A study has found that water births are no more risky than land births, and that women in the water group sustain fewer first and second-degree tears. University of Michigan researchers analysed 397 waterbirths and 2,025 land births from two midwifery practices. There were no differences in outcomes between water birth and land birth for neonatal intensive care admissions, and postpartum haemorrhage rates were similar for both groups.
"The long and short of it is that if you use proper techniques…the outcomes are very good," said Dr Lisa Kane Low, professor in the U-M School of Nursing, and senior author on the paper. "They mirror what we see in international studies of water birth."
Dr Ruth Zielinski, clinical associate professor of nursing and study co-author, said more facilities should offer water birth and have guidelines for implementing it.
In water birth, the woman gives birth in a water-filled tub rather than a bed. Few US hospitals or birth centres offer tub births because of perceived risk to the new-born, mainly suggested by case studies of neonatal infections or cord tearing. Professional organisations tend to agree that women in labour should have access to water for comfort, but not all support birth in the water. This means hospitals must make women leave the tub before the birth.
During a water birth, babies take their first breath when removed from the tub. Until then, their lungs are filled with water, which is displaced when they hit the air and breathe. The connected umbilical cord provides oxygen.
"It's important not to re-submerge babies," Zielinski said. At U-M, they are birthed in the water, brought out almost immediately, and they're careful to not re-submerge them. Mom and baby exit the tub with help and warm blankets, typically prior to delivering the placenta so that blood loss can be more accurately calculated.
Zielinski said more studies are needed to understand the satisfaction level of women who have water births.
Abstract
Background: Water immersion during labor is an effective comfort measure; however, outcomes for waterbirth in the hospital setting have not been well documented. Our 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.
Authors
Uche Menakaya, Shakeeba Albayati, Elizabeth Vella, Jennifer Fenwick, Donald Angstetra
[link url="https://news.umich.edu/study-water-births-are-as-safe-as-land-births-for-mom-baby/"]University of Michigan material[/link]
[link url="https://onlinelibrary.wiley.com/doi/10.1111/birt.12473"]Birth abstract[/link]