Factors Associated With Normal Physiologic Birth for Women Who Labor In Water: A Secondary Analysis of A Prospective Observational Study.
Jane Carpenter, Ethel Burns, Lesley Smith
PMID 35029843WHAT IT FOUND
Among 8064 low-risk women who labored in water, 71.4% had a spontaneous unassisted vaginal birth without epidural, spinal, general anesthetic, or episiotomy.
Planned community or midwifery-led birth was linked to higher likelihood; oxytocin augmentation and longer second stage to lower likelihood.
Key findings
01After removing ineligible and incomplete cases, 8064 women were analyzed, and 5758 (71.4%) had a normal physiologic birth.
02Planned birth in a community setting or an alongside midwifery unit was associated with higher likelihood of normal physiologic birth.
03Oxytocin augmentation, opioid or nonopioid analgesia, maternal age under 25 years, longer time in the pool, longer second stage, and heavier neonatal birth weight were associated with lower likelihood of normal physiologic birth.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was an observational study, so it can show associations but cannot prove that any factor caused normal physiologic birth. The data were collected between 2000 and 2008 and are now more than 10 years old. Only women considered low risk of childbirth complication were included, so results may not apply to women with obstetric or clinical complications. There was no comparator group of low-risk women who did not labor in water. Some potentially important variables were not included, such as continuity of care, accoucheur experience, ethnicity, and body mass index. Waterbirth was included in the model, but women who intended a waterbirth and then exited the pool were not distinguished, which may bias the waterbirth finding.
Declared interests
The authors have no conflicts of interest to disclose.
The easy way to misread this
Do not conclude that waterbirth, planned community birth, or avoiding oxytocin causes a normal physiologic birth. This was an observational study with no comparator group of low-risk women who did not labor in water, and the authors state that causality cannot be inferred.