards experimenting with unassisted homebirths as an alternative, which can carry risks for the mother and baby.

The Malaysian public understands that proper measures need to be in place to ensure the safety of mother and baby; however, we are disappointed at the way in which the whole process has been carried out. Women who want to make informed decisions regarding their births have lost a major option without any prior notice and feel that their civil liberties have been restricted. 

We call for an immediate repeal of the suspension of waterbirths at PHKL, and for waterbirth guidelines and midwifery training in line with UK and Singapore protocol to be implemented in due course at all government hospitals in Malaysia.

Further justification and research supporting our position is based on the following points:

1. PHKL has been offering the option of waterbirth to birthing mothers for over 7 years with no adverse outcomes.

2. The Cluett meta-analysis (Cochrane Review 2009) states that "There is no evidence of increased adverse effects to the fetus/neonate or woman from labouring in water or waterbirth."

3. Scientific evidence shows favourable outcomes in waterbirths with regards to:

a) Reduced c-sections (Henderson et al, 2014)

b) Reduced episiotomies (Otigbahl et al. 2000; Burns 2001; Geissbuehler et al. 2004; Thoeni et al. 2005; Zanetti-Daellenbach et al. 2007; Chaichian et al. 2009; Torkamani et al. 2010; Mollamahmutoglu et al. 2012; Menakaya et al. 2013)

c) Intact perineum (Otigbah et al. 2000; Burns 2001; Geissbuehler et al. 2004; Thoeni et al. 2005)

d) Reduced need for medical pain relief (Otigbah et al. 2000; Geissbuehler et al. 2004; Chaichian et al. 2009; Torkamani et al. 2010)

e) No increase in perinatal mortality (Burns et al. 2012; Henderson et al. 2014)

f) Same or better APGAR scores at 5-minutes (Otigbah et al. 2000; Zanetti-Daellenbach et al. 2007; Chaichian et al. 2009; Mollamahmutoglu et al. 2012; Menakaya et al. 2013)

g) Fewer newborn infections (Geissbuehler et al. 2004)

4. By restricting hospital birthing options and basic civil liberties to the Malaysian public, birthing mothers may be forced to resort to unsafe birth practices such as unassisted home births without trained medical personnel.

The Ministry has stated that proper guidelines are in the final stages of being formalised, therefore we call for the option of waterbirth to be re-instated with immediate effect while the Ministry works to implement these guidelines.

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Penggesaan Pilihan Kaedah Bersalin Dalam Air Kembali Berkuatkuasa Di Hospital Terpilih

Kenyataan Kementerian Kesihatan untuk menggantung kaedah bersalin di dalam air di hospital swasta, Hospital Pantai Kuala Lumpuri (PHKL) baru-baru ini dirujuk. Selama 7 tahun berturut-turut sejak tahun 2009, PHKL telah menawarkan perkhidmatan tersebut yang telah membuktikan kejayaan ratusan ibu dan bayi bersalin berkesudahan lebih positif. Sepanjang tempoh itu, perkhidmatan ‘water birth’ oleh PHKL adalah menurut garis panduan pakar di dalam bidang bersalin dalam air dan Kementerian Kesihatan sedia maklum kewujudan fasiliti tersebut.

Keputusan mendadak oleh Kementerian Kesihatan terhadap PHKL sungguhpun selama ini  menampakkan kejayaan persalinan bukan dalam angka yang sedikit sememangnya mencetuskan emosi amarah di kalangan ibu. Ramai  yang telah memilih kaedah ini untuk bersalin sedikit masa lagi juga ibu-ibu yang merancang untuk mengambil perkhidmatan tersebut di masa hadapan kerana tahu kaedah bersalin di dalam air banyak memberi kebaikan.

Amat kritikal untuk ada kesedaran bahawasanya kewujudan hak kebebasan memilih untuk bersalin termasuk kaedah ‘waterbirth’ telah diikitiraf oleh UK Royal College of Obstetricians and Gynecologists dan Royal College of Midwives, di dalam gabungan kenyataan mereka yang diterjemahkan “Rendaman di dalam air semasa bersalin“(Immersion in Water During Labour and Birth), di mana salah satu perenggan menegaskan “Semua Wanita Sihat yang hamil tanpa sebarang komplikasi sehingga kandungan matang cukup usia, seharusnya diberi pilihan untuk bersalin di dalam air dan dibenarkan untuk meneruskan pilihan mereka jika itulah pemutusan cara bersalin yang diingini.”

