Investigate maternal and neonatal outcomes following waterbirth.
Retrospective cohort study, with propensity score matching to address confounding.
Community births, United States.
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
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.
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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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