A pilot study for a randomised controlled trial of waterbirth versus land birth

Abstract

Objectives To assess the feasibility of undertaking an adequately powered multicentre study comparing waterbirth with land birth. To assess whether women are willing to participate in such a trial and whether participation has a negative effect on their birthing experience. Design A randomised controlled trial (RCT) with 'preference arm'.Setting District general hospital with 3600 deliveries annually.Population Women with no pregnancy complications and no anticipated problems for labour/delivery.Methods Women were recruited and randomised between 36 and 40 weeks of gestation. Comparison of randomised and 'preference arm' to assess any impact of randomisation on women's birthing experience. Main outcome measures Data were collected at delivery concerning the labour, the pool water and baby's condition at birth and six weeks of age. The main outcome measures are means and standard deviation of cord O 2 , CO 2 , haemoglobin, haematocrit and base excess; medians and ranges of time to first breathe and cord pH; bacterial growth from pool water samples and neonatal swabs; and maternal satisfaction. Results Eighty women participated -60 women were randomised. Twenty women participated in a nonrandomised 'preference arm'. The babies randomised to a waterbirth demonstrated a significantly lower umbilical artery pCO 2 (P ¼ 0.003); however, it is recognised that this study is underpowered. Women were willing to participate and randomisation did not appear to alter satisfaction. Conclusion This small study has shown that a RCT is feasible and demonstrated outcome measures, which can be successfully collected in an average delivery suite.

The effects of immersion in water on labor, birth and newborn and comparison with epidural analgesia and conventional vaginal delivery

“…The positive physiological effects of hydrotherapy can facilitate the neurohormonal interactions of labour, reducing pain, and potentially facilitates the progress of labour (11,12). Water immersion may be associated with improved uterine perfusion, less painful contractions and a shorter labour with fewer interventions (13)(14)(15) sion shortens the process of labour (1,15), however some others found no significant difference for the duration of the 1st stages of labour (13,(16)(17)(18)(19)(20). The present study also demonstrates that the 1st stage of labour is not shortened by immersion in water in either primigravidas or multigravidas.…”

“…The present study also demonstrates that the 1st stage of labour is not shortened by immersion in water in either primigravidas or multigravidas. Cammu et al, Eckert et al, Rush et al and Woodward et al provided data on analgesia and anesthesia use in their studies and found that there was a significant reduction in the incidence of analgesia and anesthesia use among women placed in water during the first stage of labour (16,17,19,20). In the present study, we have shown that VAS scores indicating the pain felt by the women were lowest among women having water birth, even lower than the women labouring with epidural analgesia.…”

Labour augmentation and fetal outcomes in relation to birth positions: A secondary analysis of an RCT evaluating birth seat births

“…Childbirth is a personal and individual experience as well as a very vulnerable state of being for the birthing woman. A feasibility study regarding randomisation to either water birth or land-birth indicated that women were willing to participate (Woodward & Kelly, 2004). However it must be acknowledged that women willing to participate in intrapartal trials may differ from the birthing population in general.…”

“…The water birth study found that the women were happy to participate to help produce evidence for healthcare professionals and other parents (Woodward & Kelly, 2004).…”

A Retrospective Study of Maternal and Neonatal Outcomes Following Conventional and Water Birth in Ecuador

“…In 2004, Woodward et.al reported that from 1985 to 1999 a total of 150,000 births were performed underwater; however, no regional analyzis have been published as far as we know (Woodward & Kelly, 2004).…”