Waterbirth Works

Hot off the press!!! So excited to see ACOG has finally come to see waterbirth is a safe option for low risk
Mothers with trained professionals!!! https://www.ajog.org/article/S0002-9378(23)00604-X/fulltext?

Water birth: a systematic review and meta-analysis of maternal and neonatal outcomes This systematic review and meta-analysis aimed to conduct a thorough and contemporary assessment of maternal and neonatal outcomes associated with water birth in comparison with land-based birth.

Objective: Investigate maternal and neonatal outcomes following waterbirth.

Design: Retrospective cohort study, with propensity score matching to address confounding.

Setting: Community births, United States.

Sample: Medical records-based registry data from low-risk births were used to create waterbirth and land birth groups (n = 17 530 each), propensity score-matched on >80 demographic and pregnancy risk covariables.

Methods: Logistic regression models compared outcomes between the matched waterbirth and land birth groups.

Main outcome measures: Maternal: immediate postpartum transfer to a hospital, any ge***al tract trauma, severe (3rd/4th degree) trauma, haemorrhage >1000 mL, diagnosed haemorrhage regardless of estimated blood loss, uterine infection, uterine infection requiring hospitalisation, any hospitalisation in the first 6 weeks. Neonatal: umbilical cord avulsion; immediate neonatal transfer to a hospital; respiratory distress syndrome; any hospitalisation, neonatal intensive care unit (NICU) admission, or neonatal infection in the first 6 weeks; and neonatal death.

Results: Waterbirth was associated with improved or no difference in outcomes for most measures, including neonatal death (adjusted odds ratio [aOR] 0.56, 95% CI 0.31-1.0), and maternal or neonatal hospitalisation in the first 6 weeks (aOR 0.87, 95% CI 0.81-0.92 and aOR 0.95, 95% CI 0.90-0.99, respectively). Increased morbidity in the waterbirth group was observed for two outcomes only: uterine infection (aOR 1.25, 95% CI 1.05-1.48) (but not hospitalisation for infection) and umbilical cord avulsion (aOR 1.57, 95% CI 1.37-1.82). Our results are concordant with other studies: waterbirth is neither as harmful as some current guidelines suggest, nor as benign as some proponents claim.

Bovbjerg, M. L., Cheyney, M., & Caughey, A. B. (2022). Maternal and neonatal outcomes following waterbirth: a cohort study of 17 530 waterbirths and 17 530 propensity score-matched land births. BJOG : an international journal of obstetrics and gynaecology, 129(6), 950–958. https://doi.org/10.1111/1471-0528.17009

Maternal and neonatal outcomes following waterbirth: a cohort study of 17,530 waterbirths and 17,530 propensity score-matched land births Investigate maternal and neonatal outcomes following waterbirthRetrospective cohort study, with propensity score matching to address confoundingCommunity births, United StatesMedical records-based registry data from low-risk births were used to create ...

Objectives: The objective of this review was to systematically synthesize the best available evidence regarding the effect of waterbirth, compared to landbirth, on the mortality and morbidity of neonates born to low risk women.

Inclusion criteria: This review considered studies that included low risk, well, pregnant women who labor and birth spontaneously, at term (37-42 weeks), with a single baby in a cephalic presentation. Low risk pregnancies are defined as pregnancies with an absence of co-morbidity or obstetric complication, such as maternal diabetes, previous cesarean section, high blood pressure or other illness. Women may be experiencing their first or subsequent pregnancy. The fetus must also be well and without any co-morbidity or complication.The intervention of interest is waterbirth. The comparator is landbirth. Women and their babies must be cared for by qualified maternity healthcare providers throughout their labor and birth. The birth setting must be clearly described but can include home, hospital or birth center, either freestanding or attached to a hospital.This review considered randomized controlled trials, quasi-experimental studies and observational prospective and retrospective cohort studies.

Results: The meta-analyses of 12 studies showed that for the majority of outcomes measured in this review there is little difference between waterbirth and landbirth groups. Meta-analysis was not conducted for mortality within 24 days of birth. Heterogeneity was significant between studies for APGAR (Appearance, Pulse, Grimace, Activity, and Respiration). scores ≤7 at one minute and admission to Special Care nursery. Sensitivity analysis for case control studies describing infection found results that were not statistically significant (OR 0.74, 95% CI 0.05-11.06). Results of meta-analysis were also not significant for studies describing resuscitation with oxygen (OR 1.12, 95% CI 0.14-8.79) and Respiratory Distress Syndrome (OR 0.81, 95% CI 0.44-1.49). Results comparing APGAR scores ≤7 at five minutes for waterbirth and landbirth groups results for included RCTs demonstrated results that were not statistically significant (OR 6.4, 95% CI 0.63-64.71). However, results for included cohort studies describing APGAR scores ≤7 at 5 minutes indicate neonates are less likely to have scores ≤7 in the waterbirth group (OR 0.32, 95% 0.15-0.68). Data were not statistically significant for meta-analysis describing admission to NICU (OR 0.51, 95% CI 0.13-1.96) between water and landbirth groups. The differences in arterial (MD 0.02, 95% CI 0.01-0.02) and venous (MD 0.03, 95% CI 0.03-0.03) cord pH, while statistically significant, were clinically negligible.

