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Gregolis TBL, Santos SDS, Silva IFD, Bessa ARDS. Influence of non-pharmacological methods on duration of labor: a systematic review. CIENCIA & SAUDE COLETIVA 2024; 29:e19032022. [PMID: 38896686 DOI: 10.1590/1413-81232024296.19032022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 08/04/2023] [Indexed: 06/21/2024] Open
Abstract
The article aims to verify the influence of MNFs on the duration of the birth process. A systematic review was carried out in the MEDLINE, Web of Science and LILACS databases, through a combination of terms that cover the topic addressed, from 1996 to 2021/April. The Excel spreadsheet was used to collect data to extract information regarding each selected article, in turn, data analysis included the evaluation and classification of quality, reliability and risk of bias, thus, the following tools were used: Cochrane RoB 2, Checklist and Newcastle-Ottawa Scale. Warm bath, walking, exercises with a birthing ball, breathing techniques, supine position, acupuncture, acupressure and water birth reduced labor time. While spontaneous pushing, massage and immersion baths prolonged labor. Non-pharmacological methods capable of reducing the duration of labor were hot/warm shower, walking, birth ball exercises, breathing techniques, maternal mobility, dorsal position, acupuncture, acupressure and water birth, as well. associated applied techniques such as hot/warm bath, ball exercises and lumbosacral massage, as well as immersion bath, ball exercises, aromatherapy, vertical postures and maternal mobility with alternating vertical postures, shortened the birth time.
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Affiliation(s)
- Thais Blaya Leite Gregolis
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Acre. Distrito Industrial, Rio Branco-Ac. 69920-900 Rio Branco AC Brasil.
| | - Sabrina da Silva Santos
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Acre. Distrito Industrial, Rio Branco-Ac. 69920-900 Rio Branco AC Brasil.
- Departamento de Epidemiologia e Métodos Quantitativos em Saúde, Escola Nacional de Saúde Pública Segio Arouca, Fundação Oswaldo Cruz. Rio de Janeiro RJ Brasil
| | - Ilce Ferreira da Silva
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Acre. Distrito Industrial, Rio Branco-Ac. 69920-900 Rio Branco AC Brasil.
- Departamento de Epidemiologia e Métodos Quantitativos em Saúde, Escola Nacional de Saúde Pública Segio Arouca, Fundação Oswaldo Cruz. Rio de Janeiro RJ Brasil
| | - Andréa Ramos da Silva Bessa
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Acre. Distrito Industrial, Rio Branco-Ac. 69920-900 Rio Branco AC Brasil.
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Halfdansdottir B, Ellinger-Kaya K, Fjøsne K, Lindgren H, Hegaard HK, Blix E. The association between waterbirth and perineal injury or other adverse outcomes among low-risk women with physiological birth: Results from the Nordic Home Birth Cohort Study. Women Birth 2024; 37:101625. [PMID: 38754250 DOI: 10.1016/j.wombi.2024.101625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/05/2024] [Accepted: 05/04/2024] [Indexed: 05/18/2024]
Abstract
PROBLEM/BACKGROUND Immersion in water has known benefits, such as reducing pain and shortening the duration of labour. The relationship between waterbirth and perineal injury remains unclear. AIM To compare the incidence of perineal injury in waterbirth and birth on land among low-risk women. Secondary outcomes were postpartum haemorrhage and 5-minute Apgar scores <7. METHODS Prospective cohort study of 2875 low-risk women who planned a home birth in Denmark, Iceland, Norway, and Sweden in 2008-2013 and had a spontaneous vaginal birth without intervention. Descriptive statistics and logistic regression were performed. FINDINGS A total of 942 women had a waterbirth, and 1933 gave birth on land. The groups differed in their various background variables. Multiparous women had moderately lower rates of intact perineum (59.3% vs. 63.9%) and primiparous women had lower rates of episiotomies (1.1% vs. 4.8%) in waterbirth than in birth on land. No statistically significant differences were detected in adjusted regression analysis on intact perineum in waterbirth (primiparous women's aOR = 1.03, CI 0.68-1.58; multiparous women's aOR = 0.84, CI 0.67-1.05). The rates of sphincter injuries (0.9% vs. 0.6%) were low in both groups. No significant differences were detected in secondary outcomes. DISCUSSION The decreased incidence of intact perineum among multiparous women was modest and inconclusive, and the prevalence of sphincter injury was low. CONCLUSION Low-risk women contemplating waterbirth should be advised to weigh the risks and benefits detected in this study against previously established benefits of waterbirth and should make an informed choice based on their values.
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Affiliation(s)
- Berglind Halfdansdottir
- University of Iceland, Faculty of Nursing and Midwifery, School of Health Sciences, Eirberg, Eiriksgata 34, 101 Reykjavik, Iceland.
