Safely Into Water
Research Citations

Given the limited space available in the film format, exact wording could not always be preserved. Similar research findings have been summarised together in the text. BirthRite believes it has been faithful to the intent of the authors in its citation, but no valid inference about the quality of the research methods used can be made from the mere fact of such citation. BirthRite encourages viewers to exercise due caution regarding the interpretation and applicability of all medical research.

By The Spring

Waterbirths pose no thermal risk. The parturient, with her “inborn code of body temperature regulation”, regulates water temperature and bathing duration to ensure body temperatures of mother and child remain within the physiological range. Cumbersome guidelines for water temperature and bathing duration during or after labour are therefore superfluous.

Geissbuehler V; Eberhardt J; Lebrecht A. Waterbirth: water temperature and bathing duration — mother knows best! 8 year prospective study. Journal of Perinatal Medicine, vol 30, no 5, 2002, pp 371–378

According to available evidence, there is no reason to worry overmuch about water temperature other than for the comfort of the mother.

Harper B. Taking the plunge: re-evaluating waterbirth temperature guidelines. MIDIRS Digest, vol 12, no 4, December 2002, pp 506–508

Creek Rising

Waterbirth is particularly beneficial in respect of the minimal use of pharmacological analgesics.

Garland D; Jones K. Waterbirth: supporting practice with clinical audit. MIDIRS Digest, vol 10, no 3, September 2000, pp 333–336

Waterbirth outcomes were seen to be preferable in relation to minimal use of analgesics, avoidance of episiotomy, and preservation of intact perineum.

Jones K. Collaborative birth audit 1998: Comparing waterbirth with dry birth. Maidstone: Mid Kent Healthcare Trust Midwifery Practice and Research Unit, 1999. 21 pages

Women randomised to immersion in water had a lower rate of epidural analgesia than women allocated to augmentation. Significantly fewer needed augmentation of labour or any form of obstetric intervention (ie, amniotomy, oxytocin, epidural or operative delivery).

Cluett ER; Pickering RM; Getliffe K; St George Saunders NJ. Randomised controlled trial of labouring in water compared with standard of augmentation for management of dystocia in first stage of labour. BMJ, doi: 10.1136/bmj.37963.606412. EE January 2004

The Rapids

Waterbirth is a consumer trend. Most women desired waterbirths as they thought it was a natural, drug-free method and would be a less painful birth. They also wanted a gentle delivery for the baby. Women felt more in control of their environment in water and particularly liked the relaxing, calming quality of water, the physical support it gave them and being able to hold their babies immediately after birth.

Richmond H. Women’s experience of waterbirth. Practising midwife, vol 6, no 3, March 2003, pp 26–31

Bursting The Dam

The essential hands-off (the perineum) technique for this type of birth is strongly encouraged.

McCloghry K. Edgeware Birth Centre: A waterbirth experience. BMJ, vol 11, no 5, May 2003, pp 314–316

Waterbirth is particularly beneficial in respect of the avoidance of episiotomy and the preservation of intact perinea.

Garland D; Jones K. Waterbirth: supporting practice with clinical audit. MIDIRS Digest, vol 10, no 3, September 2000, pp 333–336

Waterbirth outcomes were seen to be preferable in relation to minimal use of analgesics, avoidance of episiotomy and preservation of intact perineum.

Jones K. Collaborative birth audit 1998: Comparing waterbirth with dry birth. Maidstone: Mid Kent Healthcare Trust Midwifery Practice and Research Unit, 1999. 21 pages

Significantly more intact perinea in water group. Maternal satisfaction high in water group.

Rush et al. The effects of whirlpool baths in labour. Intent-to-treat design. Birth 23 (3), 1996, pp136–143

Perineal trauma higher in bed group.

Bourke E; Kilfolyle A. Retrospective comparative study of waterbirth and bedbirth. Midwives Journal, January 1995, pp 3–7

Surfacing

Labouring in water under midwifery care may be an option for slow progress in labour, reducing the need for obstetric intervention and offering alternative pain management strategies. Augmentation of labour — in particular, oxytocin administration — is associated with hyperstimulation and decreased maternal satisfaction.

Cluett ER; Pickering RM; Getliffe K; St George Saunders NJ. Randomised controlled trial of labouring in water compared with standard of augmentation for management of dystocia in first stage of labour. BMJ, doi: 10.1136/bmj.37963.606412.EE January 2004,

Referral to Neonatal Care Unit did not vary between cases and controls. No significant difference in Apgar scores at 5 mins, cephalic hematoma, fractured clavicles, neonatal distress, tachypnea, jaundice, seizures. Taking a warm tub bath during labour has no significant detrimental effects.

