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Water Birth and Perinatal Outcomes in British Columbia: A Retrospective Cohort Study

  • Zoë G. Hodgson
    Correspondence
    Corresponding author: Dr. Zoë G. Hodgson, Department of Midwifery, BC Women's Hospital & Health Centre Vancouver, BC.
    Affiliations
    Department of Midwifery, BC Women's Hospital and Health Centre, Vancouver, BC

    Department of Family Practice, University of British Columbia, Vancouver, BC

    Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC
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  • L. Ruth Comfort
    Affiliations
    Department of Midwifery, BC Women's Hospital and Health Centre, Vancouver, BC

    Department of Family Practice, University of British Columbia, Vancouver, BC
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  • Arianne A.Y. Albert
    Affiliations
    Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC

    Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC
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Published:December 13, 2019DOI:https://doi.org/10.1016/j.jogc.2019.07.007

      Abstract

      Objective

      This study aimed to quantify adverse neonatal outcomes in a cohort of registered midwife (RM)–attended conventional and water births in British Columbia.

      Methods

      The study included all term singleton births in British Columbia between January 1, 2005 and March 31, 2016 attended by RMs. Births were allocated to a conventional birth cohort or a water birth cohort according to where the actual birth of the neonate took place. The primary outcome was a composite adverse neonatal outcome (Apgar <7 at 5 minutes, resuscitation need, neonatal intensive care unit admission). Secondary outcomes included individual components of the primary outcome, maternal length of labour, and degree of perineal laceration (Canadian Task Force Classification Level II-2).

      Results

      The population included 25 798 births. Of these, 23 201 were conventional, and 2567 were water births. The rate of the composite adverse neonatal outcome was not higher in water births compared with conventional births (hospital conventional, 5.0%; hospital water, 4.2%; home conventional, 3.4%; and home water, 2.9%). Rates of individual components of the composite adverse neonatal score were not greater in the water birth cohort. Maternal outcomes included statistically shorter labours in the water birth cohort and no difference between the cohorts in incidence of third- and fourth-degree lacerations.

      Conclusion

      Water births attended by RMs in British Columbia are not associated with higher rates of adverse neonatal outcomes than conventional births attended by midwives.

      Résumé

      Objectif

      Les auteures de cette étude visaient à quantifier les issues néonatales défavorables au sein d'une cohorte d'accouchements traditionnels ou dans l'eau assistés par des sages-femmes autorisées (SFA) en Colombie-Britannique.

      Méthodologie

      Cette étude compte toutes les naissances monofœtales à terme assistées par des SFA en Colombie-Britannique pour la période du 1er janvier 2005 au 31 mars 2016. Les naissances ont été attribuées à la cohorte de l'accouchement traditionnel ou à celle de l'accouchement dans l'eau en fonction de l'endroit où la naissance du nouveau-né a eu lieu. L'issue principale est une issue néonatale défavorable composite (Apgar < 7 à 5 minutes, besoin de réanimation, admission à l'unité de soins intensifs néonatals). Les issues secondaires comptent les composants individuels de l'issue principale, la durée du travail et le degré de déchirures du périnée (classification II-2 du Groupe d'étude canadien sur les soins de santé préventifs).

      Résultats

      La population comptait 25 798 naissances. De ce groupe, on recense 23 201 accouchements traditionnels et 2 567 dans l'eau. Le taux d'issues néonatales défavorables composites n'était pas plus élevé pour les accouchements dans l'eau que pour les traditionnels (traditionnel à l'hôpital, 5,0 %; dans l'eau à l'hôpital, 4,2 %; traditionnel à domicile, 3,4 % et dans l'eau à domicile, 2,9 %). Le taux des composants individuels du score néonatal défavorable composite n'était pas plus élevé pour la cohorte des accouchements dans l'eau. Relativement aux issues maternelles, on a observé une durée du travail statistiquement plus courte dans la cohorte de l'accouchement dans l'eau et aucune différence entre les cohortes pour ce qui est de la fréquence des déchirures du troisième et quatrième degré.

      Conclusion

      En Colombie-Britannique, les accouchements dans l'eau assistés par des SFA ne sont pas liés à plus d'issues néonatales défavorables que ne le sont les accouchements traditionnels assistés par des sages-femmes.

      Key Words

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