Temperature of pool is important

Deans, Anne; Steer, Philip

doi:10.1136/bmj.311.7001.390b

Cited by 17 publications

(8 citation statements)

References 3 publications

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“…This observation requires confirmation in other studies. One possibility is that water temperatures were not well monitored in the bath group in our study, as has been observed elsewhere, and water temperatures greater than 37° C may have been used, resulting in an adverse fetal effect (14,27–29). Anecdotally it is often believed that a warm or hot bath may soothe pain in labor.…”

Section: Discussionmentioning

confidence: 95%

Immersion in Water in the First Stage of Labor: A Randomized Controlled Trial

Eckert

Turnbull

MacLennan

2001

Birth

142

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Section: Discussionmentioning

confidence: 95%

Immersion in Water in the First Stage of Labor: A Randomized Controlled Trial

Eckert

Turnbull

MacLennan

2001

Birth

142

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“…A recent Cochrane review on waterbirth stated that: “Immersion during the 2nd stage of labour needs further investigation, but at present there is no clear evidence to support or not to support a woman's decision to give birth in water.” This review, as is the case for all Cochrane Collaboration publications, focused exclusively on results of randomized controlled trials (RCTs), of which there are only a few comparing waterbirth to nonwaterbirth—and these were small and underpowered. Another problem inherent in these studies, as well as in any large, future, hypothetical RCTs, is that women in the waterbirth group whose labors become complicated are often directed to discontinue immersion, but women randomized to nonwaterbirth would not suddenly be asked to get in the water. This one‐way noncompliance with the assigned intervention group could introduce differential misclassification bias, making interpretation of intention‐to‐treat results problematic.…”

Section: Discussionmentioning

confidence: 99%

“…All other published reports of increased neonatal morbidity following waterbirth are case reports or case series without control groups. 1,14,[21][22][23][24]45,[50][51][52][53][54][55][56][57] We lacked sufficient power to calculate reliable adjusted odds ratios for early and late neonatal deaths. Nonetheless, there was no evidence of elevated mortality among the waterbirth group, a finding that is consistent with our morbidity results as well as with those published by others.…”

Section: Main Findings and Interpretationmentioning

confidence: 99%

Maternal and Newborn Outcomes Following Waterbirth: The Midwives Alliance of North America Statistics Project, 2004 to 2009 Cohort

Bovbjerg¹,

Cheyney²,

Everson³

2016

J Midwife Womens Health

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Introduction: Data on the safety of waterbirth in the United States are lacking. Methods:We used data from the Midwives Alliance of North America Statistics Project, birth years 2004 to 2009. We compared outcomes of neonates born underwater waterbirth (n = 6534), neonates not born underwater nonwaterbirth (n = 10,290), and neonates whose mothers intended a waterbirth but did not have one intended waterbirth (n = 1573). Neonatal outcomes included a 5-minute Apgar score of less than 7, neonatal hospital transfer, and hospitalization or neonatal intensive care unit (NICU) admission in the first 6 weeks. Maternal outcomes included genital tract trauma, postpartum hospital transfer, and hospitalization or infection (uterine, endometrial, perineal) in the first 6 weeks. We used logistic regression for all analyses, controlling for primiparity.Results: Waterbirth neonates experienced fewer negative outcomes than nonwaterbirth neonates: the adjusted odds ratio (aOR) for hospital transfer was 0.46 (95% confidence interval [CI], 0.32-0.68; P Ͻ .001); the aOR for infant hospitalization in the first 6 weeks was 0.75 (95% CI, 0.63-0.88; P Ͻ .001); and the aOR for NICU admission was 0.59 (95% CI, 0.46-0.76; P Ͻ .001). By comparison, neonates in the intended waterbirth group experienced more negative outcomes than the nonwaterbirth group, although only 5-minute Apgar score was significant (aOR, 2.02; 95% CI, 1.40-2.93; P Ͻ 0001). For women, waterbirth (compared to nonwaterbirth) was associated with fewer postpartum transfers (aOR, 0.65; 95% CI, 0.50-0.84; P = .001) and hospitalizations in the first 6 weeks (aOR, 0.72; 95% CI, 0.59-0.87; P Ͻ 0.001) but with an increased odds of genital tract trauma (aOR, 1.11; 95% CI, 1.04-1.18; P = .002). Waterbirth was not associated with maternal infection. Women in the intended waterbirth group had increased odds for all maternal outcomes compared to women in the nonwaterbirth group, although only genital tract trauma was significant (aOR, 1.67; 95% CI, 1.49-1.87; P Ͻ .001).Discussion: Waterbirth confers no additional risk to neonates; however, waterbirth may be associated with increased risk of genital tract trauma for women.

