Prospective cohort study of water immersion for labour and birth compared with standard care in an Irish maternity setting

• Published in: BMJ open Vol. 10; no. 12; p. e038080
• Main Authors: Barry, Paula L, McMahon, Lean E, Banks, Ruth AM, Fergus, Ann M, Murphy, Deirdre J
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 04-12-2020; BMJ Publishing Group
• Series: Original research
• Subjects: Adult; Births; Childbirth & labor; Cohort analysis; Epidemiology; Female; Humans; Immersion; Ireland; Midwifery; Obstetrics; Obstetrics and Gynaecology; Physiology; Pregnancy; Prospective Studies; Reference Standards; Regression analysis; Water; Womens health; Ireland; perinatology; obstetrics; epidemiology
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2020-038080

ObjectiveTo examine the birth outcomes for women and babies following water immersion for labour only, or for labour and birth.DesignProspective cohort study.SettingMaternity hospital, Ireland, 2016–2019.ParticipantsA cohort of 190 low-risk women who used water immersion; 100 gave birth in water and 90 laboured only in water. A control group of 190 low-risk women who received standard care.MethodsLogistic regression analyses examined associations between water immersion and birth outcomes adjusting for confounders. A validated Childbirth Experience Questionnaire was completed.Main outcome measuresPerineal tears, obstetric anal sphincter injuries (OASI), postpartum haemorrhage (PPH), neonatal unit admissions (NNU), breastfeeding and birth experiences.ResultsCompared with standard care, women who chose water immersion had no significant difference in perineal tears (71.4% vs 71.4%, adj OR 0.83; 95% CI 0.49 to 1.39) or in OASI (3.3% vs 3.8%, adj OR 0.91; 0.26–2.97). Women who chose water immersion were more likely to have a PPH ≥500 mL (10.5% vs 3.7%, adj OR 2.60; 95% CI 1.03 to 6.57), and to exclusively breastfeed at discharge (71.1% vs 45.8%, adj OR 2.59; 95% CI 1.66 to 4.05). There was no significant difference in NNU admissions (3.7% vs 3.2%, adj OR 1.06; 95% CI 0.33 to 3.42). Women who gave birth in water were no more likely than women who used water for labour only to require perineal suturing (64% vs 80.5%, adj OR 0.63; 95% CI 0.30 to 1.33), to experience OASI (3.0% vs 3.7%, adj OR 1.41; 95% CI 0.23 to 8.79) or PPH (8.0% vs 13.3%, adj OR 0.73; 95% CI 0.26 to 2.09). Women using water immersion reported more positive memories than women receiving standard care (p<0.01).ConclusionsWomen choosing water immersion for labour or birth were no more likely to experience adverse birth outcomes than women receiving standard care and rated their birth experiences more highly.