A retrospective comparison of waterbirth outcomes in two United States hospital settings

Abstract

Background Water immersion during labor is an effective comfort measure; however, outcomes for waterbirth in the hospital setting have not been well documented. Our objective was to report the outcomes from two nurse‐midwifery services that provide waterbirth within a tertiary care hospital setting in the United States. Methods This study is a retrospective, observational, matched comparison design. Data were collected from two large midwifery practices in tertiary care centers using information recorded at the time of birth for quality assurance purposes. Land birth cases were excluded if events would have precluded them from waterbirth (epidural, meconium stained fluid, chorioamnionitis, estimated gestational age < 37 weeks, or body mass index > 40). Neonatal outcomes included Apgar score and admission to the neonatal intensive care unit. Maternal outcomes included perineal lacerations and postpartum hemorrhage. Results A total of 397 waterbirths and 2025 land births were included in the analysis. There were no differences in outcomes between waterbirth and land birth for Apgar scores or neonatal intensive care admissions (1.8% vs 2.5%). Women in the waterbirth group were less likely to sustain a first‐ or second‐degree laceration. Postpartum hemorrhage rates were similar for both groups. Similar results were obtained using a land birth subset matched on insurance, hospital location, and parity using propensity scores. Discussion In this study, waterbirth was not associated with increased risk to neonates, extensive perineal lacerations, or postpartum hemorrhage. Fewer women in the waterbirth group sustained first‐ or second‐degree lacerations requiring sutures.

Opposition to Waterbirth Is Not Evidence Based

“…For instance, one could match exposed and unexposed individuals on dozens of potential confounders simultaneously using propensity scores, or address selection bias in the waterbirth group using inverse probability weighting. 19 Only one small (n = 397 waterbirths) propensity score study has been published 20 ; the rest are either prospective or retrospective cohorts.…”

Feature Article—Continuing Education Module—International Water-Birth Practices With Recommendations During a Global Pandemic

“…Even though they were still not in favor of birth in water, they did acknowledge the efficacy of using water during labor for increasing comfort, lowering intervention rates, and shortening labor duration, outcomes which are all mirrored in more recent published research (Cluett et al, 2018;Henderson et al, 2014;Bailey et al, 2020).…”

Factors influencing water immersion during labour: qualitative case studies of six maternity units in the United Kingdom

“…Women using water immersion tend to report a more positive experience of labour and birth [ 7 ]; less pain and a greater sense of control [ 8 ]; and increased comfort and relaxation [ 9 ]. Research suggests using a pool during labour is safe for mothers and babies, with no evidence of increased adverse outcomes [ 10 – 13 ]. However, due to relatively small sample sizes and the infrequency of adverse clinical events, there are no conclusive data on the safety of birth in water [ 14 ].…”