| | - Karianne Ellinger-Kaya
- Oslo University Hospital, Division of Obstetrics and Gynaecology, P.O. box 4950, Nydalen, 0424 Oslo, Norway
| | - Kathrine Fjøsne
- Oslo University Hospital, Division of Obstetrics and Gynaecology, P.O. box 4950, Nydalen, 0424 Oslo, Norway
| | - Helena Lindgren
- Karolinska Institutet, Department of Women's and Children's Health, 17177 Stockholm, Sweden; Sophiahemmet University, Department of Health Promotion Science, P O Box 5605, SE-114 86 Stockholm, Sweden
| | - Hanne K Hegaard
- Copenhagen University Hospital - Rigshospitalet, Department of Obstetrics, Section 3021, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Ellen Blix
- Oslo Metropolitan University, Research group Midwifery Science, School of Nursing and Health Promotion, Faculty of Health Sciences, P.O. box 4, St Olavs plass, 0130 Oslo, Norway
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Uccella S, Manzoni P, Militello MA, Bosco M, Porcari I, Lanzo G, Maraucci F, Violino C, Lo Cicero T, Biancotto G, Carlo Zorzato P, Franchi MP, Garzon S. Neonatal Outcomes of Water Delivery versus Land Delivery: A Retrospective Propensity Score Weighted Study. Am J Perinatol 2024; 41:e1775-e1782. [PMID: 37207659 DOI: 10.1055/s-0043-1768961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
OBJECTIVE Recent evidence has shown that water delivery is safe for the mother, but high-quality evidence is not available for the newborn. Therefore, obstetric guidelines do not support it. This retrospective study aimed to contribute to the available evidence on maternal and neonatal outcomes associated with water delivery. STUDY DESIGN Retrospective cohort study from prospectively collected birth registry data from 2015 to 2019. A total of 144 consecutive water deliveries and 265 land deliveries eligible for waterbirth were identified. The inverse probability of treatment weighting (IPTW) method was applied to address for confounders. RESULTS We identified 144 women who delivered in water (water group) and 265 women who delivered on land (land group). One (0.7%) neonatal death was observed in the water delivery group. After IPTW adjustment, water delivery was significantly associated with a higher risk of maternal fever in puerperium (odds ratio [OR]: 4.98; 95% confidence interval [CI]: 1.86-17.02; p = 0.004), of neonatal cord avulsion (OR: 20.73; 95% CI: 2.63-2,674; p = 0.001), and of positive neonatal C-reactive protein (CRP > 5 mg/L; OR: 2.59; 95% CI: 1.05-7.24; p = 0.039); delivering in water was associated with lower maternal blood loss (mean difference: 110.40 mL; 95% CI: 191.01-29.78; p = 0.007), a lower risk of major (≥1,000 mL) postpartum hemorrhage (OR: 0.96; 95% CI: 0.92-0.99; p = 0.016), lower risk of manual placenta delivery (OR: 0.18; 95% CI: 0.03-0.67; p = 0.008) and curettage (OR: 0.24; 95% CI: 0.08-0.60; p = 0.002), lower use of episiotomy (OR: 0.02; 95% CI: 0-0.12; p < 0.001), and lower risk of neonatal ward admission (OR: 0.35; 95% CI: 0.25-0.48; p < 0.001). CONCLUSION The present study showed that differences are present between water and land delivery, and among them is the risk of cord avulsion, a severe and potentially fatal event. In women choosing to deliver in water, a trained staffmust be present and immediate recognition of cord avulsion is key for a prompt management to avoid possible serious complications. KEY POINTS · High-quality evidence is not available for neonatal safety of waterbirth; therefore, retrospective studies still represent the main body of evidence.. · Differences are present between water and land delivery, and among them, the increased risk of cord avulsion is a potentially fatal event.. · A trained staff must assist women who chose to deliver in water and cord avulsion must be promptly recognized and managed to avoid severe neonatal complications..
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Affiliation(s)
- Stefano Uccella
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
| | - Paolo Manzoni
- Department of Maternal, Neonatal and Infant Medicine, Azienda Sanitaria Locale Biella, Biella, Italy
| | - Maria A Militello
- Department of Maternal, Neonatal and Infant Medicine, Azienda Sanitaria Locale Biella, Biella, Italy
| | - Mariachiara Bosco
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
| | - Irene Porcari
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
| | - Gabriele Lanzo
- Division of Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science, University of Turin, Turin, Italy
| | - Francesca Maraucci
- Department of Maternal, Neonatal and Infant Medicine, Azienda Sanitaria Locale Biella, Biella, Italy
| | - Chiara Violino
- Department of Maternal, Neonatal and Infant Medicine, Azienda Sanitaria Locale Biella, Biella, Italy
| | - Tiziana Lo Cicero
- Department of Maternal, Neonatal and Infant Medicine, Azienda Sanitaria Locale Biella, Biella, Italy
| | - Giulia Biancotto
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
| | - Pier Carlo Zorzato
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
| | - Massimo P Franchi
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
| | - Simone Garzon
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
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McKinney JA, Vilchez G, Jowers A, Atchoo A, Lin L, Kaunitz AM, Lewis KE, Sanchez-Ramos L. Water birth: a systematic review and meta-analysis of maternal and neonatal outcomes. Am J Obstet Gynecol 2024; 230:S961-S979.e33. [PMID: 38462266 DOI: 10.1016/j.ajog.2023.08.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 03/12/2024]
Abstract
OBJECTIVE This systematic review and meta-analysis aimed to conduct a thorough and contemporary assessment of maternal and neonatal outcomes associated with water birth in comparison with land-based birth. DATA SOURCES We conducted a comprehensive search of PubMed, EMBASE, CINAHL, and gray literature sources, from inception to February 28, 2023. STUDY ELIGIBILITY CRITERIA We included randomized and nonrandomized studies that assessed maternal and neonatal outcomes in patients who delivered either conventionally or while submerged in water. METHODS Pooled unadjusted odds ratios with 95% confidence intervals were calculated using a random-effects model (restricted maximum likelihood method). We assessed the 95% prediction intervals to estimate the likely range of future study results. To evaluate the robustness of the results, we calculated fragility indices. Maternal infection was designated as the primary outcome, whereas postpartum hemorrhage, perineal lacerations, obstetrical anal sphincter injury, umbilical cord avulsion, low Apgar scores, neonatal aspiration requiring resuscitation, neonatal infection, neonatal mortality within 30 days of birth, and neonatal intensive care unit admission were considered secondary outcomes. RESULTS Of the 20,642 articles identified, 52 were included in the meta-analyses. Based on data from observational studies, water birth was not associated with increased probability of maternal infection compared with land birth (10 articles, 113,395 pregnancies; odds ratio, 0.93; 95% confidence interval, 0.76-1.14). Patients undergoing water birth had decreased odds of postpartum hemorrhage (21 articles, 149,732 pregnancies; odds ratio, 0.80; 95% confidence interval, 0.68-0.94). Neonates delivered while submerged in water had increased odds of cord avulsion (10 articles, 91,504 pregnancies; odds ratio, 1.75; 95% confidence interval, 1.38-2.24) and decreased odds of low Apgar scores (21 articles, 165,917 pregnancies; odds ratio, 0.69; 95% confidence interval, 0.58-0.82), neonatal infection (15 articles, 53,635 pregnancies; odds ratio, 0.64; 95% confidence interval, 0.42-0.97), neonatal aspiration requiring resuscitation (19 articles, 181,001 pregnancies; odds ratio, 0.60; 95% confidence interval, 0.43-0.84), and neonatal intensive care unit admission (30 articles, 287,698 pregnancies; odds ratio, 0.56; 95% confidence interval, 0.45-0.70). CONCLUSION When compared with land birth, water birth does not appear to increase the risk of most maternal and neonatal complications. Like any other delivery method, water birth has its unique considerations and potential risks, which health care providers and expectant parents should evaluate thoroughly. However, with proper precautions in place, water birth can be a reasonable choice for mothers and newborns, in facilities equipped to conduct water births safely.
