Who Gives Birth in the Water? A Retrospective Cohort Study of Intended versus Completed Waterbirths

Abstract

Introduction: Most waterbirth studies have been conducted outside the United States with a primary focus on birth outcomes. Studies to date provide limited information about how often women choosing waterbirth end water immersion before the birth and about the reasons for tub exit. This study examines a cohort of women intending a hospital-based waterbirth and documents the timing and reasons for tub exit. Demographic, clinical, and intrapartum care provider characteristics among women completing waterbirth were compared with those who exited the water prior to birth.Methods: This is a collaborative, multisite study from 2 health systems (8 hospitals) using retrospective electronic health records from August 2014 through December 2017. Results:Of 576 women who entered the waterbirth tub, 48% exited prior to the birth. The primary reasons for exit were maternal choice (50%), medical indication (32%), and provider decision (13%). Women exiting in the first stage did so primarily by choice (57%), whereas medical indication (42%) was the most common reason among women exiting in the second stage. Women who completed waterbirth did not differ from those who exited prior to birth with regard to age, race, ethnicity, country of origin, language, marital status, or intrapartum care provider specialty. Women completing waterbirth were more likely to have previously given birth (72% vs 47%) and to have a provider with more water immersion births during the study period (65% vs 55%). Discussion:Giving birth in the tub was associated with parity and intrapartum care provider experience. Half of the women intending waterbirth in this study exited the tub, with variation in exit reason by stage and provider type. It is important for women to understand that they or their provider may change the birth plan based on labor progress and maternal experience.

Testing the waters — A cross-sectional survey of views about waterbirth among Swedish health professionals

“…An American study including 327 women, calculated how many of the women who initiated hydrotherapy discontinued before birth, finding that 9% left because they needed medical pain relief and 20.9% left because of complications, while the rest birthed in water (155). Another study observed that 48% of the 576 women who entered the waterbirth tub, exited the tub prior to birth, the most common reasons were maternal choice (50%) and medical indications (32%) (156). The study also found that women were more likely to continue labor in water if they had a care provider with more experience with waterbirths.…”

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

“…In addition, the study population was limited to predominantly white women with private insurance so the results may not be generalizable to the general childbearing population. The population represented in our study is similar to recent studies identifying who is seeking waterbirth access . Aside from insurance type (Medicaid as a proxy for lower income status), other socioeconomic status variables were not available for analysis.…”

“…Although randomized controlled trials are used as the benchmark in research, this can be problematic in the context of birth, as women are unlikely to enroll and risk randomization to the control group if their desire is to birth in the water. It is also noted that in the context of waterbirth, the opportunity to have a placebo or blinded measure is not possible . Randomized controlled trials (RCTs) evaluating outcomes of intended waterbirth may arguably be the next step toward evidence verifying safety and to encourage professional organizations to support wider acceptance of waterbirth in hospital settings.…”

“…The population represented in our study is similar to recent studies identifying who is seeking waterbirth access. 15 Aside from insurance type (Medicaid as a proxy for lower income status), other socioeconomic status variables were not available for analysis.…”

“…It is also noted that in the context of waterbirth, the opportunity to have a placebo or blinded measure is not possible. 15,16 Randomized controlled trials (RCTs) evaluating outcomes of intended waterbirth may arguably be the next step toward evidence verifying safety and to encourage professional organizations to support wider acceptance of waterbirth in hospital settings. However, recruitment has been shown to be a barrier in attempted RCTs of birth setting; thus, similar challenges would likely be encountered for water vs land as choices during labor and birth are highly valued.…”