Ohlsson G et al. Are there any detrimental effects of immersion in water during labour? Intent-to-treat design. Acta Obstetricia et Gynecologica Scandinavica 80, 2001, pp311–314

No case of water aspiration, or any other perinatal complication of mother or child which might be water-related, was reported. Waterbirths do not demonstrate higher birth risks for mother or child than other forms of birth, if the same medical criteria are used in the monitoring, as well as in the management, of the birth.

Geissbuehler V; Eberhardt J. Clinic for Obstetrics and Gynecology, Thurgauisches Katonsspital, Frauenfeld, Switzerland. Waterbirths: A comparative study. A prospective study on more than 2000 waterbirths. Fetal Diagnosis Ther 2000 Oct; 15 (5): 291–300

Of 4032 reviewed waterbirths, no deaths were attributable to delivery in water.

Gilbert RE; Tookey PA. Perinatal mortality and morbidity among babies delivered in water: surveillance study and postal survey. BMJ 1999; 319: 483–487

The Voyage Begins

In 2000 waterbirths, there were significantly fewer episiotomies compared with other birthing positions. Blood loss was lowest in waterbirth group. Less pain relief was used. Maternal satisfaction was high. Arterial blood pH and Apgar scoring after 5 and 10 minutes were significantly higher.

Geissbuehler V; Eberhardt J. Clinic for Obstetrics and Gynecology, Thurgauisches Katonsspital, Frauenfeld, Switzerland. Waterbirths: A comparative study. A prospective study on more than 2000 waterbirths. Fetal Diagnosis Ther 2000 Oct; 15 (5): 291–300

Casting Off

Blood loss was lowest in the waterbirth group.

Geissbuehler V; Eberhardt J. Clinic for Obstetrics and Gynecology, Thurgauisches Katonsspital, Frauenfeld, Switzerland. Waterbirths: A comparative study. A prospective study on more than 2000 waterbirths. Fetal Diagnosis Ther 2000 Oct; 15 (5): 291–300

Ocean of Love

The Council recognizes that waterbirth is preferred by some women as their chosen method for delivery of their babies. Waterbirth should, therefore, be viewed as an alternative method of care and management in labour, and as one which must, therefore, fall within the duty of care and normal sphere of the practice of a midwife. Waterbirth is not considered to be a “treatment”.

Midwifery Committe of the United Kingdom Central Council for Nursing, Midwifery and Health Vision (UKCC) 1994

Similar Apgar scores. No women in the waterbirth group received any form of intervention. 100% of waterbirth women felt they were coping better with their contractions. 98% of multipara found waterbirth easier than landbirth. All waterbirth women felt they were more in control and had more freedom to move. There was high self-satisfaction at giving birth naturally without drugs.

Bourke E; Kilfolyle A. Retrospective comparative study of waterbirth and bedbirth. Midwives Journal, January 1995, pp 3–7

Plugging the Leak

Because of the diluting effect of bath water, the potential risk for HIV exposure to intact skin is minimal. The risk is low-level and unlikely.

Colombo C; Pei P; Jost J. Water births and the exposure to HIV. Pflege 2000 June; 13 (3): 152–9

Infection of the neonate after waterbirth is not increased.

Geissbuehler V; Eberhardt J. Clinic for Obstetrics and Gynecology, Thurgauisches Katonsspital, Frauenfeld, Switzerland. Waterbirths: A comparative study. A prospective study on more than 2000 waterbirths. Fetal Diagnosis Ther 2000 Oct; 15 (5): 291–300

There was no clinical significant neonatal infection. Data analysed does not suggest any increased risk of bacterial infection to the mother or baby after delivery underwater. Neonatal morbidity is rare after waterbirth in a carefully selected group of mothers and with close attention to fetal and neonatal wellbeing.

Forde C; Creighton S, Batty A; and others. Labour and delivery in the birthing pool. BMJ, vol 7, no 3, March 1999, pp 165–171

Water bathing during labour is not associated with the development of chorioamnionitis or endometriosis.

Robertson et al. Is there an association between water baths during labour and the development of chorioamnionitis or endometritis? Retrospective study. American Journal of Obstetrics and Gynecology 178 (6), 1998, pp 1215–1221

All evidence indicates that the HIV virus is susceptible to warm water and cannot live in that environment. Risk of AIDS and other STDs from swimming pools and whirlpools is nil.

Risk of AIDS and other STDs in whirlpools. Postgraduate Medicine,Vol 80 1986, no.1, p 283

Turning the Tide

Alternative birth methods are very popular. The waterbirth rates have risen steadily and stabilized at around 40–50% of the spontaneous births.

Geissbuehler V; Eberhardt J. Clinic for Obstetrics and Gynecology, Thurgauisches Katonsspital, Frauenfeld, Switzerland. Waterbirths: A comparative study. A prospective study on more than 2000 waterbirths. Fetal Diagnosis Ther 2000 Oct; 15 (5): 291–300



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