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Affiliation(s)
- Jordan A McKinney
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Jacksonville, FL.
| | - Gustavo Vilchez
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Missouri-Kansas City, Kansas City, MO
| | - Alicia Jowers
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Jacksonville, FL
| | - Amanda Atchoo
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Jacksonville, FL
| | - Lifeng Lin
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, AZ
| | - Andrew M Kaunitz
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Jacksonville, FL
| | - Kendall E Lewis
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Jacksonville, FL
| | - Luis Sanchez-Ramos
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Florida College of Medicine, Jacksonville, FL
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Cooper M, Briley A. Sense of coherence as facilitated by water immersion during labour and birth: A concept analysis and synthesis. Midwifery 2023; 126:103824. [PMID: 37714044 DOI: 10.1016/j.midw.2023.103824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 07/22/2023] [Accepted: 09/07/2023] [Indexed: 09/17/2023]
Abstract
OBJECTIVE To explore the concept of sense of coherence as facilitated by water immersion during labour and/or birth. DESIGN A concept analysis and synthesis. A literature search of CINAHL, Medline, PubMed, PsycINFO and Emcare was undertaken in February 2022. Results were cross-checked with Google Scholar. No timeframe was specified, and results were restricted to research papers written in English. Overall, 2768 papers were retrieved and after removal of duplicates and unrelated papers, abstracts were screened to ensure the paper met the inclusion criteria i.e. women's experiences of water immersion for labour and/or birth. This process yielded a total of 37 articles and two theses, these were used for the concept analysis. Attributes were described and an exemplar case developed after mapping and charting of the data set. FINDINGS Three attributes were identified; agency, holistic and complete and more than pain relief which align with the three sense of coherence components: comprehensible, meaningfulness and manageability. KEY CONCLUSION There is a growing evidence base regarding the use of intrapartum water immersion. The literature exploring women's experiences and views of water immersion, appears to consistently report that women experience physiological, physical and psychological benefits and that these benefits complement each other to facilitate greater self-efficacy and a more holistic experience. This combination of benefits afforded by water immersion facilitates a sense of coherence and subsequently, increases the likelihood of the woman experiencing labour and birth as both positive and satisfying. IMPLICATIONS FOR PRACTICE A greater understanding of women's experiences of water immersion will provide rationale and reason for making the option a real choice while revealing the positive impacts that it can have on all outcomes beyond just the physical.
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Affiliation(s)
- Megan Cooper
- College of Nursing and Health Sciences, Flinders University, Sturt Campus Bedford Park, South Australia, Australia.
| | - Annette Briley
- College of Nursing and Health Sciences, Flinders University, Sturt Campus Bedford Park, South Australia, Australia
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Cooper M, Madeley AM, Burns E, Feeley C. Understanding the barriers and facilitators related to birthing pool use from organisational and multi-professional perspectives: a mixed-methods systematic review. Reprod Health 2023; 20:147. [PMID: 37794365 PMCID: PMC10548665 DOI: 10.1186/s12978-023-01690-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 09/13/2023] [Indexed: 10/06/2023] Open
Abstract
AIMS To identify and synthesize the evidence regarding the facilitators and barriers relating to birthing pool use from organizational and multi-professional perspectives. DESIGN A systematic integrated mixed methods review was conducted. DATA SOURCES MEDLINE, CINAHL, PsychINFO, EMCARE, PROQUEST and Web of Science databases were searched in April 2021, March 2022 and April 2024. We cross-referenced with Google Scholar and undertook reference list searches. REVIEW METHODS Data were extracted from studies meeting the inclusion criteria. Barriers and facilitators to birthing pool use were mapped and integrated into descriptive statements further synthesized to develop overarching themes. RESULTS Thirty seven articles (29 studies) were included-quantitative (12), qualitative (8), mixed methods (7), and audits (2), from 12 countries. These included the views of 9,082 multi-professionals (midwives, nurses, obstetricians, neonatologists, students, physicians, maternity support workers, doulas and childbirth educators). Additionally, 285 institutional policies or guidelines were included over 9 papers and 1 economic evaluation. Five themes were generated: The paradox of prescriptiveness, The experienced but elusive practitioner, Advocacy and tensions, Trust or Trepidation and It's your choice, but only if it is a choice. These revealed when personal, contextual, and infrastructural factors were aligned and directed towards the support of birth pool use, birthing pool use was a genuine option. Conversely, the more barriers that women and midwives experienced, the less likely it was a viable option, reducing choice and access to safe analgesia. CONCLUSION The findings demonstrated a paradoxical reality of water immersion with each of the five themes detailing how the "swing" within these factors directly affected whether birthing pool use was facilitated or inhibited.
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Branche T, Pouppirt N, Nelson LD, Khan JY. Potential Implications of Emerging Nontraditional Childbirth Practices On Neonatal Health. J Pediatr 2023; 261:113338. [PMID: 36720380 PMCID: PMC10766326 DOI: 10.1016/j.jpeds.2022.12.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 12/14/2022] [Accepted: 12/20/2022] [Indexed: 01/31/2023]
Affiliation(s)
- Tonia Branche
- Division of Neonatology, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Department of Pediatrics, Northwestern University, Feinberg School of Medicine, Chicago, IL.