Conclusions: Analyses of data reporting on a variety of neonatal clinical outcomes comparing land with waterbirth do not suggest that outcomes are worse for babies born following waterbirth. Meta-analysis of results for five-minute APGAR scores ≤7 should be treated with caution due to the different direction of results for meta-analysis of data from randomized controlled trials and cohort studies. Data measuring cord pH (an objective measure of neonatal wellbeing) were robust and showed no difference between groups. Overall this review was limited by heterogeneity between studies and meta-analysis could not be conducted on a number of outcomes. Waterbirth does not appear to be associated with adverse outcomes for the neonate in a population of low risk women.

Implications for practice: There is no evidence to suggest that the practice of waterbirth in a low risk population is harmful to the neonate.

Implications for research: There is a paucity of high level evidence to guide practice in the area of waterbirth. It is unlikely that randomized controlled trials on waterbirth will be acceptable to childbearing women or maternity caregivers. Observational studies are a more appropriate choice for researchers in this field as they offer a more practical and ethical approach.

Davies, R., Davis, D., Pearce, M., & Wong, N. (2015). The effect of waterbirth on neonatal mortality and morbidity: a systematic review and meta-analysis. JBI database of systematic reviews and implementation reports, 13(10), 180–231.

The effect of waterbirth on neonatal mortality and... : JBI Evidence Synthesis surprising that there are few randomized controlled trials available to inform practice. Much of the criticism directed at waterbirth focuses on the potential impact on the neonate. Objectives The objective of this review was to systematically synthesize the best available evidence regarding the eff...

Bailey, J. M., Zielinski, R. E., Emeis, C. L., & Kane Low, L. (2020). A retrospective comparison of waterbirth outcomes in two United States hospital settings. Birth (Berkeley, Calif.), 47(1), 98–104. https://doi.org/10.1111/birt.12473

Bailey et al., objective was to report the outcomes from two nurse-midwifery services that provide waterbirth within a tertiary care hospital setting in the United States.

Methods: This study is a retrospective, observational, matched comparison design. Data were collected from two large midwifery practices in tertiary care centers using information recorded at the time of birth for quality assurance purposes. Land birth cases were excluded if events would have precluded them from waterbirth (epidural, meconium stained fluid, chorioamnionitis, estimated gestational age < 37 weeks, or body mass index > 40). Neonatal outcomes included Apgar score and admission to the neonatal intensive care unit. Maternal outcomes included perineal lacerations and postpartum hemorrhage.

Results: A total of 397 waterbirths and 2025 land births were included in the analysis. There were no differences in outcomes between waterbirth and land birth for Apgar scores or neonatal intensive care admissions (1.8% vs 2.5%). Women in the waterbirth group were less likely to sustain a first- or second-degree laceration. Postpartum hemorrhage rates were similar for both groups. Similar results were obtained using a land birth subset matched on insurance, hospital location, and parity using propensity scores.

Discussion: In this study, waterbirth was not associated with increased risk to neonates, extensive perineal lacerations, or postpartum hemorrhage. Fewer women in the waterbirth group sustained first- or second-degree lacerations requiring sutures.

A retrospective comparison of waterbirth outcomes in two United States hospital settings Birth: Issues in Perinatal Care is an interdisciplinary obstetrics & gynecology journal covering perinatal medicine & nursing, and maternal & newborn public health.

Carlsson, T., & Ulfsdottir, H. (2020). Waterbirth in low-risk pregnancy: An exploration of women's experiences. Journal of advanced nursing, 76(5), 1221–1231. https://doi.org/10.1111/jan.14336

Aims: To explore retrospective descriptions about benefits, negative experiences and preparatory information related to waterbirths.

Design: A qualitative study.

Methods: Women who gave birth in water with healthy pregnancies and low-risk births were consecutively recruited between December 2015-October 2018 from two birthing units in Sweden. All who gave birth in water during the recruitment period were included (N = 155) and 111 responded to the survey. Women were emailed a web-based survey six weeks postpartum. Open-ended questions were analysed with qualitative content analysis.

