A prospective cohort study comparing neonatal outcomes of waterbirth and land birth in an Australian tertiary maternity unit

Abstract

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.

The use of hydrotherapy in the first stage of labour: A systematic review and meta‐analysis

“…Two studies (Seed et al, 2023;Sidebottom et al, 2020) showed no significant difference between the hydrotherapy and control groups in terms of the use of pain medication (Z = 0.21, p = 0.840).…”

“…Eight studies (Barry et al, 2020;Darsareh et al, 2018;Lanier et al, 2021;Lewis et al, 2018;Liu et al, 2014;Neiman et al, 2020;Seed et al, 2023;Tas ¸kın & Ergin, 2022) Five studies (Darsareh et al, 2018;Lewis et al, 2018;Seed et al, 2023;Tas ¸kın & Ergin, 2022;Zhao et al, 2017) showed that compared to the control group, the likelihood of assisted vaginal birth was lower in the hydrotherapy group (Z = 5.65, p < 0.001). This significant effect was associated with observational studies.…”

“…The pooled results failed to show any significant differences between the groups with respect to these variables. Five studies (Darsareh et al, 2018;Neiman et al, 2020;Seed et al, 2023;Tas ¸kın & Ergin, 2022;Zhao et al, 2017) revealed that the use of hydrotherapy in the first stage of labour did not affect the rate of episiotomy (Figure 7).…”

“…In four studies (Barry et al, 2020;Lewis et al, 2018;Neiman et al, 2020;Seed et al, 2023), the groups were similar in terms of the incidence of intrapartum blood loss. Another two studies (Büyük F I G U R E 3 Risk of bias' domains: RoB-2.…”

“…Eight of the articles were randomized controlled experimental studies (Abo‐Romia & El‐Adham, 2014; Darsareh et al, 2018; Lee et al, 2013; Maddady et al, 2018; Sert et al, 2020; Solt Kirca & Kanza Gul, 2022; Taghavi et al, 2015; Taşkın & Ergin, 2022), three were quasi‐experimental with controls (Grymel‐Kulesza et al, 2021; Liu et al, 2014; Tuncay et al, 2017), five were retrospective cohort studies (Büyük et al, 2019, 2020; Lewis et al, 2018; Neiman et al, 2020; Sidebottom et al, 2020), three were prospective cohort studies (Barry et al, 2020; Lanier et al, 2021; Seed et al, 2023), and one was a case–control study (Zhao et al, 2017).…”