Labouring women who used a birthing pool in obsteric units in Italy: prospective observational study

Abstract

BackgroundFor women at low risk of childbirth complications, water immersion during labour is a care option in many high income countries. Our aims were (a) to describe maternal characteristics, intrapartum events, interventions, maternal and neonatal outcomes for all women who used a birthing pool during labour who either had a waterbirth or left the pool and had a landbirth, and for the subgroup of women who had a waterbirth in 19 obstetric units, and (b) to compare maternal characteristics, intrapartum events, interventions, and maternal and neonatal outcomes for women who used a birthing pool with a control group of women who did not use a birthing pool for whom we prospectively collected data in a single centre.MethodsProspective observational study in 19 Italian obstetric units 2002-2005. Participants were: (a) 2,505 women in labour using a birthing pool in 19 obstetric units; and (b) 114 women in labour using a birthing pool and 459 women who did not use a birthing pool in one obstetric unit. Descriptive statistics were calculated for the sample as a whole and, separately, for those women who gave birth in water. Categorical data were compared using Chi square statistics and continuous data by T-tests.ResultsOverall, 95.6% of women using a birthing pool had a spontaneous vertex delivery, 63.9% of which occurred in water. Half of nulliparas and three quarters of multiparas delivered in water. Adverse maternal and neonatal outcomes were rare. There were two cases of umbilical cord snap with waterbirth. Compared with controls, significantly more women who used a birthing pool adopted an upright birth position, had hands off delivery technique, and a physiological third stage. Significantly fewer nulliparas had an episiotomy, and more had a second degree perineal tear, with no evidence of a difference for extensive perineal tears.ConclusionsBirthing pool use was associated with spontaneous vaginal birth. The increase in second degree tears was balanced by fewer episiotomies. Undue umbilical cord traction should be avoided during waterbirth.

Outcomes of Waterbirth in a US Hospital‐Based Midwifery Practice: A Retrospective Cohort Study of Water Immersion During Labor and Birth

“…The body of evidence that addresses the safety of hydrotherapy during birth (waterbirth) is not extensive, with few studies conducted in the United States. In studies that have been published evaluating water immersion

during labor and birth, the findings include no differences in maternal infection rates, decreased episiotomy rates, decreased duration of labor, decreased reported pain, decreased use of analgesia and anesthesia, decreased blood loss or incidence of postpartum hemorrhage, and increased maternal satisfaction . Evidence is conflicting regarding the incidence of perineal lacerations.…”

“…Giving birth while submerged in water has gained in popularity over the past 40 years, as women seek a lower-intervention birth and nonpharmacologic pain relief options. [1][2][3] In 2016, the American College of Nurse-Midwives released a position statement stating that low-risk women should be given the choice to remain immersed in water for birth as part of a shared decision-making process. 3 This document also states that labor management for these women should be evidence-based and include ongoing maternal and fetal assessment during labor.…”

“…1,4 Water immersion during labor has shown mixed results for perineal integrity. 2,5 Studies have not demonstrated neonatal harm from the use of hydrotherapy in the first stage of labor. 7 The body of evidence that addresses the safety of hydrotherapy during birth (waterbirth) is not extensive, with few studies conducted in the United States.…”

Women's experiences with water birth: A matched groups prospective study

“…9 Evidence for the effect of water birth on perineal trauma is mixed. 12 A 5-year observational study, using data collected by the Midwives Alliance of North America compared 3 groups: water birth (n = 6534), nonwater birth (n = 10 290), and intended water birth (n = 1573). 10 Another study found higher rates of perineal laceration but fewer episiotomies among women giving birth in the water.…”

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

“…Waterbirth is highly controversial in the United States, [1][2][3][4][5][6][7][8] despite being an accepted practice in other high-resource nations. [9][10][11][12] Proponents of waterbirth cite anthropological evidence from Odent and Tjarkovsky regarding childbearing traditions that include immersion 13,14 ; the maternal benefits of laboring in water, such as pain relief and reduced stress on tissues secondary to buoyancy 15,16 ; the potential benefits to a neonate of being born into a warm, liquid environment similar to the amniotic fluid 17 ; and a series of studies, mostly small and observational, suggesting no adverse effects for either the laboring woman or the neonate. 18,19 By contrast, in the spring of 2014, the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) jointly issued clinical recommendations advising strongly against allowing women to labor in water after the first stage of labor is complete.…”