Menidakkan hak sejagat wanita tempatan dalam membuat pilihan kaedah bersalin seolah-olah memperkotak-katikkan kemajuan penjagaan materniti di Malaysia. Seterusnya, tindakan Kementerian boleh menjerumuskan umum untuk bereksperimen dengan kaedah  bersalin dalam air di rumah tanpa rangka keselamatan. Pilihan mereka ini boleh mengundang risiko yang amat tinggi baik si ibu dan si anak.

Masyarakat faham tentang pentingnya pengawalan terperinci berpandukan garis panduan untuk  memastikan keselamatan ibu dan anak. Namun demikian, memansuhkan pilihan bersalin tersebut, telah mengecewakan ramai wanita di Malaysia secara tiba-tiba bila mana pilihan selamat untuk bersalin di hospital dirompak tanpa usul-periksa. Wanita yang memilih bagaimana hendak bersalin berbekalkan ilmu hilang serta-merta hak penawaran pilihan tanpa sebarang notis, termasuklah hak sivil kepenggunaan diterhadkan.

Kami memohon pembatalan tindakan pergantungan terhadap Hospital Pantai Kuala Lumpur (PHKL) berkuat kuasa serta-merta, dan garis panduan bersalin di dalam air dan latihan perbidanan (midwifery training) sejajar dengan protokol hospital di UK dan Singapura dimeterikan di semua hospital kerajaan dengan kadar segera.

Justifikasi dan penyelidikan seterusnya yang menyokong kedudukan kami untuk petisyen ini adalah berlandaskan butiran tersebut:

1. PHKL telah menawarkan perkhidmatan ini lebih daripada 5 tahun tanpa sebarang rekod yang negatif.

2. Cluett meta-analysis (Cochrane Review 2009) mengeluarkan kenyataan seperti berikut “Tiada bukti sehingga kini implikasi negatif terhadap janin dan bayi juga wanita yang telah bersalin dengan kaedah bersalin dalam air”

3. Bukti saintifik yang menyokong hasil bersalin di dalam air

a) Penurunan kadar Cesarean (Henderson et al, 2014)

b) Penurunan episiotomi (Otigbahl et al. 2000; Burns 2001; Geissbuehler et al. 2004; Thoeni et al. 2005; Zanetti-Daellenbach et al. 2007; Chaichian et al. 2009; Torkamani et al. 2010; Mollamahmutoglu et al. 2012; Menakaya et al. 2013)

c) Perineum kekal utuh (Otigbah et al. 2000; Burns 2001; Geissbuehler et al. 2004; Thoeni et al. 2005)

d) Penurunan kebergantungan pada ubatan penahan sakit (Otigbah et al. 2000; Geissbuehler et al. 2004; Chaichian et al. 2009; Torkamani et al. 2010)

e) Tiada peningkatan angka kematian (Burns et al. 2012; Henderson et al. 2014)

f) Sama atau lebih baik angka SKOR APGAR di minit yang ke lima (Otigbah et al. 2000; Zanetti-Daellenbach et al. 2007; Chaichian et al. 2009; Mollamahmutoglu et al. 2012; Menakaya et al. 2013)

g) Infeksi bayi baru lahir berkurangan (Geissbuehler et al. 2004)

4. Menterhadkan pilihan-pilihan di wad bersalin dan hak sivil asasi rakyat Malaysia, memungkinkan peningkatan kaum wanita memilih untuk bersalin di rumah tanpa pantauan pihak medikal.

 Kementerian telah mengeluarkan kenyataan garis panduan dalam proses pembikinan dan di fasa hampir siap. Justeru, kami memohon pergantungan fasiliti ini ditarik balik dengan segera sementara pihak Kementerian menyiapkan garis panduan tersebut.