Background: Maternal preference for warm water immersion (WWI) and waterbirth is increasing, but adoption into obstetric guidelines and clinical practice remains limited. Concerns regarding safety and a paucity of evidence have been cited as reasons for the limited adoption and uptake. Aim:The aim was to investigate maternal and neonatal outcomes after WWI and/ or waterbirth compared with land birth. Materials and methods: A prospective cohort study was conducted in anAustralian public maternity hospital between 2019 and 2020. Maternal and neonatal outcomes for 1665 women who had a vaginal birth were studied.Primary outcome was admission to the neonatal unit (NNU). Secondary outcomes included neonatal antibiotic administration, maternal intrapartum fever, epidural use and perineal injury. Multivariate logistical regression analyses compared the outcomes between three groups: waterbirth, WWI only and land birth.Results: NNU admissions for a suspected infectious condition were significantly higher in the land birth group (P = 0.035). After accounting for labour duration, epidural use and previous birth mode, no significant difference was detected between groups in the odds of NNU admission (P = 0.167). No babies were admitted to NNU with water inhalation or drowning. Women birthing on land were more likely to be febrile (2 vs 0%; P = 0.007); obstetric anal sphincter injury and postpartum haemorrhage were similar between groups. Regional analgesia use was significantly lower in the WWI group compared to the land birth group (21.02 vs 38.58%; P = <0.001).There was one cord avulsion in the waterbirth group (0.41%). Conclusion:Maternal and neonatal outcomes were similar between groups, with no increased risk evident in the waterbirth and WWI groups.

Objective: This study investigated maternal and fetal outcomes following warm water immersion (WWI) and/or waterbirth compared with land birth for women with moderate obstetric risk factors. Design: Prospective cohort study. Setting: Maternity hospital, Australia, 2019-2020 Population: 1665 participants, some with ‘risk factors’ for adverse perinatal outcomes requiring continuous electronic fetal monitoring (CEFM) during labour. Method: Multivariate logistical regressions were used to determine the odds of neonatal and maternal outcome measures between three groups: waterbirth, WWI and land birth Main outcome measures: Neonatal morbidity and mortality, including neonatal unit admission (NNU). Maternal clinical outcome measures, including mode of birth, perineal injury, postpartum haemorrhage, length of labour and morbidity. Results: NNU admissions for a suspected infectious condition were significantly higher in the land birth group (p=0.035). After accounting for labour duration, epidural use, previous birth mode, and labour onset, no significant difference was detected between land births and WWI/water births in the odds of NNU admission (p=0.200). No babies were admitted to NNU with signs of water inhalation or drowning. Women birthing on land had a higher mean blood loss (p=0.036) and were more likely to be febrile (2% v 0%; p=0.007); Obstetric anal sphincter injury was similar between groups. Pharmacological analgesia use was lower in the WB/WWI group (p<0.001). There was 1 cord avulsion in the waterbirth group (0.41%). Mode of birth was similar between groups (p=0.697). Conclusion: Despite moderate obstetric risk factors such as oxytocin administration and induction of labour; maternal and neonatal outcomes were similar between groups.

Chronic kidney disease significantly increases the risk of adverse maternal and perinatal outcomes. A growing body of evidence suggests that intensive dialysis, achieving physiologic pre-dialysis blood urea, is associated with decreased morbidity. We report a case of a successful pregnancy outcome in a 32-year-old nulliparous woman with stage 4 chronic kidney disease who dialysed from 11 to 31 weeks, gestation for fetal benefit and concurrently trialled a plant-based diet. We hypothesise that her dietary changes assisted with urea reduction, enabling her to become dialysis independent. Although we must recognise that such pregnancies remain high risk, as demonstrated both in this case and more recent literature, advances in complex obstetric care and dialysis protocols may now give women with chronic kidney disease a realistic hope of a successful pregnancy.