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Waterbirths compared with landbirths: An observational study of nine years

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Abstract

This study compares neonatal and maternal morbidity and mortality between waterbirths and landbirths (spontaneous singleton births in cephalic presentation, vacuum extractions are excluded). In this observational study covering nine years, standardized questionnaires were used to document 9,518 spontaneous singleton cephalic presentation births, of which 3,617 were waterbirths and 5,901 landbirths. Landbirths show higher rates of episiotomies as well as third and fourth degree perineal lacerations. Waterbirths show a higher rate of births "without injuries", first and second-degree perineal lacerations, vaginal and labial tears. After a waterbirth, there is an average loss of 5.26 g/l blood; this is significantly less than landbirths where there is an 8.08 g/l blood loss on average. In 69.7% waterbirths required no analgesic, compared to 58.0% for landbirths. Water and landbirths do not differ with respect to maternal and neonatal infections. After landbirths, there was a higher rate of newborn complications with subsequent transfer to an external NICU. During the study, there were neither maternal nor neonatal deaths related to spontaneous labor. Waterbirths are associated with low risks for both mother and child when obstetrical guidelines are followed.
Kopie von subito e.V., geliefert für Aerztebibliothek (SLS03X00365)
Kopie von subito e.V., geliefert für Aerztebibliothek (SLS03X00365)
Kopie von subito e.V., geliefert für Aerztebibliothek (SLS03X00365)
Kopie von subito e.V., geliefert für Aerztebibliothek (SLS03X00365)
Kopie von subito e.V., geliefert für Aerztebibliothek (SLS03X00365)
Kopie von subito e.V., geliefert für Aerztebibliothek (SLS03X00365)
Kopie von subito e.V., geliefert für Aerztebibliothek (SLS03X00365)
Kopie von subito e.V., geliefert für Aerztebibliothek (SLS03X00365)
... A 2004 study compared outcomes for women according to actual place of birth: landbirth (n = 5901) or waterbirth (n = 3617); it concluded waterbirth was low risk. 28 A 2021 study compared outcomes for women in three groups (intended-actual place of birth): ...
... Several observational studies have shown that women who use a birthing pool for labor and/or birth are more likely to have a normal vaginal birth and are less likely to require labor augmentation, have an episiotomy, or receive epidural analgesia. 28,32,37,[39][40][41][42] An increase in perineal trauma has been reported in waterbirth; 32,43 however, other research has found no increase in adverse events for women, including perineal trauma. 31,[44][45][46][47] These mixed results, alongside concerns about potential harm to mothers and babies, selection bias in small and/ or nonrandomized studies, and a lack of blinding, have resulted in ongoing recommendations to conduct robust prospective studies (trial or cohort). ...
... Secondary outcomes showed minimal differences. Like other prospective studies of waterbirth compared with landbirth, 10,28 our study demonstrated maternal benefits associated with waterbirth without additional risks. The occurrence of cord avulsion in the waterbirth group (and not the landbirth group) was not measured or reported by previous prospective studies. ...
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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.
... 4 Published estimates indicate up to 70% of women labouring in water either choose to or are asked by a provider to leave the water prior to birth. 11,13,14,15,16,17,18,19,20,21,22,23,24 Finally, the intervention crossover discussed above would be unidirectional. Among participants randomised to waterbirth, one can imagine numerous scenarios in which the labouring person would be asked to get out of the tub to allow for closer monitoring, but it is highly unlikely that women randomised to land birth would begin immersion. ...
... Snapp et al. 40 found fewer reproductive tract infections (relative risk [RR] 0.73, range 0.52-1.04), and Geissbuehler et al. 16 reported less postpartum antibiotic use (3.1% waterbirth, 4.7% land birth), but neither adjusted for confounders. Jacoby et al. 39 reported 80% fewer maternal fevers in the waterbirth group than in the land birth group (aOR 0.21, 95% CI 0.03-1.49, ...
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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 genital 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. Tweetable abstract New study demonstrates #waterbirth is neither as harmful as some current guidelines suggest, nor as benign as some proponents claim. @TheUpliftLab @BovbjergMarit @31415926abc @NICHD_NIH.
... 21 Geissbuehler V et al, and FIGO guidelines on management of the second stage of labor, recommend that the care provider should respect the wishes of a pregnant woman opting for water birth as much as possible without compromising safety. 22,23 Continuous support during labour ...
