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

Abstract

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.

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

“…Various studies have found that water birth is associated with decreased trauma, 10 increased trauma, 13 increased trauma in some groups of women but not others, 12 and either decreased 10 or the same 12 likelihood of extensive trauma such as 3rd/4th degree lacerations. Various studies have found that water birth is associated with decreased trauma, 10 increased trauma, 13 increased trauma in some groups of women but not others, 12 and either decreased 10 or the same 12 likelihood of extensive trauma such as 3rd/4th degree lacerations.…”

“…One observational study found that water birth was associated with lower rates of 3rd/4th degree lacerations, and higher rates of birth "without injuries." 13 Compared with nonwater birth, water birth was associated with an increase in genital tract trauma, representing all episiotomies and lacerations. 11 Henderson et al 12 found that water birth was associated with more second degree lacerations among nulliparous, but not parous women.…”

“…10 Another study found higher rates of perineal laceration but fewer episiotomies among women giving birth in the water. 13 One criticism of water birth is that there is insufficient evidence of its purported benefits. Regardless of parity, there was no difference in extensive perineal trauma.…”

A Model Practice Template for Hydrotherapy in Labor and Birth

“…16,17 C. Perineal laceration. Waterbirth is associated with a decreased rate of third-and fourth-degree perineal lacerations [7][8][9]18 ; however, waterbirth may slightly increase the risk of less significant perineal trauma. However, if the tub is not cleaned properly or harbors unusual organisms such as Pseudomonas or Legionella, the woman and/or neonate could acquire an atypical infection.…”

“…No maternal deaths have been reported, and only isolated fetal deaths have been attributed to immersion during labor or birth. 12,13,[16][17][18] VI. STANDARD REQUIREMENTS TO FACILITATE HYDROTHERAPY During the prenatal period, health care providers should discuss the potential use of water during labor and/or birth with all low-risk women as part of an overall discussion and education regarding evidencebased options for pain relief.…”