| | - Nicole Pouppirt
- Division of Neonatology, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Department of Pediatrics, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - LaTasha D Nelson
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Janine Y Khan
- Division of Neonatology, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Department of Pediatrics, Northwestern University, Feinberg School of Medicine, Chicago, IL
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Iglesias Casás S, Pérez-Fernández MR, Montenegro-Alonso MS, Parada-Cabaleiro ME, Sanmartín-Freitas L, Mena-Tudela D. Neonatal outcomes after water birth: A retrospective cohort study. ENFERMERIA CLINICA (ENGLISH EDITION) 2023; 33:292-302. [PMID: 37394138 DOI: 10.1016/j.enfcle.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 05/28/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVE To compare neonatal outcomes between water births, births with immersion only during labour, and births in which immersion was never used. METHODS A retrospective cohort study was performed including mother-baby dyads attended between 2009 and 2019 at the Hospital do Salnés regional hospital (Pontevedra, Spain). These women were categorised into 3 groups: water birth; immersion only during dilation; and women who never used immersion. Several sociodemographic-obstetric variables were studied and the main outcome was the admission of the neonate to the intensive care unit (NICU). Permission was obtained from the responsible provincial ethics committee. Descriptive statistics were used and between-group comparisons were performed using variance for continuous variables and chi-square for categorical variables. Multivariate analysis was performed with backward stepwise logistic regression and incidence risk ratios with 95%CI were calculated for each independent variable. Data were analysed using IBM SPSS® statistical software. RESULTS A total of 1191 cases were included. 404 births without immersions; 397 immersions only during the first stage of labor; and 390 waterbirths were included. No differences were found in the need to transfer new-borns to a NICU (p = .735). In the waterbirth cohort, neonatal resuscitation (p < .001, OR: 0,1), as well as respiratory distress (p = .005, OR: 0,2) or neonatal problems during admission (p < .001, OR: 0,2), were lower. In the immersion only during labor cohort, less neonatal resuscitation (p = .003; OR: 0,4) and respiratory distress (p = .019; OR: 0,4) were found. The probability of not breastfeeding upon discharge was higher for the land birth cohort (p < .001, OR: 0,4). CONCLUSIONS The results of this study indicated that water birth did not influence the need for NICU admission, but was associated with fewer adverse neonatal outcomes, such as resuscitation, respiratory distress, or problems during admission.
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Affiliation(s)
| | | | | | | | | | - Desirée Mena-Tudela
- Departamento de Enfermería, Facultad de Ciencias de la Salud, Universitat Jaume I, Castelló de la Plana, Castelló, Spain
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Demandas de autocuidado no parto na água: estudo qualitativo. ACTA PAUL ENFERM 2023. [DOI: 10.37689/acta-ape/2023ao02601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Bjelke M, Thurn L, Oscarsson M. Mode of delivery and birth outcomes in relation to the duration of the passive second stage of labour: A retrospective cohort study of nulliparous women. PLoS One 2023; 18:e0281183. [PMID: 36716315 PMCID: PMC9886259 DOI: 10.1371/journal.pone.0281183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 01/17/2023] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE To investigate the mode of delivery and birth outcomes in relation to the duration of the passive second stage of labour in nulliparous women. METHODS AND FINDINGS A retrospective cohort study of all nulliparous women (n = 1131) at two delivery units in Sweden. Maternal and obstetric data were obtained from electronic medical records during 2019. The passive second stage was defined as the complete dilation of the cervix until the start of the active second stage. The duration of the passive second stage was categorized into three groups: 0 to 119 min (0 to <2 h), 120-239 min (2- <4h) and ≥240 min (≥4h). Differences between the groups were examined using t-test and Chi2-tests and regression analyses were used to analyse adjusted odds ratio with 95% confidence intervals. The primary outcome was mode of delivery in relation to the duration of the passive second stage and the secondary outcomes covered a series of adverse maternal and neonatal birth outcomes. The rates of instrumental and caesarean deliveries increased as the duration of the passive second stage increased. A ≥4-hour duration of the passive second stage was associated with a nine-times increased risk of caesarean section, and a four-times risk of instrumental delivery compared to a duration of <2 hours in the adjusted analyses. No differences were found in the maternal birth outcomes. The risk of a 5-minute Apgar score <7 was increased in the 2-<4h group. A longer passive second stage was not associated with an increased risk of negative birth experience. CONCLUSIONS Our study demonstrates an increased risk of operative delivery for a longer duration (>2h) of the passive second stage in nulliparous women, although most of the women gave birth by spontaneous vaginal delivery even after ≥4 hours. There was no evidence of an increased risk of adverse maternal outcomes in a longer duration of the passive second stage but there were indications of increased adverse neonatal outcomes. Assessment of fetal well-being is important when the duration of the passive phase is prolonged.
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Affiliation(s)
- Maria Bjelke
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
- * E-mail:
| | - Lars Thurn
- Department of Obstetrics and Gynaecology, Lund University, Lund, Sweden
| | - Marie Oscarsson
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
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Bashaikh SM, Mahboub FA, Orabi A. Perception and knowledge of Saudi women about water birth: A cross-sectional study. BELITUNG NURSING JOURNAL 2022; 8:422-430. [PMID: 37554490 PMCID: PMC10405653 DOI: 10.33546/bnj.2185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/26/2022] [Accepted: 09/18/2022] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Water birth has been considered an efficient non-pharmacological modality with numerous maternal and neonatal benefits as well as rare complications. Perception and knowledge about water birth can affect women's decisions in the future. Few available studies addressed this area in Saudi Arabia. Thus, the current research fills this gap and contributes to further understanding this phenomenon. OBJECTIVE This study aimed to assess the perception and knowledge of Saudi women about water birth. METHODS A cross-sectional study was employed among 388 Saudi women conveniently enrolled for the study. An online questionnaire that included four sections: sociodemographic characteristics, obstetrical history, perception, and knowledge of water birth, was used for data collection. Descriptive statistics (frequencies, percentages, means, and standard deviations) and inferential statistics (Chi-Square, Fisher Exact, and t-tests) were used for data analysis. RESULTS The participants' mean age was 34.91 ± 8.851, with 83.2% of them highly educated. The mean number of deliveries was 3.36 ± 2.167, with 60% having no history of abortion. Less than half of the participants (40.2%) preferred to have a water delivery. Of the total participants, 96.4% had a fair knowledge level, and 3.6% had a good knowledge of water delivery. A significant relationship was found between age, educational course, and the knowledge of the participants about water delivery (p <0.05). CONCLUSION Most Saudi women had a fair knowledge of water birth; however, they wanted more information on it. It is recommended that midwives and nurses broaden their understanding of water birth and enhance its practice in order to educate and inspire women to make informed decisions about all available childbirth delivery methods, including water birth.
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Affiliation(s)
- Saja Mohammed Bashaikh
- College of Nursing, King Saud bin Abdulaziz University for Health Sciences, Saudi Arabia
| | | | - Abeer Orabi
- College of Nursing, King Saud bin Abdulaziz University for Health Sciences, Saudi Arabia
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Burns E, Feeley C, Hall PJ, Vanderlaan J. Systematic review and meta-analysis to examine intrapartum interventions, and maternal and neonatal outcomes following immersion in water during labour and waterbirth. BMJ Open 2022; 12:e056517. [PMID: 35790327 PMCID: PMC9315919 DOI: 10.1136/bmjopen-2021-056517] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
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.