Article
The second stage of labor begins with full dilatation of cervix and ends with delivery of the fetus. In most of the cases the labor progresses uneventfully, without any need of an active intervention but in few cases complications may occur. With passage of time there has been better understanding about second stage of labor, still there are several grey areas yet to be resolved. This review endeavours to scrutinize a variety of care practices including positions, time and type of pushing, use of epidural analgesia, and perineal support techniques etc and discuss evidence based management of second stage of labor. The review was carried out in the period of 1900-2019 by searching in Pub Med, Embase, Scopus, Google scholar, Web of sciences using relevant key words. Reports, articles, fact sheets and official publications of World health Organization (WHO), Ministry of health and family welfare-Govt of India and various other countries were also reviewed
... Regarding the general condition of the newborn measured with the Apgar score, several studies even indicated an improvement for water birth ( Poder and Larivière, 2014 ;Taylor et al., 2016 ;Vanderlaan et al., 2018 ). In the literature, there are several variations among studies in the reported effects of water immersion, but one of the most frequent effects is that it reduces the duration of the labor phase ( Poder and Larivière, 2014 ;Cluett et al., 2018 ;Cluett and Burns, 2009 ;Geissbuehler et al., 2004 ;Otigbah et al., 2000 ;Malarewicz et al., 2005 ;Thöni et al., 2010 ;Torkamani et al., 2010 ). Previously, in the selection of attributes for the DCE, in the women's preferences exercise that followed the focus groups, labor duration was not given high priority by women but was still included, as it is the main significant clinical outcome discussed in the literature ( Poder and Larivière, 2014 ;Cluett et al., 2018 ). ...
Article
Background and aim No discrete choice experiment study has been conducted to elicit women's preferences for water immersion during labor and birth. Methods An online survey including sociodemographic questions and choice cards was conducted in 2019 to explore women's preferences (i.e., factors that may influence their decision). Each participant responded to 12 choice cards with 6 attributes/factors (i.e., birth mode, duration of the labor phase, pain sensation, risk of severe perineal tears, risk of death of the newborn, and newborn general condition). Utilities were estimated using logit, latent class, and hierarchical Bayesian analyses. Findings A total of 1088 subjects completed the survey in 2019. The risk of death of the newborn was given high priority by women in all but one analyses, while the risk of severe perineal tears was always considered the least important attribute. The latent class analysis clearly revealed three classes of women. The largest class including 52.9% of women was interested in water birth if it could reduce pain and would be risk-free for the newborn. The second class included 30.8% of women interested in water immersion but only during the labor phase. Finally, the third class (16.2%) did not want to consider water immersion during labor and birth, regardless of its risks and benefits. Follow-up questions revealed that many women were interested in water birth only if they could be assured that there would be no risk for the newborn. Discussion and conclusion This study provided insights in favor of water immersion during labor and birth contingent upon the safety of the procedure for the newborn.
... e baseline characteristics, namely, the author, year, median age, number of participants in the control and experiment group, of the 17 included studies are shown in Table 1 [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29]. ...
Article
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In many maternal settings, water delivery is widely available for women who do not have an increased risk of complications during childbirth. Soaking in water during labor has been associated with a number of maternal benefits. However, the situation of water birth is not well known, there is lack of hard evidence on safety, and little is known about the characteristics of women who give birth in water. In this paper, we have explored the effects of water delivery compared to the conventional delivery on the health of mothers and babies. For this purpose, clinical trials were conducted including women in labor, in which participants were treated with water labor or conventional labor, respectively, in the experimental and control group. In this analysis, we have selected 17 eligible studies which included 175654 participants. Compared to the conventional birth group, the risk of Apgar score <7 at 5 min of age in the water birth group dropped by 28% (OR = 0.72, 95% CI: 0.52–1.00, I2 = 25%, P = 0.05 ). Also, the duration of labor was shorter the in water birth group whatever the labor stage was. The patients who underwent water birth showed an obviously lower rate of neonatal intensive care unit (NICU) admission (OR = 0.58, 95% CI: 0.39–0.86, I2 = 53%, P = 0.007 ). In this meta-analysis, it was seen that water delivery has clinical significance in alleviating the pain of mothers, promoting the safety of mothers and infants, and reducing postpartum complications.
