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
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Obstetrics and Gynaecology CanadaAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
REFERENCES
- Labour and birth in water in England and Wales: survey report.Br J Midwifery. 1995; 3: 375-382
- Nonpharmacologic relief of pain during labor: systematic reviews of five methods.Am J Obstet Gynecol. 2002; 186: S131-S159
- The effects of hydrotherapy on anxiety, pain, neuroendocrine responses, and contraction dynamics during labour.Biol Res Nurs. 2010; 12: 28-36
- Immersion in water in labour and birth.Cochrane Database Syst Rev. 2009; (CD000111)
- Characteristics, interventions, and outcomes of women who used a birthing pool: a prospective observational study.Birth. 2012; 39: 192-202
- Labouring women who used a birthing pool in obstetric units in Italy: prospective observational study.BMC Pregnancy Childbirth. 2014; 14: 17
- Water birth and infection in babies.BMJ. 1994; 309: 511
- Underwater birth: missing the evidence or missing the point?.Pediatrics. 2003; 112 ([published erratum appears in Pediatrics 2004;113:433]): 972-973
- Water birth—a near-drowning experience.Pediatrics. 2002; 110: 411-413
- Underwater birth and neonatal respiratory distress.BMJ. 2005; 330: 1071-1072
- Water aspiration syndrome at birth - report of two cases.J Matern Fetal Neonatal Med. 2009; 22: 365-367
- Water birth—a near-drowning experience.Pediatrics. 2002; 110: 409
- Immersion in water during labour and birth.Cochrane Database Syst Rev. 2018; (CD000111)
- Maternal and newborn outcomes following waterbirth: the Midwives Alliance of North America statistics project, 2004 to 2009 cohort.J Midwifery Womens Health. 2016; 61: 11-20
- Immersion in water for pain relief and the risk of intrapartum transfer among low risk nulliparous women: secondary analysis of the birthplace national prospective cohort study.BMC Pregnancy Childbirth. 2014; 14: 60
- Characteristics, interventions, and outcomes of women who used a birthing pool: a prospective observational study.Birth. 2012; 39: 192-202
- Water birth maternal and neonatal outcomes among midwifery clients in Alberta, Canada, from 2014 to 2017: a retrospective study.J Obstet Gynaecol Can. 2019; 41: 805-812
- Guideline for the Use of Water in Labour and for Birth.College of Midwives of British Columbia, Vancouver, BCrevised 2014 (Available at:) (Accessed on July 26, 2019)
Perinatal Services BC. British Columbia Perinatal Data Registry. Years Provided: (1 January 2005-31 March 2016). Resource Type: Data Extract. Data Provided October 2018.
- Critical incident audit and feedback to improve perinatal and maternal mortality and morbidity.Cochrane Database Syst Rev. 2005; (CD002961)
- Outcomes associated with planned home and planned hospital births in low-risk women attended by midwives in Ontario, Canada, 2003-2006: a retrospective cohort study.Birth. 2009; 36: 180-189
- Outcomes associated with planned place of birth among women with low-risk pregnancies.CMAJ. 2016; 188: E80-E90
- Outcomes of planned home births versus planned hospital births after regulation of midwifery in British Columbia.CMAJ. 2002; 166: 315-323
- Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician.CMAJ. 2009; 181: 377-383
- The effect of waterbirth on neonatal mortality and morbidity: a systematic review and meta-analysis.JBI Database System Rev Implement Rep. 2015; 13: 180-231
- Neonatal outcomes of waterbirth: a systematic review and meta-analysis.Arch Dis Child Fetal Neonatal Ed. 2016; 101: F357-F365
- Neonatal outcomes with water birth: a systematic review and meta-analysis.Midwifery. 2018; 59: 27-38
- Water Immersion in Queensland: Evidence, Access and Uptake.Queensland Centre for Mothers and Babies, The University of Queensland, Brisbane, Australia2012 (Available at:) (Accessed on July 26, 2019)
Article info
Publication history
Published online: December 13, 2019
Footnotes
Competing interests: The authors declare that they have no competing interests.
Each author has indicated that they meet the journal's requirements for authorship.
Identification
Copyright
© 2019 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
