Adverse Outcomes from vaginal delivery during immersion in water versus traditional vaginal delivery




Combs, Shanna
Shillington, Amelle
Felini, Martha
Donaldson, Kathleen
Lopez, Tania
Hicks, Candis
Griffith, Lindsay
Cochrane, Cindy
Zimmerman, Leah


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Hypothesis: There are no adverse events examining four years of hospital midwifery vaginal delivery during immersion in water versus traditional vaginal delivery. At our institution, our Certified Nurse Midwife practice has been practicing vaginaldeliveries via immersion in water since 2008. In light of the ACOG committee opinion 594, we conducted a matched-pair analysis to compare the frequency of adverse events during immersion in water vs traditional vaginal delivery. Materials and Methods: A retrospective chart review was conducted for deliveries occurring at a single urban hospital from 2010 – 2014. Deliveries were grouped into waterbirths and landbirths. Women who had a waterbirth were matched by parity and gestational age to women having a traditional vaginal delivery. Adverse outcomes assessed included lacerations, episiotomy, hemorrhage, APGAR score, shoulder dystocia, and NICU admission. Conditional logistic regression was used to estimate adjusted odds ratios (AOR) and 95% confidence intervals (95% CI). Results: Of the 149 matched pairs assessed, the median age was 28; 71% were Caucasian and 20% were Hispanic. Women were similar across delivery groups in age, race, chronic conditions, and number of previous preterm births. The odds of a laceration during waterbirth delivery were observed to be 90% lower when compared with landbirth (AOR = 0.10, 95% CI: 0.01 – 0.78). Likewise, a poor 1 minute APGAR ( Conclusion: This study suggests that there were fewer lacerations and higher 1-minute APGAR scores among waterbirth deliveries.