... 2,8 Safety or risk in association with labor in water translates into results equivalents in a different stage of labor; specifically, the results during the first stage of labor may not be the same as the results associated with underwater birth. 1,2,[8][9][10][11][12] Conditions vary between retrospective, observational, prospective, and randomized clinical trials. Retrospective studies, often reporting single-center data, cannot demonstrate causal relationships between observed outcomes and exposure to water labor. ...
Article
Background: Labor is a physiological process during which the fetus, the membranes, the umbilical cord and the placenta are expelled from the uterus and water delivery has become popular, although its prevalence is unknown, it is supported by healthy women with full-term pregnancies, without complications; although there is insufficient evidence to support or discourage it. Objective: To identify obstetric and neonatal outcomes and complications in women who delivered in water and to compare them with traditional deliveries. Material and methods: It is a retrospective, observational and cross-sectional study, where 2486 women were included from a database of 4223 women assisted from 2004 to 2020 in private hospitals; Of the 2486 patients included, 1025 had a water delivery and 1461 had a conventional delivery, discarding 1737 women who underwent caesarean section from the study. The information obtained from the patients, their data obtained for this study were kept in the anonymity of the patients, where they were analyzed: non-parametric data reported in percentages using Chi square; Parametric, perinatal and neonatal data are reported as mean plus standard deviation (±SD) and analyzed using Student's T, using the SPSS version 25 statistical package. Results: A total of 2486 women were included in this study, the birth in 1025 was water delivery (24%) and 1461 was conventional delivery (35%), 1737 caesarean section (41%) were excluded from the study, no difference was observed maternal age; unlike weight, height, body mass index; they were higher in women with water birth compared to conventional. No difference was demonstrated between nulliparous (45.99%) and multiparous (53.86%) when comparing both birth in water and conventional; only increase in previous caesarean sections (9.36 vs 6.5%, p=0.008) and decrease in previous abortions (16.19 vs 20.94%, p=0.002) in water delivery with the conventional one; complications were not different: administration of oxytocin (3.2 vs 3.1) or postpartum hemorrhage (0.29 vs 0.13) in both deliveries; no differences in first degree perineal tears (21.4 vs 18.5%). Conclusion: Water birth reduces stress, pain sensation, second and third degree perineal lacerations and contributes to better newborn outcomes; the selection and inclusion of patients with low-risk pregnancies allows better perinatal results than conventional delivery; but, further studies are required to use it routinely.
... After laboring for some 48 hours, a woman was helped into a warm bath in an effort to soothe her and provide temporary pain relief. Shortly after entering the bath the woman's stalled labor quickly progressed, and her baby was born before any effort could be made to remove her form the bath (Geissbuehler, Stein, & Eberhard, 2004;Pairman, 2015;Swain, 2013). Water birth was pioneered in the 1960s by the Russian researcher Igor Tjarkovsky. ...
Article
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Objective: Water birth, in which women experience part of their labor and delivery in a tub filled with warm water, is a non-invasive method of childbirth. It is also the most attention-grabbing among all delivery methods. This study aimed to identify the knowledge levels regarding giving birth in water among pregnant women, and to determine and increase their awareness on water birth. Material and Method: The sample of this cross-sectional study consisted of 1,000 pregnant women in varied phases of their pregnancy who were referred to the Polyclinics of Gynecology and Obstetrics of a university hospital and a state hospital in Eskisehir. Research data were collected using a questionnaire form which was developed through literature review. Data were analyzed using IBM SPSS (version 20.0) and Minitab (version 16.0) statistical software through descriptive statistics, the Chi-square test, the K-Means clustering analysis and the Roc analysis. P<0.05 was accepted as the significance level. Findings: The mean age of the pregnant women who participated in this study was 26.52±5.17. Of the pregnant women, 39.5% stated that they wanted to give birth in water. After the pregnant women watched the video on giving birth in water, it was determined that 63.1% of the women wanted to give birth in water. In the study, it was determined that 70.9% of the women had insufficient knowledge on water birth. Statistically significant correlations were found between the knowledge level of the pregnant women on water birth, and their age group, residence, education, employment status, family income, registered health institution, number of deliveries, level of education received on maternal health, and on water birth (for all: p<0.05). Conclusion: The research found that although pregnant women are aware of water birth, their information level is not sufficient.