Results: Two themes were identified related to benefits: (a) physical benefits: the water eases labour progression while offering buoyancy and pain relief; and (b) psychological benefits: improved relaxation and control in a demedicalized and safe setting. Two themes were identified related to negative experiences: (a) equipment-related issues due to the construction of the tub and issues related to being immersed in water; and (b) fears and worries related to waterbirth. In regard to preparatory information, respondents reported a lack of general and specific information related to waterbirths, even after they contacted birthing units to ask questions. Supplemental web-based information was sought, but the trustworthiness of these sources was questioned and a need for trustworthy web-based information was articulated.

Conclusion: Women who give birth in water experience physical and psychological benefits, but need better equipment and sufficient information. There is room for improvement with regard to prenatal and intrapartum care of women who give birth in water.

Impact: Judging from women's recounts, midwives and nurses should continue advocating waterbirth in low-risk pregnancies. The lack of adequate equipment in Swedish birthing units articulated by women challenge current routines and resources. The findings illustrate unfulfilled needs for preparatory information about waterbirth, further strengthening that midwives should discuss the possibility of waterbirth when meeting expectant parents in the antenatal setting.

Waterbirth in low‐risk pregnancy: An exploration of women’s experiences Aims To explore retrospective descriptions about benefits, negative experiences and preparatory information related to waterbirths. Design A qualitative study. Methods Women who gave birth in wa...

Waterbirth is associated with a less painful childbirth, enhanced couples' intimacy, and positive feelings toward women's bodies and sexuality. In a qualitative, descriptive case study involving 21 participants, we examined the sexual experiences-during childbirth and postpartum-of women who had a waterbirth in a hospital environment. Women discussed their sexuality in the intrapartum and postpartum period after having a waterbirth in public or private hospitals. Two main themes were developed from the data analysis: 'women's sexual pleasure during waterbirth' and 'sexuality after childbirth'. Experiences included transcendence during waterbirth, a feeling that it represented a unique experience, and couples' more positive feelings about intimacy. The shared representations of women suggest that waterbirth can be a calming, joyful event for couples. During this process, they felt that it was a loving, shared event. In addition, after childbirth women experienced positive feelings toward their bodies and sexuality (including or**sm), as well as closer intimacy with their partners.

Camargo, J., Araújo, N., Catão, L., Sarubbi Junior, V., Silva, L. C., Nené, M., & Grande, M. C. (2021). Sexuality and childbirth: a qualitative analysis of women who had a waterbirth. Culture, health & sexuality, 23(7), 1006–1013.

Sexuality and childbirth: a qualitative analysis of women who had a waterbirth Waterbirth is associated with a less painful childbirth, enhanced couples’ intimacy, and positive feelings toward women’s bodies and sexuality. In a qualitative, descriptive case study involving 21...

Cristina, T., Mara, T., Arianna, S., Gennaro, S., Rosaria, C., & Pantaleo, G. (2022). Impact of waterbirth on post-partum hemorrhage, ge***al trauma, retained placenta and shoulder dystocia: A systematic review and meta-analysis. European journal of obstetrics, gynecology, and reproductive biology, 276, 26–37. https://doi.org/10.1016/j.ejogrb.2022.06.016

Objectives: To examine different maternal complications of WB compared to standard land birth (LB). The primary outcomes were postpartum hemorrhage and ge***al trauma. The secondary outcome included the risk of retained placenta and shoulder dystocia.

Methods: We searched the electronic databases including PubMed, MEDLINE, Embase, Scopus, EBSCO. In addition, we searched in Google Scholar and ClinicalTrials.gov. The pooled results were used to evaluate the association between WB and obstetric outcomes. This systematic review (SR) was reported according to PRISMA statement 2020. Statistical meta-analyses were performed using Cochrane RevMan version 5.4 software (http://www.cochrane.org).

Results: This systematic review included 22 studies (20 observational studies and 2 RCT). The pooled results showed lower risk of major PPH compared to the LB group (OR = 0.76, 95% CI: 0.66-0.89), no significant difference (OR: 0.94, 95% CI: 0.50-1.78) in the incidence of minor PPH (500-1000 mL blood loss) between WB and LB, no significant difference in the rate of third- and fourth-degree lacerations (OR = 0.87, 95% CI: 0.71-1.07) and in the incidence of retained placenta (OR = 1.30, 95% CI: 0.50-3,35), fewer shoulder dystocia for WB (OR = 0.42, 95% CI: 0.35-0.50). However, compared with the LB group, the rate of first-second-degree tears in the WB group increased by 45% (OR = 1.45, 95% CI: 1.16-1.81).

