Systematic Review of Case Reports of Poor Neonatal Outcomes With Water Immersion During Labor and Birth

Abstract

Water immersion is a valuable comfort measure in labor, that can be used during the first or second stage of labor. Case reports of adverse outcomes create suspicion about water birth safety, which restricts the availability of water birth in the United States. The objective of this study was to synthesize the information from case reports of adverse water birth events to identify practices associated with these outcomes, and to identify patterns of negative outcomes. The research team conducted a systematic search for cases reports of poor neonatal outcomes with water immersion. Eligible manuscripts reported any adverse neonatal outcome with immersion during labor or birth; or excluded if no adverse outcome was reported or the birth reported was unattended. A qualitative narrative synthesis was conducted to identify patterns in the reports. There were 47 cases of adverse outcomes from 35 articles included in the analysis. There was a pattern of cases of Pseudomonas and Legionella, but other infections were uncommon. There were cases of unexplained neonatal hyponatremia following water birth that need further investigation to determine the mechanism that contributes to this complication. The synthesis was limited by reporting information of interest to pediatricians with little information about water birth immersion practices. These data did not support concerns of water aspiration or cord rupture, but did identify other potential risks. Water immersion guidelines need to address infection risk, optimal management of compromised water-born infants, and the potential association between immersion practice and hyponatremia.

Systematic review and meta-analysis to examine intrapartum interventions, and maternal and neonatal outcomes following immersion in water during labour and waterbirth

“…A review of case reports of poor newborn outcomes found that when reported, cord avulsion was easily managed by the midwife with no consequences for the newborn. 75 Our results show that water immersion has the potential to make a meaningful contribution to the global agenda towards promoting physiological birth. [76][77][78][79][80] Labouring and/or giving birth in water can reduce maternal pain with no increased risk of an adverse event, and without the risk introduced by epidural and opioids.…”

“…A review of case reports of poor newborn outcomes found that when reported, cord avulsion was easily managed by the midwife with no consequences for the newborn. 75 …”

“…Interestingly, the incidence of cord avulsion varied from 0.2 per 1000 to 11.8 per 1000 in the five studies that reported this outcome, suggesting individual practice characteristics are more relevant to the incidence of cord avulsion than whether the birth occurs in water. A review of case reports of poor newborn outcomes found that when reported, cord avulsion was easily managed by the midwife with no consequences for the newborn 74…”

Taking the plunge: Water immersion for labour and birth amongst women with moderate obstetric risk factors: A prospective cohort study

“…The risk of neonatal sepsis is often cited by those who oppose WWI/Waterbirth (15) . However, case reports of neonates infected with L. pneumophila and P. aeruginosa (16) , appear to have resulted from a deviation from established waterbirth protocols and the use of unclean water. Overwhelmingly, recent literature suggests no increase in infective sequalae from WWI/WB, which is consistent with our findings (17,18) .…”

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

“…The risk of neonatal sepsis is often cited by those who oppose WWI/waterbirth 16 . However, case reports of neonates infected with Legionella pneumophila and Pseudomonas aeruginosa 17 appear to have resulted when a deviation from established waterbirth protocols had occurred or from the use of unclean water. Overwhelmingly, recent literature suggests no increase in infective sequalae from WWI/waterbirth 18,19 …”