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

Stefano Uccella; Paolo Manzoni; Maria A. Militello; Mariachiara Bosco; Irene Porcari; Gabriele Lanzo; Francesca Maraucci; Chiara Violino; Tiziana Lo Cicero; Giulia Biancotto; Pier Carlo Zorzato; Massimo P. Franchi; Simone Garzon

doi:10.1055/s-0043-1768961

American Journal of Perinatology, Inhaltsverzeichnis

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

¹Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy

,

Paolo Manzoni

²Department of Maternal, Neonatal and Infant Medicine, Azienda Sanitaria Locale Biella, Biella, Italy

,

Maria A. Militello

²Department of Maternal, Neonatal and Infant Medicine, Azienda Sanitaria Locale Biella, Biella, Italy

,

Mariachiara Bosco

¹Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy

,

Irene Porcari

¹Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy

,

Gabriele Lanzo

³Division of Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science, University of Turin, Turin, Italy

,

Francesca Maraucci

²Department of Maternal, Neonatal and Infant Medicine, Azienda Sanitaria Locale Biella, Biella, Italy

,

Chiara Violino

²Department of Maternal, Neonatal and Infant Medicine, Azienda Sanitaria Locale Biella, Biella, Italy

,

Tiziana Lo Cicero

²Department of Maternal, Neonatal and Infant Medicine, Azienda Sanitaria Locale Biella, Biella, Italy

