Want to promote normality? Try adding water!

small_2121437918An open access study just published in BMC Pregnancy and Childbirth by the Birthplace in England team shows that, for women having their first babies, getting into water while in labour helps in all kinds of ways and across all settings.  Analysis of data from 16,577 women showed that water immersion reduced the transfer rate for women who planned to birth at home or in freestanding or alongside midwifery units.  Furthermore, the data collected from the women who planned to give birth in freestanding midwifery units showed that using water during labour also reduced the caesarean section rate and increased their chance of having a straightforward normal birth.

The publication of this paper closely follows a study of water immersion and waterbirth in Italian obstetric units by Henderson et al (2014) also published in BMC which found that,

Overall, 95.6% of women using a birthing pool had a spontaneous vertex delivery, 63.9% of which occurred in water. Half of nulliparas and three quarters of multiparas delivered in water. Adverse maternal and neonatal outcomes were rare. There were two cases of umbilical cord snap with waterbirth. Compared with controls, significantly more women who used a birthing pool adopted an upright birth position, had hands off delivery technique, and a physiological third stage. Significantly fewer nulliparas had an episiotomy, and more had a second degree perineal tear, with no evidence of a difference for extensive perineal tears.”  (Henderson et al 2014:1)

Some groups of women in the English study were more likely to use water than others, though.  The results showed that, although immersion in water for pain relief was popular, women under 25, women who were not fluent in understanding English, women living in more deprived areas and women who were single or unsupported by their partner were less likely to use water in labour.  It’s up to midwives to consider whether this is something that we should directly try to address and, if so, how…

The Research: (provisional at the time of posting)

Background: Immersion in water during labour is an important non-pharmacological method to manage labour pain, particularly in midwifery-led care settings where pharmacological methods are limited. This study investigates the association between immersion for pain relief and transfer before birth and other maternal outcomes.

Methods: A prospective cohort study of 16,577 low risk nulliparous women planning birth at home, in a freestanding midwifery unit (FMU) or in an alongside midwifery unit (AMU) in England between April 2008 and April 2010.

Results: Immersion in water for pain relief was common; 50% in planned home births, 54% in FMUs and 38% in AMUs. Immersion in water was associated with a lower risk of transfer before birth for births planned at home (adjusted RR 0.88; 95% CI 0.79-0.99), in FMUs (adjusted RR 0.59; 95% CI 0.50-0.70) and in AMUs (adjusted RR 0.78; 95% CI 0.69-0.88). For births planned in FMUs, immersion in water was associated with a lower risk of intrapartum caesarean section (RR 0.61; 95% CI 0.44-0.84) and a higher chance of a straightforward vaginal birth (RR 1.09; 95% CI 1.04-1.15). These beneficial effects were not seen in births planned at home or AMUs.

Conclusion: Immersion of water for pain relief was associated with a significant reduction in risk of transfer before birth for nulliparous women. Overall, immersion in water was associated with fewer interventions during labour. The effect varied across birth settings with least effect in planned home births and a larger effect observed for planned FMU births.

Lukasse M, Rowe R, Townend J, Knight M and Hollowell J (2014).  Immersion in water for pain relief and the risk of intrapartum transfer among low risk nulliparous women: secondary analysis of the birthplace national prospective cohort study. BMC Pregnancy and Childbirth 2014:60  doi:10.1186/1471-2393-14-60
photo credit: Fadzly @ Shutterhack via photopin cc

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