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Affiliation(s)
- Ethel Burns
- Faculty of Health and Life Sciences, Oxford Brookes University Faculty of Health and Life Sciences, Oxford, UK
| | - Claire Feeley
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Priscilla J Hall
- VA School of Nursing Academic Partnership, Emory University, Atlanta, Georgia, USA
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Hautala M, Smeds M, Taittonen L. Waterbirths were associated with low pain relief during delivery, high breastfeeding success and healthy newborn infants. Acta Paediatr 2022; 111:1885-1890. [PMID: 35748524 DOI: 10.1111/apa.16467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 06/21/2022] [Accepted: 06/22/2022] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
| | - Marika Smeds
- Department of Gynaecology, Vaasa Central hospital, Vaasa, Finland
| | - Leena Taittonen
- Department of Paediatrics, Tampere University Hospital, Tampere, Finland
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Cristina T, Mara T, Arianna S, Gennaro S, Rosaria C, Pantaleo G. Impact of waterbirth on post-partum hemorrhage, genital trauma, retained placenta and shoulder dystocia: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2022; 276:26-37. [DOI: 10.1016/j.ejogrb.2022.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/11/2022] [Accepted: 06/17/2022] [Indexed: 11/28/2022]
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15
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Ulfsdottir H, Saltvedt S, Edqvist M, Georgsson S. Management of the active second stage of labor in waterbirths compared with conventional births – a prospective cohort study. Midwifery 2022; 107:103283. [DOI: 10.1016/j.midw.2022.103283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 01/11/2022] [Accepted: 02/06/2022] [Indexed: 11/28/2022]
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16
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Zhang G, Yang Q. Comparative Efficacy of Water and Conventional Delivery during Labour: A Systematic Review and Meta-Analysis. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:7429207. [PMID: 35392147 PMCID: PMC8983243 DOI: 10.1155/2022/7429207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/22/2021] [Accepted: 12/30/2021] [Indexed: 11/17/2022]
Abstract
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, I 2 = 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, I 2 = 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.
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Affiliation(s)
- Guanran Zhang
- Key Laboratory for Experimental Teratology of Ministry of Education, Department of Histology & Embryology, School of Basic Medical Sciences, Shandong University, Jinan, Shandong 250012, China
| | - Qiuhong Yang
- Department of Obstetrics and Gynecology, Jinan Maternity and Child Care Hospital, Jinan, Shandong 250001, China
- Department of Gynaecology and Obstetrics, Qilu Hospital Affiliated to Shandong University, Jinan, Shandong 250000, China
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17
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Dado M, Smith V, Barry P. Women's experiences of water immersion during labour and childbirth in a hospital setting in Ireland: A qualitative study. Midwifery 2022; 108:103278. [DOI: 10.1016/j.midw.2022.103278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/24/2022] [Accepted: 02/06/2022] [Indexed: 10/19/2022]
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Aughey H, Jardine J, Moitt N, Fearon K, Hawdon J, Pasupathy D, Urganci I, Harris T. Waterbirth: a national retrospective cohort study of factors associated with its use among women in England. BMC Pregnancy Childbirth 2021; 21:256. [PMID: 33771115 PMCID: PMC8004456 DOI: 10.1186/s12884-021-03724-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 03/16/2021] [Indexed: 11/15/2022] Open
Abstract
Background Waterbirth is widely available in English maternity settings for women who are not at increased risk of complications during labour. Immersion in water during labour is associated with a number of maternal benefits. However for birth in water the situation is less clear, with conclusive evidence on safety lacking and little known about the characteristics of women who give birth in water. This retrospective cohort study uses electronic data routinely collected in the course of maternity care in England in 2015–16 to describe the proportion of births recorded as having occurred in water, the characteristics of women who experienced waterbirth and the odds of key maternal and neonatal complications associated with giving birth in water. Methods Data were obtained from three population level electronic datasets linked together for the purposes of a national audit of maternity care. The study cohort included women who had no risk factors requiring them to give birth in an obstetric unit according to national guidelines. Multivariate logistic regression models were used to examine maternal (postpartum haemorrhage of 1500mls or more, obstetric anal sphincter injury (OASI)) and neonatal (Apgar score less than 7, neonatal unit admission) outcomes associated with waterbirth. Results 46,088 low and intermediate risk singleton term spontaneous vaginal births in 35 NHS Trusts in England were included in the analysis cohort. Of these 6264 (13.6%) were recorded as having occurred in water. Waterbirth was more likely in older women up to the age of 40 (adjusted odds ratio (adjOR) for age group 35–39 1.27, 95% confidence interval (1.15,1.41)) and less common in women under 25 (adjOR 18–24 0.76 (0.70, 0.82)), those of higher parity (parity ≥3 adjOR 0.56 (0.47,0.66)) or who were obese (BMI 30–34.9 adjOR 0.77 (0.70,0.85)). Waterbirth was also less likely in black (adjOR 0.42 (0.36, 0.51)) and Asian (adjOR 0.26 (0.23,0.30)) women and in those from areas of increased socioeconomic deprivation (most affluent versus least affluent areas adjOR 0.47 (0.43, 0.52)). There was no association between delivery in water and low Apgar score (adjOR 0.95 (0.66,1.36)) or incidence of OASI (adjOR 1.00 (0.86,1.16)). There was an association between waterbirth and reduced incidence of postpartum haemorrhage (adjOR 0.68 (0.51,0.90)) and neonatal unit admission (adjOR 0.65 (0.53,0.78)). Conclusions In this large observational cohort study, there was no association between waterbirth and specific adverse outcomes for either the mother or the baby. There was evidence that white women from higher socioeconomic backgrounds were more likely to be recorded as giving birth in water. Maternity services should focus on ensuring equitable access to waterbirth. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03724-6.
