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Am J Perinatol 2024; 41(S 01): e1775-e1782
DOI: 10.1055/s-0043-1768961
Original Article

Neonatal Outcomes of Water Delivery versus Land Delivery: A Retrospective Propensity Score Weighted Study

Stefano Uccella
1   Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
,
Paolo Manzoni
2   Department of Maternal, Neonatal and Infant Medicine, Azienda Sanitaria Locale Biella, Biella, Italy
,
Maria A. Militello
2   Department of Maternal, Neonatal and Infant Medicine, Azienda Sanitaria Locale Biella, Biella, Italy
,
Mariachiara Bosco 
1   Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
,
Irene Porcari
1   Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
,
Gabriele Lanzo
3   Division of Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science, University of Turin, Turin, Italy
,
Francesca Maraucci
2   Department of Maternal, Neonatal and Infant Medicine, Azienda Sanitaria Locale Biella, Biella, Italy
,
Chiara Violino
2   Department of Maternal, Neonatal and Infant Medicine, Azienda Sanitaria Locale Biella, Biella, Italy
,
Tiziana Lo Cicero
2   Department of Maternal, Neonatal and Infant Medicine, Azienda Sanitaria Locale Biella, Biella, Italy
,
Giulia Biancotto
1   Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
,
Pier Carlo Zorzato
1   Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
,
Massimo P. Franchi
1   Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
,
Simone Garzon 
1   Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
› Author Affiliations
Funding None.
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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.

Keywords

cord avulsion - cord rupture - maternal outcomes - neonatal outcomes - safety - water labor

Ethical Approval

All procedures and medical research were conducted in compliance with the ethical principles stated in the Declaration of Helsinki 1975 (revised in 2008). The Institutional Review Board and the Ethical Committee of the ASL Biella/University of East Piedmont approved the study in April 2019 (protocol number: 440/CA; study number: IRB NUMBERCE40/19). All women provided written informed consent for study participation, data collection, and analysis for research purposes.


Authors' Contributions

Conceptualization: S.U., P.M., M.B., M.A.M., S.G.; methodology: S.G., S.U., M.B., I.P., M.A.M.; validation: S.U., P.M., M.P.F., S.G.; formal analysis: S.G., M.B.; resources: S.U., P.M., F.M., T.L.C., C.V.; writing draft: S.U., S.G., M.B.; writing-review and editing: S.U., S.G., M.B., I.P., P.C.Z., G.L., M.A.M., G.B.; supervision: S.U., S.G.


Supplementary Material



Publication History

Received: 27 February 2023

Accepted: 06 April 2023

Article published online:
19 May 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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