Article
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Objectives: Water immersion during labour using a birth pool to achieve relaxation and pain relief during the first and possibly part of the second stage of labour is an increasingly popular care option in several countries. It is used particularly by healthy women who experience a straightforward pregnancy, labour spontaneously at term gestation and plan to give birth in a midwifery led care setting. More women are also choosing to give birth in water. There is debate about the safety of intrapartum water immersion, particularly waterbirth. We synthesised the evidence that compared the effect of water immersion during labour or waterbirth on intrapartum interventions and outcomes to standard care with no water immersion. A secondary objective was to synthesise data relating to clinical care practices and birth settings that women experience who immerse in water and women who do not. Design: Systematic review and meta-analysis. Data sources: A search was conducted using CINAHL, Medline, Embase, BioMed Central and PsycINFO during March 2020 and was replicated in May 2021. Eligibility criteria for selecting studies: Primary quantitative studies published in 2000 or later, examining maternal or neonatal interventions and outcomes using the birthing pool for labour and/or birth. Data extraction and synthesis: Full-text screening was undertaken independently against inclusion/exclusion criteria in two pairs. Risk of bias assessment included review of seven domains based on the Robbins-I Risk of Bias Tool. All outcomes were summarised using an OR and 95% CI. All calculations were conducted in Comprehensive Meta-Analysis V.3, using the inverse variance method. Results of individual studies were converted to log OR and SE for synthesis. Fixed effects models were used when I2 was less than 50%, otherwise random effects models were used. The fail-safe N estimates were calculated to determine the number of studies necessary to change the estimates. Begg's test and Egger's regression risk assessed risk of bias across studies. Trim-and-fill analysis was used to estimate the magnitude of effect of the bias. Meta-regression was completed when at least 10 studies provided data for an outcome. Results: We included 36 studies in the review, (N=157 546 participants). Thirty-one studies were conducted in an obstetric unit setting (n=70 393), four studies were conducted in midwife led settings (n=61 385) and one study was a mixed setting (OU and homebirth) (n=25 768). Midwife led settings included planned home and freestanding midwifery unit (k=1), alongside midwifery units (k=1), planned homebirth (k=1), a freestanding midwifery unit and an alongside midwifery unit (k=1) and an alongside midwifery unit (k=1). For water immersion, 25 studies involved women who planned to have/had a waterbirth (n=151 742), seven involved water immersion for labour only (1901), three studies reported on water immersion during labour and waterbirth (n=3688) and one study was unclear about the timing of water immersion (n=215).Water immersion significantly reduced use of epidural (k=7, n=10 993; OR 0.17 95% CI 0.05 to 0.56), injected opioids (k=8, n=27 391; OR 0.22 95% CI 0.13 to 0.38), episiotomy (k=15, n=36 558; OR 0.16; 95% CI 0.10 to 0.27), maternal pain (k=8, n=1200; OR 0.24 95% CI 0.12 to 0.51) and postpartum haemorrhage (k=15, n=63 891; OR 0.69 95% CI 0.51 to 0.95). There was an increase in maternal satisfaction (k=6, n=4144; OR 1.95 95% CI 1.28 to 2.96) and odds of an intact perineum (k=17, n=59 070; OR 1.48; 95% CI 1.21 to 1.79) with water immersion. Waterbirth was associated with increased odds of cord avulsion (OR 1.94 95% CI 1.30 to 2.88), although the absolute risk remained low (4.3 per 1000 vs 1.3 per 1000). There were no differences in any other identified neonatal outcomes. Conclusions: This review endorses previous reviews showing clear benefits resulting from intrapartum water immersion for healthy women and their newborns. While most included studies were conducted in obstetric units, to enable the identification of best practice regarding water immersion, future birthing pool research should integrate factors that are known to influence intrapartum interventions and outcomes. These include maternal parity, the care model, care practices and birth setting. Prospero registration number: CRD42019147001.