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Affiliation(s)
- H Aughey
- National Maternity and Perinatal Audit (NMPA), RCOG Centre for Quality Improvement and Clinical Audit, Royal College of Obstetricians and Gynaecologists, 10 -18 Union Street, London, SE1 1SZ, UK. .,University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
| | - J Jardine
- National Maternity and Perinatal Audit (NMPA), RCOG Centre for Quality Improvement and Clinical Audit, Royal College of Obstetricians and Gynaecologists, 10 -18 Union Street, London, SE1 1SZ, UK.,Department of Health Service Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - N Moitt
- Population Health Analytics, Cerner, London, UK
| | - K Fearon
- Centre for Reproduction Research, De Montfort University, Leicester, UK
| | - J Hawdon
- National Maternity and Perinatal Audit (NMPA), RCOG Centre for Quality Improvement and Clinical Audit, Royal College of Obstetricians and Gynaecologists, 10 -18 Union Street, London, SE1 1SZ, UK.,Royal Free London NHS foundation Trust, London, UK
| | - D Pasupathy
- National Maternity and Perinatal Audit (NMPA), RCOG Centre for Quality Improvement and Clinical Audit, Royal College of Obstetricians and Gynaecologists, 10 -18 Union Street, London, SE1 1SZ, UK.,Specialty of Obstetrics, Gynaecology and Neonatology, Westmead Clinical School, University of Sydney, Sydney, Australia
| | - I Urganci
- National Maternity and Perinatal Audit (NMPA), RCOG Centre for Quality Improvement and Clinical Audit, Royal College of Obstetricians and Gynaecologists, 10 -18 Union Street, London, SE1 1SZ, UK.,Department of Health Service Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - T Harris
- National Maternity and Perinatal Audit (NMPA), RCOG Centre for Quality Improvement and Clinical Audit, Royal College of Obstetricians and Gynaecologists, 10 -18 Union Street, London, SE1 1SZ, UK.,Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
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19
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Yorgancı A, Buyuk GN, Akyol M, Gündüz Ö, Seven B, Engin-Ustun Y. The Effects of Water Immersion during First Stage of Labor on Postpartum Systemic Inflammatory Response. Z Geburtshilfe Neonatol 2021; 225:251-256. [PMID: 33694147 DOI: 10.1055/a-1370-0620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The systemic inflammatory response is a cascade of physiologic reactions that arise in response to trauma, infection, burn, or any kind of injury. This study aimed to determine the effects of water immersion during the first stage of labor on the systemic inflammatory indices in the postpartum period. MATERIALS AND METHODS In this retrospective study, 125 healthy multiparous women with uncomplicated pregnancies between 37 and 41 weeks of gestation who elected for immersion in water during the first stage of labor were compared with multiparous uncomplicated term women who had conventional vaginal births on land (n=125). Age, parity, body mass index (BMI), gestational age, duration of labor, birth weight, Apgar scores, neonatal intensive care unit admissions, and ante- and postpartum whole blood parameters were noted. Antepartum and postpartum neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), and mean platelet volume (MPV) were calculated for all patients as systemic inflammatory indices. RESULTS Demographic characteristics and birth outcomes of both groups were similar except BMI, which was statistically significantly higher in the water immersion group. There were no statistical differences in antepartum NLR, MLR, PLR, and MPV between the 2 groups. However, postpartum NLR, MLR, PLR, and MPV were statistically significantly lower in the water immersion group compared to the controls. CONCLUSION Water immersion during the first stage of labor might decrease systemic inflammatory indices in the early postpartum period.
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Affiliation(s)
- Ayçağ Yorgancı
- Department of Obstetrics and Gynecology, Ministry of Health Ankara City Hospital, Cankaya, Turkey
| | - Gul Nihal Buyuk
- Department of Obstetrics and Gynecology, Ministry of Health Ankara City Hospital, Cankaya, Turkey
| | - Mesut Akyol
- Department of Biostatistics and Medical Informatics, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Özlem Gündüz
- Department of Obstetrics and Gynecology, Ministry of Health Ankara City Hospital, Cankaya, Turkey
| | - Banu Seven
- Department of Obstetrics and Gynecology, Ministry of Health Ankara City Hospital, Cankaya, Turkey
| | - Yaprak Engin-Ustun
- Obstetrics and Gynecology, University of Health Sciences, Etlik Zübeyde Hanım Women's Health Education and Research Hospital, Ankara, Turkey
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Efectos maternos y neonatales del parto en el agua. Una revisión sistemática. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2021. [DOI: 10.1016/j.gine.2020.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Barry PL, McMahon LE, Banks RA, Fergus AM, Murphy DJ. Prospective cohort study of water immersion for labour and birth compared with standard care in an Irish maternity setting. BMJ Open 2020; 10:e038080. [PMID: 33277276 PMCID: PMC7722381 DOI: 10.1136/bmjopen-2020-038080] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To examine the birth outcomes for women and babies following water immersion for labour only, or for labour and birth. DESIGN Prospective cohort study. SETTING Maternity hospital, Ireland, 2016-2019. PARTICIPANTS A 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. METHODS Logistic regression analyses examined associations between water immersion and birth outcomes adjusting for confounders. A validated Childbirth Experience Questionnaire was completed. MAIN OUTCOME MEASURES Perineal tears, obstetric anal sphincter injuries (OASI), postpartum haemorrhage (PPH), neonatal unit admissions (NNU), breastfeeding and birth experiences. RESULTS Compared 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). CONCLUSIONS Women 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.
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Affiliation(s)
- Paula L Barry
- Midwifery, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Lean E McMahon
- National Clinical Programme for Obstetrics & Gynaecology/National Women & Infants Health Programme, Coombe Women's Hospital, Dublin, Ireland
| | - Ruth Am Banks
- Midwifery, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Ann M Fergus
- Midwifery, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Deirdre J Murphy
- Obstetrics & Gynaecology, Trinity College Dublin, Dublin, Ireland
- Obstetrics, Coombe Women and Infants University Hospital, Dublin, Ireland
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22
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Abstract
Hospital-based deliveries with second-stage water immersion had no higher risk of neonatal intensive care or special care nursery admissions than a clinically comparable population. OBJECTIVE: To compare neonatal intensive care unit (NICU) or special care nursery admission for deliveries with water immersion compared with deliveries in the matched control group without water immersion. Secondary outcomes included adverse neonatal diagnoses, maternal infections, and perineal lacerations. METHODS: We conducted a retrospective study using electronic health record data (2014–2018) from two health systems (eight hospitals), with similar clinical eligibility, associated with low risks of intrapartum complications, and implementation policies for waterbirth. The water immersion group included women intending waterbirth. Water immersion was recorded prospectively during delivery. The comparison population were women who met the clinical eligibility criteria for waterbirth but did not experience water immersion during labor. Comparison cases were matched (1:1) using propensity scores. Outcomes were compared using Fischer's exact tests and logistic regression with stratification by stage of water immersion. RESULTS: Of the 583 women with water immersion, 34.1% (199) experienced first-stage water immersion only, 65.9% (384) experienced second-stage immersion, of whom 12.0% (70) exited during second stage, and 53.9% (314) completed delivery in the water. Neonatal intensive care unit or special care nursery admissions were lower for second-stage water immersion deliveries than deliveries in the control group (odds ratio [OR] 0.3, 95% CI 0.2–0.7). Lacerations were lower in the second-stage immersion group (OR 0.5, 95% CI 0.4–0.7). Neonatal intensive care unit or special care nursery admissions and lacerations were not different between the first-stage immersion group and their matched comparisons. Cord avulsions occurred for 0.8% of second-stage water immersion deliveries compared with none in the control groups. Five-minute Apgar score (less than 7), maternal infections, and other adverse outcomes were not significantly different between either the first- or second-stage water immersion groups and their control group. CONCLUSION: Hospital-based deliveries with second-stage water immersion had lower risk of NICU or special care nursery admission and perineal lacerations than matched deliveries in the control group without water immersion.
