Water births safe for mother, neonate in first, second stages of labor

Current available research on immersion in water during labor does not suggest any additional adverse events to the mother or neonate during the first or second stage of labor, according to findings from a Cochrane review.

“Many women choose to labor and give birth in water — or water immersion — and this practice is becoming more popular in many countries, particularly in midwifery-led units,” Elizabeth R. Cluett, PhD, MSc, RM, RGN, PHCEA, lead midwife for education and senior lecturer atthe faculty of health sciences at the University of Southampton, England, and colleagues wrote. “Therefore, it is important to understand more about the benefits of water immersion in labor and birth for women and their newborns, along with any risks.”

To assess maternal and infant benefits and the risks associated with water immersion in various stages of labor, the researchers examined data from 15 trials. These trials included 3,663 women. No trial included in the analysis tested different forms of baths or pools or examined the effects of water immersion in the third stage of labor. All deliveries occurred in a hospital labor ward and included the use of a wide range of medical interventions deemed necessary to maintain routine practice.

Cluett and colleagues wrote that the although water immersion may result in less use of regional analgesia in the first stage of labor, little to no difference was observed in the number of spontaneous vaginal births between women who were immersed and those who were not (82% vs. 83%; RR = 1.01; 95% CI, 0.97-1.04), instrumental vaginal birth (14% vs. 12%; RR = 0.86; 95% CI, 0.70-1.05) and caesarean sections (4% vs. 5%; RR = 1.27; 95% CI, 0.91-1.79).

Perinatal mortalities were not reported for the first stage of labor. The researchers said there was inadequate evidence to determine the impact of water immersion on NICU admissions (6% vs. 8%; average RR = 1.30; 95% CI, 0.42-3.97) or the rate of neonatal infection (1% vs. 1%; RR = 2.00; 95% CI, 0.50-7.94).

Comparable results were observed during the second stage of labor, in which Cluett and colleagues observed no obvious differences between those immersed in water and those not immersed for spontaneous vaginal birth (97% vs. 99%; RR = 1.02; 95% CI, 0.96-1.08), instrumental vaginal birth (2% vs. 2%; RR = 1.00; 95% CI, 0.06-15.62), caesarean section (2% vs. 1%; RR = 0.33; 95% CI, 0.01-8.02). Additionally, no significant difference in NICU admissions were observed when mothers were immersed in water during the second stage of labor (11% vs. 9%; RR = 0.78; 95% CI, 0.38-1.59).

Although neonatal infection rates were not reported in any of the trials, findings did show neonatal temperatures lower than 36.2°C at birth (9% vs. 9%; RR = 0.98; 95% CI, 0.30-3.20), higher than 37.5°C at birth (6% vs. 15%; RR = 2.62; 95% CI, 0.73-9.35) and fever within 1 week of birth (5% vs. 2%; RR = 0.53; 95% CI, 0.10-2.82).

However, previous findings suggest two Arizona newborns delivered during water births contracted Legionnaires’ disease, revealing gaps in infection prevention using this method of delivery.

In the review, one perinatal death following immersion was reported in one trial (RR = 3.00; 95% CI, 0.12-72.20). The infant was born to a mother infected with HIV, and the neonate’s cause of death was determined to be intrauterine infection.

“Evidence suggests that women who are at low risk of complications who use water immersion during labor are probably no more or less likely to experience vaginal delivery and may be less likely to have to use regional analgesia, particularly when immersion occurs during the first stage of labor,” Cluett and colleagues wrote. “There is no evidence of increased adverse effects to the neonate in terms of admissions to NICUs and infection rates.” – by Katherine Bortz

References:

Cluett ER, et al. Cochrane Database Syst Rev. 2018;doi: 10.1002/14651858.CD000111.pub4.

ADHS. Guidelines for water immersion and water births. 2016. http://www.azdhs.gov/documents/licensing/special/midwives/training/guidelines-for-water-immersion-water-birth.pdf. Accessed June 25, 2018.

ADHS. Legionnaires’ disease: a water birth concern. 2016. http://www.azdhs.gov/documents/licensing/special/midwives/training/legionella-infographic.pdf. Accessed June 25, 2018.

Granseth G, et al. MMWR Morb Mortal Wkly Rep. 2017;doi:10.15585/mmwr.mm6622a4.

Disclosures: The authors report no relevant financial disclosures.