Article
Aim: Our aim was to compare the outcomes of waterbirths and conventional births in a Finnish hospital setting for the first time. Methods: This retrospective study compared waterbirths with conventional low-risk deliveries from September 2018 to March 2021 at a level-two hospital in Finland. Cases and controls were collected from the patient records database. Results: The study comprised 78 waterbirths and 1,623 matched conventional births. Mothers in the waterbirth group only required a quarter of the amount of pain medication required by those in the control group. Babies born in water had slightly lower birth temperatures than those born conventionally (36.6°C versus 36.8°C). Umbilical cord artery and vein pH were slightly higher in the waterbirth group than in the control group: artery 7.31 versus 7.28 and vein 7.38 versus 7.35). The Apgar scores did not differ. Hospital stays were shorter in the waterbirth group than in the conventional birth group (1.90 days versus 2.33 days). Babies in the waterbirth group were significantly less likely to require formula than those in the conventional birth group during their hospital stay. Conclusion: Waterbirth decreased the requirement for maternal pain medication and favoured greater breastfeeding and earlier discharge. Prospective studies must confirm these findings.
Article
Background: Labor is a physiological process during which the fetus, the membranes, the umbilical cord, and the placenta are expelled from the uterus and water delivery has become popular, although its prevalence is unknown, it is supported by healthy women with full-term pregnancies, without complications; although there is insufficient evidence to support or discourage it. Objective : To identify obstetric and neonatal outcomes and complications in women who delivered in water and to compare them with traditional deliveries. Material and methods: It is a retrospective, observational and cross-sectional study, where 2486 women were included from a database of 4223 women assisted from 2004 to 2020 in private hospitals; Of the 2486 patients included, 1025 had a water delivery and 1461 had a conventional delivery, discarding 1737 women who underwent caesarean section from the study. The information obtained from the patients, their data obtained for this study were kept in the anonymity of the patients, where they were analyzed: non-parametric data reported in percentages using Chi-square ; Parametric, perinatal and neonatal data are reported as mean plus Standard Deviation (± SD) and analyzed using Student’s T, using the SPSS version 25 statistical package. Results: A total of 2486 women were included in this study, the birth in 1025 was water delivery (24%) and 1461 was conventional delivery (35%), 1737 caesarean section (41%) were excluded from the study, no difference was observed maternal age; unlike weight, height, body mass index; they were higher in women with water birth compared to conventional. No difference was demonstrated between nulliparous (45.99%) and multiparous (53.86%) when comparing both births in water and conventional; only increase in previous cesarean sections (9.36 vs 6.5%, p = 0.008) and decrease in previous abortions (16.19 vs 20.94%, p = 0.002) in water delivery with the conventional one; complications were not different: administration of oxytocin (3.2 vs 3.1) or postpartum hemorrhage (0.29 vs 0.13) in both deliveries; no differences in first degree perineal tears (21.4 vs 18.5%); Only for the second and third-degree was it greater in conventional delivery than in water delivery (6.6 vs 11.4%, p = 0.00), (0 vs 2.8%) respectively, only 1.9% of deliveries in water that required epidural block ended in delivery conventional. Conclusion : Water birth reduces stress, pain sensation, second and third-degree perineal lacerations and contributes to better newborn outcomes; the selection and inclusion of patients with low-risk pregnancies allow better perinatal results than conventional delivery; but, further studies are required to use it routinely.
Article
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This paper discusses the water birth experiences of women who delivered at The Family Birthing Center of Upland, California, from February, 1985 to June 1, 1989. Of the 831 who used warm water immersion during their labor, 483 gave birth in the water with good Apgar scores; and there was only one minor maternal infection. These results clearly suggest that water birth--with certain precautions--is not only a desirable alternative for many women, but also a safe and positive intrapartum intervention.
Article
The media have recently questioned the safety of waterbirths; many of the criticisms appear unfounded. More research is needed, but all midwives should be familiar with the protocols involved with this practice.
