October 22, 2020
Research Review: Maternal and Neonatal Outcomes in Hospital-Based Deliveries With Water Immersion
By: Sharon Muza, BS, CD/BDT(DONA), LCCE, FACCE, CLE | 0 Comments
A new study was just released in the journal Obstetrics and Gynecology that examined the outcomes of parents and newborns who were born in the water in a hospital setting. This is a topic that Connecting the Dots has covered before, most recently with a synopsis here and here with the expert on water birth, Barbara Harper and one that I wrote here.
Maternal and Neonatal Outcomes in Hospital-Based Deliveries With Water Immersion was a retrospective study that was primarily seeking to compare NICU admissions for newborns born in water versus NICU admissions for those born on land. Additionally, the researchers looked at some secondary outcomes such adverse neonatal diagnoses, maternal infections and perineal lacerations.
How was the study done
This was a retrospective study conducted using electronic medical records from babies born between 2014 and 2018 in a total of eight hospitals representing two health systems that had already had policies in place for water birth. The participants intended to birth in the water and labored and/or birthed in the water. Once the 583 subjects were identified, the researches selected 583 similar subjects for the control group from electronic health records. The control group consisted of parents who met water birth eligibility criteria but did not labor or birth in the water. Only low risk pregnant people were included as subjects. The groups who used water at any time after admission were then subdivided into people who only labored in water and those who labored and pushed in the water, regardless of where birth ultimately occurred.
What were the result
583 people were in the water immersion group and 34.1% (199) of them labored in water but did not birth in water. 65.9% (384) were in the water for all or part of second stage with 53.9% (314) birthing in the water. 12% (70) people started second stage in the water but got out of the tub before they birthed their baby.
NICU admissions were lower for the babies who were born in the water than those in the control group. People experienced fewer perineal tears when they birthed int the water.
There were no cord avulsions in the control group and 0.8% of the people who gave birth in the water experienced this complication. There were no significant differences in five minute APGAR scores, infections in the parent or other adverse outcomes between the two groups.
Laboring in water has long been known to reduce the pain of labor and result in shorter labors for people giving birth. Obstetricians have had longstanding concerns about the potential impact of newborns being born in water, such as infections, respiratory distress, oxygen deprivation, tub water aspiration, thermoregulation and more. The researchers wanted to specifically look at US based deliveries in a hospital setting as there was much published on out of hospital births outside the United States in previous studies.
It is important to consider that people in the labor or birth group who did not complete delivery in the water may have been asked to leave the tub because of developing fetal or maternal concerns that might send more babies to the NICU than those who birthed in the water. People who labored or pushed in water but did not deliver in water were classified into two groups: those who exited for a medical reason or upon recommendation of a health care professional (71) and those who exited for maternal choice or were missing exit reasons (128).
Of those who exited for medical reasons, it was found that their babies experienced higher adverse outcomes including admission to the NICU.
Fewer lacerations of any severity were found in the group that birthed in the water. This may be a result of limited access to the perineum for perineal massage and other perineal contact between the health care provider and the birthing person. Little to no contact may lead to less friable, edematous perineal tissue, resulted in less tearing.
Both physicians and certified nurse midwives (CNM) were attending the subjects who intended to birth in water. Of the number who actually used water during second stage, almost 85 percent of them were attended by CNMs. Could the CNM comfort level and familiarity with physiological birth in and out of the water lead to more stable newborns and less tearing?
There may be other considerations that should be examined, including motivation to labor or birth in the water by the pregnant person, preparation in advance of labor and other factors.
Newborns born in the water at a hospital-based faciity had a lower risk of being admitted to NICU than those born on land. Parents who gave birth in the water were less likely to have a perineal laceration.
Families may want to choose that option if they are already birthing in locations that offer water birth and consumers may want to request that more facilities begin to offer this option if it is not available. Alternately, they may want to change providers and birth locations to another hospital that does.
Sidebottom, A. C., Vacquier, M., Simon, K., Wunderlich, W., Fontaine, P., Dahlgren-Roemmich, D., ... & Saul, L. (2020). Maternal and Neonatal Outcomes in Hospital-Based Deliveries With Water Immersion. Obstetrics and Gynecology, 136(4), 707.
TagsWater Birth Research NICU Waterbirth Labor And Birth Research Review Barbara Harper Sharon Muza