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Papoutsis D, Antonakou A, Gornall A, Tzavara C. The Incidence of and Predictors for Severe Perineal Trauma and Intact Perineum in Women Having a Waterbirth in England: A Hospital-Based Study. J Womens Health (Larchmt) 2020; 30:681-688. [PMID: 32907460 DOI: 10.1089/jwh.2019.8244] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: To determine the incidence of and predictors for obstetric anal sphincter injuries (OASIS) and intact perineum in women giving birth in the water and compare with the general obstetric population. Materials and Methods: Data were retrospectively collected for women who had singleton cephalic presentation vaginal births in the water and the general obstetric population between August 2007 and December 2017. Results: We identified 1,007 women who had a waterbirth and 36,924 women from the general obstetric population. There was no significant difference in the incidence of OASIS between waterbirths and the general obstetric population (2.3% vs. 2.0%). Having a waterbirth was associated with a lower probability for an intact perineum (odds ratio [OR] = 0.83; confidence interval [95% CI]: 0.73-0.94) when compared with the general obstetric population (44.7% vs. 51.3%). Nulliparous women with a waterbirth when compared with multiparous women had an eightfold higher likelihood for the occurrence of OASIS (OR = 8.28; 95% CI: 2.64-25.86). The risk for a higher degree of OASIS was associated with increased maternal age in the total sample (OR = 1.08; 95% CI: 1.06-1.11) and with a lower body mass index (BMI) at booking in multiparous women (OR = 0.96; 95% CI: 0.92-0.99). The risk for any type of perineal trauma was associated with increased maternal age in the total sample (OR = 1.10; 95% CI: 1.07-1.13) and with a lower BMI at booking in multiparous women (OR = 0.95; 95% CI: 0.91-0.99). Conclusions: We found that giving birth in the water reduced the chance of having an intact perineum. We have also shown that nulliparity, increased maternal age in all women, and a lower BMI at booking in multiparous were associated with OASIS and lower rates of intact perineum in waterbirths.
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Affiliation(s)
- Dimitrios Papoutsis
- Department of Obstetrics and Gynaecology, Shrewsbury and Telford Hospitals NHS Trust, Telford, United Kingdom.,School of Health Sciences, University of Western Macedonia, Kozani, Greece
| | - Angeliki Antonakou
- Department of Midwifery, Midwifery School, International Hellenic University, Thessaloniki, Greece
| | - Adam Gornall
- Department of Obstetrics and Gynaecology, Shrewsbury and Telford Hospitals NHS Trust, Telford, United Kingdom
| | - Chara Tzavara
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, University of Athens, Athens, Greece
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Carlsson T, Ulfsdottir H. Waterbirth in low‐risk pregnancy: An exploration of women’s experiences. J Adv Nurs 2020; 76:1221-1231. [DOI: 10.1111/jan.14336] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 01/15/2020] [Accepted: 02/19/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Tommy Carlsson
- Sophiahemmet University College Stockholm Sweden
- The Swedish Red Cross University College Huddinge Sweden
- Department of Women’s and Children’s Health Uppsala University Uppsala Sweden
| | - Hanna Ulfsdottir
- Sophiahemmet University College Stockholm Sweden
- Karolinska University Hospital PO pregnancy and birth Stockholm Sweden
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25
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Ulfsdottir H, Saltvedt S, Georgsson S. Testing the waters — A cross-sectional survey of views about waterbirth among Swedish health professionals. Women Birth 2020; 33:186-192. [DOI: 10.1016/j.wombi.2019.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 03/11/2019] [Accepted: 04/13/2019] [Indexed: 10/26/2022]
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The Experience of Land and Water Birth Within the American Association of Birth Centers Perinatal Data Registry, 2012-2017. J Perinat Neonatal Nurs 2020; 34:16-26. [PMID: 31834005 DOI: 10.1097/jpn.0000000000000450] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Consumer demand for water birth has grown within an environment of professional controversy. Access to nonpharmacologic pain relief through water immersion is limited within hospital settings across the United States due to concerns over safety. The study is a secondary analysis of prospective observational Perinatal Data Registry (PDR) used by American Association of Birth Center members (AABC PDR). All births occurring between 2012 and 2017 in the community setting (home and birth center) were included in the analysis. Descriptive, correlational, and relative risk statistics were used to compare maternal and neonatal outcomes. Of 26 684 women, those giving birth in water had more favorable outcomes including fewer prolonged first- or second-stage labors, fetal heart rate abnormalities, shoulder dystocias, genital lacerations, episiotomies, hemorrhage, or postpartum transfers. Cord avulsion occurred rarely, but it was more common among water births. Newborns born in water were less likely to require transfer to a higher level of care, be admitted to a neonatal intensive care unit, or experience respiratory complication. Among childbearing women of low medical risk, personal preference should drive utilization of nonpharmacologic care practices including water birth. Both land and water births have similar good outcomes within the community setting.