Article
Background: Waterbirths were introduced in 1991 as part of a new birth concept which consisted of careful monitoring and birth management, restrictive use of invasive methods and free choice of different birth methods. Methods: After the introduction of this new birth concept a prospective observational study was initiated. All parturients of the region give birth in our clinic without preselection, ours being the only birth clinic of the region. 2% of the parturients will be referred to a larger birth clinic (university clinic) mainly because of preterm births before the end of the 33rd week of pregnancy. Every one of the 7,508 births between November 1991, and May 21, 1997, was analyzed. In this article the birth parameters of mother and child in the most often chosen spontaneous birth methods will be compared to assess the safety of alternative birth methods in general and of waterbirths in particular. 2,014 of these 5,953 spontaneous births were waterbirths, 1,108 were Maia-birthing stool births and 2,362 bedbirths (vacuum extractions not included). Results: The parity and age of the mother as well as the newborn’s birth weight are comparable in all 3 groups: waterbirth, Maia-birthing stool, and bedbirths. An episiotomy was performed in only 12.8% of the births in water, in 27.7% of the births on the Maia-birthing stool and in 35.4% of the bedbirths. These differences are statistically significant. In spite of the highest episiotomy rates, the bedbirths also show the highest 3rd- and 4th-degree laceration rates (4.1%), thus the difference between the rates for bedbirths and alternative births methods for severe lacerations is significant. The mothers’ blood loss is the lowest in waterbirths. Fewer painkillers are used in waterbirths and the experience of birth itself is more satisfying after a birth in water. The average arterial blood pH of the umbilical cord as well as the Apgar scoring at 5 and 10 min are significantly higher after waterbirths. Infections of the neonate do not occur more often after waterbirths. No case of water aspiration or any other perinatal complication of the mother or child which might be water-related was reported. Conclusion: Waterbirths and other alternative forms of birthing such as Maia-birthing stool do not demonstrate higher birth risks for the mother or the child than bedbirths if the same medical criteria are used in the monitoring as well as in the management of birth.
Article
Full textFull text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (303K), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References. 390 Selected References These references are in PubMed. This may not be the complete list of references from this article. Alderdice F, Renfrew M, Marchant S, Ashurst H, Hughes P, Berridge G, Garcia J. Labour and birth in water in England and Wales. BMJ. 1995 Apr 1;310(6983):837–837. [PMC free article] [PubMed]
Article
Objective: To determine risk factors for third degree obstetric perineal tears and to give recommendations for prevention. Design: Retrospective case control study. Setting: A teaching hospital in The Netherlands. Participants and methods: One hundred and twenty cases of vaginal delivery complicated by third degree perineal tear and 702 uncomplicated vaginal deliveries were compared, with respect to possible risk factors. Results: In a multivariate model high birthweight, forceps delivery, induced labour, epidural anaesthesia and parity were risk factors for anal sphincter tear. In addition, mediolateral episiotomy was associated with fewer sphincter injuries. Separate analysis of nulli- and multiparous women demonstrated that high birthweight and epidural anaesthesia (increased risk) and mediolateral episiotomy (decreased risk) were factors associated with anal sphincter tear only in nulliparous women. Conclusions: We found several risk factors for anal sphincter tear. Nulliparous women are at higher risk than multiparous women. Mediolateral episiotomy may be sphincter-saving especially in nulliparous women and therefore prevent them from chronic faecal incontinence.
Article
Episiotomy, one of the most common surgical procedures, was introduced in clinical practice in the eighteenth century without having strong scientific evidence of its benefits. Its use was justified by the prevention of severe perineal tears, better future sexual function, and a reduction of urine and fecal incontinence. With regard to the first assumption, the evidence that is based on five randomized controlled trials shows a 9% reduction in severe perineal tears in the selective use of episiotomy, but this effect fluctuates between a 40% reduction and a 38% increase. In relation to long-term effects, women in whom management includes routine use of episiotomy have shown poorer future sexual function, similar pelvic floor muscle strength, and similar urinary incontinence in comparison with women in whom episiotomy is used in a selective manner. In summary, there is no reliable evidence that routine use of episiotomy has any beneficial effect; on the contrary, there is clear evidence that it may cause harm such as a greater need for surgical repair and a poorer future sexual capability. In view of the available evidence the routine use of episiotomy should be abandoned and episiotomy rates >30% do not seem justified. (AM J OBSTET GYNECOL 1996;174:1399-402.)
Article
This paper underscores the serious problems facing institutionalized obstetrics in the United States (demonstrated by alarming cesarean rates) and provides information about a new, safe, gentle birth alternative that uses water during labor and delivery. Pioneered by doctors, nurses, and midwives to lower cesarean rates and increase possibilities for natural childbirth, water birth assists the mother in achieving deep relaxation during labor and thereby alleviates much of the pain and stress of birth for both mother and baby. Water birth may be a safe, helpful, and easy to implement method of improving obstetrical statistics in the U.S. and should be investigated by those health care providers concerned with promoting humanistic childbirth practices.