Water Birth, More Than a Trendy Alternative: A Prospective, Observational Study

Abstract

Water birth has become increasingly popular, particularly in German-speaking countries. The relevant literature provides some basis for thinking that the overall outcome may be comparable to—or even superior to—that of traditional methods. However, few prospective observational studies have been done. The present study was planned to prospectively study the effects of water birth on maternal and fetal outcomes in low-risk parturients seen at a tertiary obstetrical unit. A total of 513 women who requested a water birth in the years 1998–2002 were eligible for the study. All of them had a singleton pregnancy after 37 weeks' gestation with a cephalic presentation and a normal fetal cardiotocogram. The study group included 89 women (17% of the total) who delivered in water. Serving as controls were 133 women who had a normal vaginal delivery following temporary immersion; 146 who delivered without any immersion; and 145 who had either cesarean section or a forceps- or vacuum-assisted vaginal delivery. These groups were comparable in most demographic and obstetrical respects. After being offered an enema, the woman was permitted to enter the tub at any time, but preferably when the cervix was about 5 cm dilated. Soaps and other bath products were not recommended. The fetal heart rate was continuously monitored. Oxytocin was infused as needed if cervical dilation failed or, alternately, membrane rupture was initiated. Patients' wishes for pain relief were fully respected, but immersion ceased if an epidural block was needed. A midwife brought the infant to the surface within seconds of birth and then clamped and cut the umbilical cord. Significantly fewer women in the study group than in the temporary immersion and operative delivery control groups required additional analgesia. The first stage of labor lasted significantly longer in control cases than in women having water delivery. Women in all the control groups had a significantly prolonged second stage of labor. More pathological cardiotocograms were recorded in all control groups during the second stage of labor. More control women received IV oxytocin and uterine relaxants. Significantly more episiotomies were made in all control groups than in the study group, but there were more first- and second-degree perineal lacerations in the water group. None of the study patients had a third-degree laceration. Mean birth weights were similar in all groups, but infants whose mothers had operative delivery had low 1-minute APGAR scores. The operative delivery group had lower arterial pH values, and all control groups had significantly lower venous pH measurements. There were no group differences in rates of admission to neonatal intensive care. No significant group differences were found in hemoglobin or hematocrit values as estimated in the third trimester and during the first stage of labor. There were no cases of postpartum infection that could be ascribed to water delivery. When limited to low-risk parturients, water delivery appears to be safe and not associated with adverse fetal or maternal outcomes. Continuous intrapartum observation and fetal monitoring are essential, and more studies are needed to confirm the safety of this practice.