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Ulfsdottir H, Saltvedt S, Georgsson S. Women's experiences of waterbirth compared with conventional uncomplicated births. Midwifery 2019; 79:102547. [PMID: 31610362 DOI: 10.1016/j.midw.2019.102547] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 08/30/2019] [Accepted: 09/29/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To compare childbirth experiences between women having a waterbirth and women having an uncomplicated conventional birth. DESIGN A prospective cohort study using the validated Childbirth Experience Questionnaire (CEQ) six weeks postpartum. The 22-item questionnaire assesses four domains of the childbirth experience; Own capacity, Professional support, Perceived safety and Participation. These four domains constituted the main outcome of the study. Further, supplementary questions about the second stage of labour were added to the web-questionnaire. SETTING One city-located hospital in Stockholm and one small-town hospital in Southern Sweden offering waterbirth to low risk women. PARTICIPANTS 215 women; 99 nulli- and 116 multiparas. 111 gave birth in water and 104 had an uncomplicated conventional birth. MEASUREMENTS AND FINDINGS The total CEQ score did not differ between the groups, while women having a waterbirth scored significantly higher in the domain, "Own capacity" and lower in the domain, "Professional support". Women having a waterbirth rated less pain and higher scores of being in control in the second stage of labour. KEY CONCLUSIONS A waterbirth seems to empower and enhance women's capacity for those who choose this alternative. Waterbirth can improve their birth experience and can possibly make women less dependent on the midwife. IMPLICATIONS FOR PRACTICE To provide waterbirth could be a way of empowering women and giving them a positive birth experience.
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Affiliation(s)
- Hanna Ulfsdottir
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden; Sophiahemmet University, Box 5605, SE-114 86 Stockholm, Sweden.
| | - Sissel Saltvedt
- Department of Women's and Children's Health (KBH), Karolinska Institutet, Stockholm, Sweden
| | - Susanne Georgsson
- Sophiahemmet University, Box 5605, SE-114 86 Stockholm, Sweden; Department of Clinical Science Intervention and Technology, Karolinska Institutet, Stockholm Sweden, The Swedish red Cross University College, Hälsovägen 11, 141 57 Huddinge, Sweden
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Neiman E, Austin E, Tan A, Anderson CM, Chipps E. Outcomes of Waterbirth in a US Hospital-Based Midwifery Practice: A Retrospective Cohort Study of Water Immersion During Labor and Birth. J Midwifery Womens Health 2019; 65:216-223. [PMID: 31489975 DOI: 10.1111/jmwh.13033] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 06/30/2019] [Accepted: 07/15/2019] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Although the safety of water immersion during labor is largely supported by evidence from research, the risks to women and neonates during waterbirth are not well established. The purpose of this study was to generate evidence regarding maternal and neonatal outcomes related to water immersion in labor and during birth. METHODS A retrospective cohort study included a convenience sample of women receiving prenatal care at a nurse-midwifery practice. Participants were categorized into 3 groups: 1) waterbirth, 2) water labor, or 3) neither. Participant characteristics, maternal outcomes, and newborn outcomes were collected at time of birth and health record abstraction. At the 6-week postpartum visit, another maternal outcome, satisfaction with birth, was measured using the Care in Obstetrics: Measure for Testing Satisfaction (COMFORTS) scale. Analysis included effect size, descriptive statistics (sample characteristics), and maternal and neonatal group differences (analysis of variance and chi-square) with a significance level of P < .05. RESULTS Women in the waterbirth (n = 58), water labor (n = 61), and neither (n = 111) groups were primarily white, married, and college educated and did not differ by age or education. Women in the waterbirth group were more likely to be multiparous. Nulliparous women who had a waterbirth had a significantly shorter second stage of labor than nulliparous women who did not have a waterbirth (P = .03). The most commonly cited reasons for discontinuation of hydrotherapy were maternal choice (42.6%) and need for pain medication (29.5%). Significantly more women in the waterbirth group experienced a postpartum hemorrhage, compared with water labor or neither (n = 5, n = 3, n = 1, respectively; P = .045); there was no difference in related clinical measures. Neonatal outcomes were not significantly different. Maternal satisfaction was high across all groups. DISCUSSION The results of this study suggest that waterbirth, attended by qualified intrapartum care providers in hospital settings in the United States, is a reasonable option for low-risk women and their neonates.
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Affiliation(s)
- Emily Neiman
- The Ohio State University College of Medicine, Columbus, Ohio
| | | | - Alai Tan
- Center for Research and Health Analytics, The Ohio State University College of Nursing, Columbus, Ohio
| | - Cindy M Anderson
- Martha S. Pitzer Center for Women, Children, and Youth, The Ohio State University College of Nursing, Columbus, Ohio
| | - Esther Chipps
- The Ohio State University College of Nursing, Columbus, Ohio
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Giordano J, Surita FG. The role of the respectful maternity care model in São Paulo, Brazil: A cross-sectional study. Birth 2019; 46:509-516. [PMID: 31435983 DOI: 10.1111/birt.12448] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 07/11/2019] [Accepted: 07/12/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The promotion of a positive birth experience has been a main goal of the World Health Organization's (WHO) recent work on improving maternity care. The purpose of this study was to assess the cesarean rates, the prevalence of birth practices, perinatal outcomes, and maternal satisfaction, in women involved with the respectful maternity care (RMC) support groups in Sao Paulo, Brazil. METHODS This was a cross-sectional study of women with low-risk pregnancies who were assisted by professionals recommended by the RMC groups. An online questionnaire was administered. Variables to assess birth practices were classified as positive, negative, or unspecified according to the WHO guidelines. The Pearson chi-square tests and odds ratios (ORs) with their corresponding 95% confidence intervals (CIs) were computed to assess differences between the groups. RESULTS Five-hundred and eighty women completed the questionnaire. The cesarean rate was 14.7%, and the operative vaginal birth rate was 9.5%. The VBAC rate was 87.1%, and there was no significant difference in risk for cesarean between women with or without a prior cesarean. Of all women, 83.1% had a midwife's assistance and 75.5% hired a doula; 81.4% gave birth in a nonlithotomic position. The practices of enema, fasting and episiotomy were all under 2%. All 5-minute Apgar scores were ≥7. Most (83.1%) women reported having a positive birth experience. CONCLUSIONS Woman's engagement with the birth support groups and a transdisciplinary team focused on RMC are key elements to achieve positive perinatal outcomes and high women's satisfaction.
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Affiliation(s)
- Juliana Giordano
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
| | - Fernanda G Surita
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
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