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Clews, C., Church, S., & Ekberg, M. (2020). Women and waterbirth: A systematic meta-synthesis of qualitative studies. Women and birth : journal of the Australian College of Midwives, 33(6), 566–573. https://doi.org/10.1016/j.wombi.2019.11.007

Aim: To undertake a review of qualitative studies exploring women's experiences of waterbirth. This understanding is pertinent when supporting women who birth in water.

Methods: A literature search was conducted in databases British Nursing Index, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Maternity and Infant Care, Medline, Applied Social Sciences Index and Abstracts and Web of Science, using search terms waterbirth, labour/labor, childbirth, women, mothers, experience, perception and maternity care. Five primary research articles published between 2003 and 2018 which explored the views of women who had birthed in water were selected for inclusion. Using meta-ethnography, qualitative research studies were analysed and synthesised using the method of 'reciprocal translational analysis' identifying themes relating to women's experiences of birthing in water.

Findings: Four themes were identified: women's knowledge of waterbirth; women's perception of physiological birth; water, autonomy and control; and waterbirth: easing the transition.

Conclusion: Despite the paucity of qualitative studies exploring women's experiences of waterbirth, meta-synthesis of those that do exist suggested women identify positively with the choice. The experience of birthing in water appears to enhance a woman's sense of autonomy and control during childbirth suggesting waterbirth can be an empowering experience for women who choose it.

Redirecting

Aughey, H., Jardine, J., Moitt, N., Fearon, K., Hawdon, J., Pasupathy, D., Urganci, I., NMPA Project Team, & Harris, T. (2021). Waterbirth: a national retrospective cohort study of factors associated with its use among women in England. BMC pregnancy and childbirth, 21(1), 256.

Waterbirth: a national retrospective cohort study of factors associated with its use among women in England - BMC Pregnancy and Childbirth Background Waterbirth is widely available in English maternity settings for women who are not at increased risk of complications during labour. Immersion in water during labour is associated with a number of maternal benefits. However for birth in water the situation is less clear, with conclusive e...

Allen, J., Gao, Y., Dahlen, H., Reynolds, M., Beckmann, M., Cooper, C., & Kildea, S. (2022). Is a randomized controlled trial of waterbirth possible? An Australian feasibility study. Birth (Berkeley, Calif.), 49(4), 697–708. https://doi.org/10.1111/birt.12635

Background: The safety of waterbirth is contested because of the lack of evidence from randomized trials and conflicting results. This research assessed the feasibility of a prospective study of waterbirth (trial or cohort).

Methods: We conducted a prospective cohort study at an Australian maternity hospital. Eligible women with uncomplicated pregnancies at 36 weeks of gestation were recruited and surveyed about their willingness for randomization. The primary midwife assessed waterbirth eligibility and intention on admission in labor, and onset of second stage. Primary outcomes measured feasibility. Intention-to-treat analysis, and per-protocol analysis, compared clinical outcomes of women and their babies who intended waterbirth and nonwaterbirth at onset of second stage.

Results: 1260 participants were recruited; 15% (n = 188) agreed to randomization in a future trial. 550 women were analyzed by intention-to-treat analysis: 351 (waterbirth) and 199 (nonwaterbirth). In per-protocol analysis, 14% (n = 48) were excluded. Women in the waterbirth group were less likely to have amniotomy and more likely to have water immersion and physiological third stage. There were no differences in other measures of maternal morbidity. There were no significant differences between groups for serious neonatal morbidity; four cord avulsions occurred in the waterbirth group with none in the landbirth group. An RCT would need approximately 6000 women to be approached at onset of second stage.

Conclusions: A randomized trial of waterbirth compared with nonwaterbirth, powered to detect a difference in serious neonatal morbidity, is unlikely to be feasible. A powered prospective study with intention-to-treat analysis at onset of second stage is feasible.

Vidiri A, Zaami S, Straface G, Gullo G, Turrini I, Matarrese D, Signore F, Cavaliere AF, Perelli F, Marchi L. Waterbirth: current knowledge and medico-legal issues. Acta Biomed. 2022 Mar 14;93(1):e2022077. doi: 10.23750/abm.v93i1.12617. PMID: 35315386; PMCID: PMC8972863.

Waterbirth: current knowledge and medico-legal issues Water immersion during labour and birth has become increasingly popular and widespread in many countries, in particular in midwifery-led care settings. Nevertheless, there is a dearth of quality data about waterbirth, with currently available findings ...