,

Giulia Biancotto

¹Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy

,

Pier Carlo Zorzato

¹Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy

,

Massimo P. Franchi

¹Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy

,

Simone Garzon

¹Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy

› Institutsangaben

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

Volltext

Referenzen

References
1 Embry M. Observations sur un accouchement termine dans le bain. Ann Soc Med Prat Montp 1805; (53) 185-191
2 Church LK. Water birth: one birthing center's observations. J Nurse Midwifery 1989; 34 (04) 165-170
3 Daniels K. Water birth: the newest form of safe, gentle, joyous birth. J Nurse Midwifery 1989; 34 (04) 198-205
4 Care Quality Commission. Maternity survey 2022. Accessed January 16, 2023 at: https://www.cqc.org.uk/publication/surveys/maternity-survey-2022
5 Otigbah CM, Dhanjal MK, Harmsworth G, Chard T. A retrospective comparison of water births and conventional vaginal deliveries. Eur J Obstet Gynecol Reprod Biol 2000; 91 (01) 15-20
6 Ulfsdottir H, Saltvedt S, Georgsson S. Women's experiences of waterbirth compared with conventional uncomplicated births. Midwifery 2019; 79: 102547
7 Cluett ER, Burns E, Cuthbert A. Immersion in water during labour and birth. Cochrane Database Syst Rev 2018; 5 (05) CD000111
8 Nikodem VC, Edwards SE, Krzyzanski AM, Berghella V, Hofmeyr GJ. Immersion in water during the second stage of labor: a randomized controlled trial. Am J Obstet Gynecol MFM 2022; 4 (06) 100721
9 Zhang G, Yang Q. Comparative efficacy of water and conventional delivery during labour: a systematic review and meta-analysis. J Healthc Eng 2022; 2022: 7429207
10 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
11 Committee Opinion No. Committee opinion no. 679: immersion in water during labor and delivery. Obstet Gynecol 2016; 128 (05) e231-e236
12 Overview / Intrapartum care for healthy women and babies / Guidance / NICE. Accessed April 12, 2021 at: https://www.nice.org.uk/guidance/cg190
13 Bovbjerg ML, Cheyney M, Caughey AB. Maternal and neonatal outcomes following waterbirth: a cohort study of 17 530 waterbirths and 17 530 propensity score-matched land births. BJOG 2021; 129 (06) 950-958
14 Sidebottom AC, Vacquier M, Simon K. et al. Maternal and neonatal outcomes in hospital-based deliveries with water immersion. Obstet Gynecol 2020; 136 (04) 707-715
15 Geissbuehler V, Stein S, Eberhard J. Waterbirths compared with landbirths: an observational study of nine years. J Perinat Med 2004; 32 (04) 308-314
16 Aughey H, Jardine J, Moitt N. et al; NMPA Project Team. Waterbirth: a national retrospective cohort study of factors associated with its use among women in England. BMC Pregnancy Childbirth 2021; 21 (01) 256
17 Lanier AL, Wiegand SL, Fennig K, Snow EK, Maxwell RA, McKenna D. Neonatal outcomes after delivery in water. Obstet Gynecol 2021; 138 (04) 622-626
18 Davies R, Davis D, Pearce M, Wong N. The effect of waterbirth on neonatal mortality and morbidity: a systematic review and meta-analysis. JBI Database Syst Rev Implement Reports 2015; 13 (10) 180-231
19 Gimovsky AC, Berghella V. Evidence-based labor management: second stage of labor (part 4). Am J Obstet Gynecol MFM 2022; 4 (02) 100548
20 Simpson KR. Underwater birth. J Obstet Gynecol Neonatal Nurs 2013; 42 (05) 588-594
21 Woodward J, Kelly SM. A pilot study for a randomised controlled trial of waterbirth versus land birth. BJOG 2004; 111 (06) 537-545
22 Bovbjerg ML. Opposition to waterbirth is not evidence based. J Womens Health (Larchmt) 2021; 30 (05) 625-627
23 Chesnaye NC, Stel VS, Tripepi G. et al. An introduction to inverse probability of treatment weighting in observational research. Clin Kidney J 2021; 15 (01) 14-20
24 Schafer R. Umbilical cord avulsion in waterbirth. J Midwifery Womens Health 2014; 59 (01) 91-94
25 Ulfsdottir H, Saltvedt S, Georgsson S. Waterbirth in Sweden - a comparative study. Acta Obstet Gynecol Scand 2018; 97 (03) 341-348
26 Gilbert RE, Tookey PA. Perinatal mortality and morbidity among babies delivered in water: surveillance study and postal survey. BMJ 1999; 319 (7208): 483-487
27 Snapp C, Stapleton SR, Wright J, Niemczyk NA, Jolles D. 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 (01) 16-26
28 Pinette MG, Wax J, Wilson E. The risks of underwater birth. Am J Obstet Gynecol 2004; 190 (05) 1211-1215
29 Henderson J, Burns EE, Regalia AL, Casarico G, Boulton MG, Smith LA. Labouring women who used a birthing pool in obstetric units in Italy: prospective observational study. BMC Pregnancy Childbirth 2014; 14: 17
30 Nguyen S, Kuschel C, Teele R, Spooner C. Water birth–a near-drowning experience. Pediatrics 2002; 110 (2 Pt 1): 411-413
31 Mammas IN, Thiagarajan P. Water aspiration syndrome at birth - report of two cases. J Matern Fetal Neonatal Med 2009; 22 (04) 365-367
32 Sotiridou E, Mukhopadhyay S, Clarke P. Neonatal aspiration syndrome complicating a water birth. J Obstet Gynaecol 2010; 30 (06) 631-633
33 Macones GA, Hankins GDV, Spong CY, Hauth J, Moore T. The 2008 National Institute of Child Health and Human Development workshop report on electronic fetal monitoring: update on definitions, interpretation, and research guidelines. Obstet Gynecol 2008; 112 (03) 661-666
34 Jacoby S, Becker G, Crawford S, Wilson RD. 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 (06) 805-812
35 Burns E, Hunter L, Rodd Z, MacLeod M, Smith L. Developing and evaluating an online learning tool to improve midwives' accuracy of visual estimation of blood loss during waterbirth: an experimental study. Midwifery 2019; 68: 65-73
36 Burns EE, Boulton MG, Cluett E, Cornelius VR, Smith LA. Characteristics, interventions, and outcomes of women who used a birthing pool: a prospective observational study. Birth 2012; 39 (03) 192-202
37 Demirel G, Moraloglu O, Celik IH. et al. The effects of water birth on neonatal outcomes: a five-year result of a referral tertiary centre. Eur Rev Med Pharmacol Sci 2013; 17 (10) 1395-1398
38 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 (12) e038080
39 Atalik KE, Kiliç M, Nurullahoğlu ZU, Doğan N. Effects of cooling and warming on 5-hydroxytryptamine- and acetylcholine-induced contractions of human umbilical vessels: role of nitric oxide. Fundam Clin Pharmacol 2008; 22 (01) 37-44
40 Boura AL, Boyle L, Sinnathuray TA, Walters WA. Release of prostaglandins during contraction of the human umbilical vein on reduction of temperature. Br J Pharmacol 1979; 65 (03) 360-362
41 Vanderlaan J, Hall P. Systematic review of case reports of poor neonatal outcomes with water immersion during labor and birth. J Perinat Neonatal Nurs 2020; 34 (04) 311-323

Zusatzmaterial

Supplementary Material