Immersion in Water During Labor and Delivery

Abstract

Immersion in water has been suggested as a beneficial alternative for labor, delivery, or both and over the past decades has gained popularity in many parts of the world. Immersion in water during the first stage of labor may be associated with decreased pain or use of anesthesia and decreased duration of labor. However, there is no evidence that immersion in water during the first stage of labor otherwise improves perinatal outcomes, and it should not prevent or inhibit other elements of care. The safety and efficacy of immersion in water during the second stage of labor have not been established, and immersion in water during the second stage of labor has not been associated with maternal or fetal benefit. Given these facts and case reports of rare but serious adverse effects in the newborn, the practice of immersion in the second stage of labor (underwater delivery) should be considered an experimental procedure that only should be performed within the context of an appropriately designed clinical trial with informed consent. Facilities that plan to offer immersion in the first stage of labor need to establish rigorous protocols for candidate selection, maintenance and cleaning of tubs and immersion pools, infection control procedures, monitoring of mothers and fetuses at appropriate intervals while immersed, and immediately and safely moving women out of the tubs if maternal or fetal concerns develop. Pediatrics 2014;133:758-761 INTRODUCTIONImmersion in water has been suggested as a beneficial alternative for labor, delivery, or both and over the past decades has gained popularity in many parts of world. [1][2][3][4] Approximately 1% of births in the United Kingdom include at least a period of immersion, 5 and a 2006 joint statement from the Royal College of Obstetricians and Gynaecologists and Royal College of Midwives supported immersion in water during labor for healthy women with uncomplicated pregnancies and stated that to achieve best practice with water birth, it is necessary for organizations to provide systems and structure to support this service. 6 The prevalence of this practice in the United States is unknown, because such data are not collected as part of

Immersion in water during labor and delivery

“…Our results concurred to data reported in a recent Cochrane review, that reported an increase in second degree tears with reduction in episiotomy in women who were in an upright position. [1,10,11] These maternal birth position was typically adopted by pool users and it would seem to influence perineal outcomes. [12]…”

A Model Practice Template for Hydrotherapy in Labor and Birth

“…[1][2][3][4] The resulting lack of consensus has made consistent and equitable access to this nonpharmacologic method for pain relief in labor challenging.…”

Is a randomized controlled trial of waterbirth possible? An Australian feasibility study

“… 11 In Australia and the United Kingdom, waterbirth is recognized as an option for healthy women with uncomplicated pregnancies. 12 , 13 , 14 However, obstetric and pediatric colleges in the United States are opposed to waterbirth; 15 , 16 whereas in Canada, they cite a lack of adequate studies to determine safety. 17 Neonatal concerns include fetal temperature rises, 18 , 19 respiratory distress or water aspiration, 20 , 21 infection, 22 , 23 and “snapped” umbilical cords.…”