Maternal and neonatal outcomes following waterbirth: a cohort study of 17,530 waterbirths and 17,530 propensity score-matched land births
Abstract
Objective
Investigate maternal and neonatal outcomes following waterbirth.
Design
Retrospective cohort study, with propensity score matching to address confounding.
Setting
Community births, United States.
Sample
Medical records-based registry data from low-risk births were used to create waterbirth and land birth groups (n=17,530 each), propensity score-matched on >80 demographic and pregnancy risk covariables
Methods
Logistic regression models compared outcomes between the matched waterbirth and land birth groups
Main outcome measures
Maternal: immediate postpartum transfer to a hospital, any genital tract trauma, severe (3rd/4th degree) trauma, haemorrhage >1000 cc, diagnosed haemorrhage regardless of estimated blood loss, uterine infection, uterine infection requiring hospitalisation, any hospitalisation in the first 6 weeks. Neonatal: umbilical cord avulsion; immediate neonatal transfer to a hospital; respiratory distress syndrome; any hospitalisation, neonatal intensive care unit (NICU) admission, or neonatal infection in the first 6 weeks; and neonatal death.
Results
Waterbirth was associated with improved or no difference in outcomes for most measures, including neonatal death (aOR 0.56 [95% CI, 0.31 – 1.0]), and maternal or neonatal hospitalisation in the first 6 weeks (0.87 [0.81 – 0.92] and 0.95 [0.90 – 0.99], respectively). Increased morbidity in the waterbirth group was observed for two outcomes only: uterine infection (1.25 [1.05 – 1.48]) (but not hospitalisation for infection) and umbilical cord avulsion (1.57 [1.37 – 1.82]). Our results are concordant with other studies: waterbirth is neither as harmful as some current guidelines suggest, nor as benign as some proponents claim.
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Citation
Bovbjerg, M.L., Cheyney, M. and Caughey, A.B. (2021), Maternal and neonatal outcomes following waterbirth: a cohort study of 17,530 waterbirths and 17,530 propensity score-matched land births. BJOG: An International Journal of Obstetrics & Gynaecology. Accepted Author Manuscript. doi.org/10.1111/1471-0528.17009