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“…Therefore, the water temperature of a pool should not exceed the maternal body temperature, as immersing a woman in water above her natural core temperature will result in fetal hyperthermia and associated cardiovascular and metabolic disturbances (Johnson 1996). High temperatures have been identified as a safety issue by several authors as being associated with fetal mortality and morbidity, based on individual case studies and/or theory (Deans 1995; Johnson 1996; Rosevear 1993). The theory underpinning this was originally based on a study on pregnant ewes (Cefalo 1978).…”

Section: Introductionmentioning

confidence: 99%

Immersion in water in labour and birth

Cluett

Burns

2009

Cochrane Database of Systematic Reviews

166

167

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Background Enthusiasts suggest that labouring in water and waterbirth increase maternal relaxation, reduce analgesia requirements and promote a midwifery model of care. Critics cite the risk of neonatal water inhalation and maternal/neonatal infection. Objectives To assess the evidence from randomised controlled trials about immersion in water during labour and waterbirth on maternal, fetal, neonatal and caregiver outcomes. Search methods We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (30 June 2011) and reference lists of retrieved studies. Selection criteria Randomised controlled trials comparing immersion in any bath tub/pool with no immersion, or other non-pharmacological forms of pain management during labour and/or birth, in women during labour who were considered to be at low risk of complications, as defined by the researchers. Data collection and analysis We assessed trial eligibility and quality and extracted data independently. One review author entered data and the other checked for accuracy. Main results This review includes 12 trials (3243 women): eight related to just the first stage of labour: one to early versus late immersion in the first stage of labour; two to the first and second stages; and another to the second stage only. We identified no trials evaluating different baths/pools, or the management of third stage of labour. Results for the first stage of labour showed there was a significant reduction in the epidural/spinal/paracervical analgesia/anaesthesia rate amongst women allocated to water immersion compared to controls (478/1254 versus 529/1245; risk ratio (RR) 0.90; 95% confidence interval (CI) 0.82 to 0.99, six trials). There was also a reduction in duration of the first stage of labour (mean difference −32.4 minutes; 95% CI −58.7 to −6.13). There was no difference in assisted vaginal deliveries (RR 0.86; 95% CI 0.71 to 1.05, seven trials), caesarean sections (RR 1.21; 95% CI 0.87 to 1.68, eight trials), use of oxytocin infusion (RR 0.64; 95%CI 0.32 to 1.28,five trials), perineal trauma or maternal infection. There were no differences for Apgar score less than seven at five minutes (RR 1.58; 95% CI 0.63 to 3.93, five trials), neonatal unit admissions (RR 1.06; 95% CI 0.71 to 1.57, three trials), or neonatal infection rates (RR 2.00; 95% CI 0.50 to 7.94, five trials). Of the three trials that compared water immersion during the second stage with no immersion, one trial showed a significantly higher level of satisfaction with the birth experience (RR 0.24; 95% CI 0.07 to 0.80). A lack of data for some comparisons prevented robust conclusions. Further research is needed. Authors’ conclusions Evidence suggests that water immersion during the first stage of labour reduces the use of epidural/spinal analgesia and duration of the first stage of labour. There is limited information for other outcomes related to water use during the first and second stages of labour, due to intervention and outcome variability. There is no evidence of increased adverse ...

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Temperature of pool is important

Cited by 17 publications

References 3 publications

Immersion in Water in the First Stage of Labor: A Randomized Controlled Trial

Immersion in Water in the First Stage of Labor: A Randomized Controlled Trial

Maternal and Newborn Outcomes Following Waterbirth: The Midwives Alliance of North America Statistics Project, 2004 to 2009 Cohort

Immersion in water in labour and birth

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