Immersion in water in labour and birth

[Intervention Review]
Immersion in water in labour and birth

Elizabeth R Cluett1, Ethel Burns2

1School of Health Sciences , University of Southampton, Southampton, UK. 2Oxford Brookes University, School of Health and Social Care, Oxford, UK

Contact address: Elizabeth R Cluett, School of Health Sciences , University of Southampton, Nightingale Building (67), Highfield, Southampton, Hants, SO17 1BJ, UK. e.cluett@soton.ac.uk. (Editorial group: Cochrane Pregnancy and Childbirth Group.)

Cochrane Database of Systematic Reviews, Issue 2, 2009 (Status in this issue: New search for studies completed, conclusions not changed, commented)
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
DOI: 10.1002/14651858.CD000111.pub3
This version first published online: 15 April 2009 in Issue 2, 2009. Last assessed as up-to-date: 19 November 2008. (Help document - Dates and Statuses explained).

This record should be cited as: Cluett ER, Burns E. Immersion in water in labour and birth. Cochrane Database of Systematic Reviews 2009, Issue 2. Art. No.: CD000111. DOI: 10.1002/14651858.CD000111.pub3.
--------------------------------------------------------------------------------


Abstract


Background
Enthusiasts suggest that labouring in water and waterbirth increase maternal relaxation, reduce analgesia requirements and promote a midwifery model of care. Sceptics cite the possibility of neonatal water inhalation and maternal/neonatal infection.


Objectives
To assess the evidence from randomised controlled trials about immersion in water during labour and waterbirth on maternal, fetal, neonatal and caregiver outcomes.


Search strategy
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (October 2008).


Selection criteria
Randomised controlled trials comparing any bath tub/pool with no immersion during labour and/or birth.


Data collection and analysis
We assessed trial eligibility and quality and extracted data independently. One review author entered data and another checked for accuracy.


Main results
This review includes 11 trials (3146 women); eight related to the first stage of labour, one to the first and second stages, one to early versus late immersion in the first stage of labour, and another to the second stage. We identified no trials evaluating different baths/pools, or the management of third stage of labour.

Results for the first stage of labour showed there was a significant reduction in the epidural/spinal/paracervical analgesia/anaesthesia rate amongst women allocated to water immersion compared to controls (478/1254 versus 529/1245; odds ratio (OR) 0.82, 95% confidence interval (CI) 0.70 to 0.98, six trials). There was no difference in assisted vaginal deliveries (OR 0.84, 95% CI 0.66 to 1.06, seven trials), caesarean sections (OR 1.23, 95% CI 0.86 to 1.75, eight trials), perineal trauma or maternal infection. There were no differences for Apgar score less than seven at five minutes (OR 1.59, 95% CI 0.63 to 4.01, five trials), neonatal unit admissions (OR 1.06, 95% CI 0.70 to 1.62, three trials), or neonatal infection rates (OR 2.01, 95% CI 0.50 to 8.07, five trials).

A lack of data for some comparisons prevented robust conclusions. Further research is needed.


Authors' conclusions
Evidence suggests that water immersion during the first stage of labour reduces the use of epidural/spinal analgesia. There is limited information for other outcomes related to water use during the first and second stages of labour, due to intervention and outcome variability. There is no evidence of increased adverse effects to the fetus/neonate or woman from labouring in water or waterbirth. The fact that use of water immersion in labour and birth is now a widely available care option for women threatens the feasibility of a large, multicentre randomised controlled trial.


--------------------------------------------------------------------------------

Plain language summary

Immersion in water in labour and birth
Immersion in water during the first stage of labour significantly reduces women's perception of pain and use of epidural/spinal analgesia.

Eleven trials were of an adequate quality to include in this review. Of these, six reported that water immersion during the first stage of labour significantly reduced epidural/spinal analgesia requirements, without adversely affecting labour duration, operative delivery rates, or neonatal wellbeing. One study showed that immersion in water during the second stage of labour increased women's reported satisfaction with pushing. Further research is needed to assess the effect of immersion in water on neonatal and maternal morbidity. No trials could be located that assessed the immersion of women in water during the third stage of labour, or evaluating different types of pool/bath.






--------------------------------------------------------------------------------


About Wiley InterScience | About Wiley | Privacy | Terms & Conditions
Copyright© 1999-2009 John Wiley & Sons, Inc. All rights reserved.