Immersion in water in labour and birth
Cluett ER, Burns E
Summary
Immersion in water in labour and birth
Immersion in water during the first stage of labour significantly reduces women's perception of pain and use of epidural/spinal analgesia.
Eleven trials were of an adequate quality to include in this review. Of these, six reported that water immersion during the first stage of labour significantly reduced epidural/spinal analgesia requirements, without adversely affecting labour duration, operative delivery rates, or neonatal wellbeing. One study showed that immersion in water during the second stage of labour increased women's reported satisfaction with pushing. Further research is needed to assess the effect of immersion in water on neonatal and maternal morbidity. No trials could be located that assessed the immersion of women in water during the third stage of labour, or evaluating different types of pool/bath.
This is a Cochrane review
abstract and plain language summary, prepared and maintained by The
Cochrane Collaboration,
currently published in The Cochrane Database
of
Systematic Reviews 2010 Issue 2, Copyright © 2010 The Cochrane
Collaboration. Published by John Wiley and Sons, Ltd.. The full
text of
the review is available in The Cochrane
Library (ISSN 1464-780X).
This record should be cited as:
Cluett ER, Burns E. Immersion in water in labour and birth. Cochrane
Database of Systematic Reviews 2009, Issue 2. Art. No.:
CD000111.
DOI: 10.1002/14651858.CD000111.pub3.
This version first published online:
July 21. 1997
Last assessed as up-to-date:
November 20. 2008
Abstract
Background
Enthusiasts suggest that labouring in water and waterbirth increase maternal relaxation, reduce analgesia requirements and promote a midwifery model of care. Sceptics cite the possibility of neonatal water inhalation and maternal/neonatal infection.
Objectives
To assess the evidence from randomised controlled trials about immersion in water during labour and waterbirth on maternal, fetal, neonatal and caregiver outcomes.
Search strategy
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (October 2008).
Selection criteria
Randomised controlled trials comparing any bath tub/pool with no immersion during labour and/or birth.
Data collection and analysis
We assessed trial eligibility and quality and extracted data independently. One review author entered data and another checked for accuracy.
Main results
This review includes 11 trials (3146 women); eight related to the first stage of labour, one to the first and second stages, one to early versus late immersion in the first stage of labour, and another to the second stage. We identified no trials evaluating different baths/pools, or the management of third stage of labour.
Results for the first stage of labour showed there was a significant reduction in the epidural/spinal/paracervical analgesia/anaesthesia rate amongst women allocated to water immersion compared to controls (478/1254 versus 529/1245; odds ratio (OR) 0.82, 95% confidence interval (CI) 0.70 to 0.98, six trials). There was no difference in assisted vaginal deliveries (OR 0.84, 95% CI 0.66 to 1.06, seven trials), caesarean sections (OR 1.23, 95% CI 0.86 to 1.75, eight trials), perineal trauma or maternal infection. There were no differences for Apgar score less than seven at five minutes (OR 1.59, 95% CI 0.63 to 4.01, five trials), neonatal unit admissions (OR 1.06, 95% CI 0.70 to 1.62, three trials), or neonatal infection rates (OR 2.01, 95% CI 0.50 to 8.07, five trials).
A lack of data for some comparisons prevented robust conclusions. Further research is needed.
Authors' conclusions
Evidence suggests that water immersion during the first stage of labour reduces the use of epidural/spinal analgesia. There is limited information for other outcomes related to water use during the first and second stages of labour, due to intervention and outcome variability. There is no evidence of increased adverse effects to the fetus/neonate or woman from labouring in water or waterbirth. The fact that use of water immersion in labour and birth is now a widely available care option for women threatens the feasibility of a large, multicentre randomised controlled trial.Fetal Diagn Ther. 2000 Sep-Oct;15(5):291-300.
Waterbirths: a comparative study. A prospective study on more than 2,000 waterbirths.
Clinic for Obstetrics and Gynecology, Thurgauisches Kantonsspital, Frauenfeld, Switzerland. vgeissbuehler@bluewin.ch
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. Copyright 2000 S. Karger AG, Basel.
PMID: 10971083 [PubMed - indexed for MEDLINE]
Aust N Z J Obstet Gynaecol. 1997 May;37(2):137-42.
Effects of intrapartum hydrotherapy on labour related parameters.
Aird IA, Luckas MJ, Buckett WM, Bousfield P.
Department of Obstetrics and Gynaecology, University of Liverpool, United Kingdom.
The use of birthing pools during labour is increasing in the United Kingdom. This is without good scientific evidence of their efficacy or safety. To further investigate the value and safety of intrapartum hydrotherapy, an historical cohort study was performed in a District General Hospital in Liverpool. The study group consisted of 100 women of low obstetric risk who used the birthing pool at some stage during their labours and the control group consisted of 100 women who were matched in terms of age, parity and obstetric history but laboured and delivered in air. The main outcome measures were operative delivery rates, duration of labour, analgesic requirements, perineal trauma and Apgar scores at 1 and 5 minutes. The results showed that nulliparas who used the birthing pool had significantly reduced operative delivery rates, a shorter second stage of labour, reduced analgesic requirements and a lower incidence of perineal trauma. In multiparas there were significant reductions in analgesic requirements.
PMID: 9222454 [PubMed - indexed for MEDLINE]