Is waterbirth safe?

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The current stance of the American Academy of Pediatrics and ACOG support the use of hydrotherapy during labor, but not for the birth. Several studies including a Cochrane Review have concluded that it is safe for both the birthing parent, and the baby. Unfortunately those studies were done in European countries. So they hold little weight here. But, in 2016 the Journal of Midwifery and Women’s Health published a study compiling data from the Midwives Alliance of North America (MANA) Statistics Project 2004 to 2009 cohort. MANA Stats is an ongoing web-based form of data collection that midwives use to report birth information. To prevent falsified reporting midwives must enter their clients in the MANA Stats database near the onset of care and will continue to report until the final visit. Usually at 6 weeks postpartum (Bovbjerg, Cheyney & Everson, 2016).

For the purposes of this study Bovbjerg, et al. drew from the MANA Stats 2004 to 2009 cohort to evaluate the safety of waterbirth both maternally, and on neonates. They specifically focused only on births in a free-standing birth centers or at home. They did not include clients who may have transferred prenatally or intrapartum, likely due to their elevated risk and lack of opportunity for a waterbirth in the hospital. Of the free-standing birth center and home birth groups they divided the information further; non-waterbirth, waterbirth and intended waterbirth (2016).

A total of 18,355 pregnancies and 18,409 newborns were included in their data. 10,252 birthing individuals (10,290 newborns) did not give birth in the water and had not planned to give birth in the water. 6521 parents did give birth in the water (6534 newborns). 1570 parents (1573 newborns) intended to give birth in the water, but did not (Bovbjerg, et al., 2016).

Researchers found that the waterbirth group had the best neonatal outcomes but had worse genital tract trauma than the non-waterbirth group. The intended waterbirth group had the highest rates negative maternal outcomes and highest rates negative of neonatal outcomes. The non-waterbirth group was about in the middle of the two. Researchers suggested that the high levels of negative outcomes in the intended waterbirth group is due to the elevated risk that occurred requiring them to get out of the water and that the non-waterbirth group consisted of individuals with the same level of risk as the intended waterbirth group and of the waterbirth group. In the waterbirth group researchers did not find neonatal adverse outcomes or maternal adverse outcomes caused by waterbirth and concluded that waterbirth is a safe option in low-risk birthing parents in a low-intervention setting (Bovbjerg, et al., 2016).

The information in this article was very clear in laying out the what’s and why’s of the data. I found it helpful that it did address the neonatal deaths and their causes. It also identified the other studies that have been done on this topic, specifically a Cochrane Review. While the numbers alone would make it appear that waterbirth was the safest option, the authors did acknowledge the fact that the non-waterbirth group consisted of individuals who would be capable of having a waterbirth if they wanted one and of individuals who would likely be asked to get out of the water due to elevating risk factors. I was left curios about the rates of postpartum hemorrhage in the different groups. I would also be interested in seeing the rates of hearing screens at 24 hours for neonates born in the water vs neonates born on land. 

I am very fortunate to live in a community where even hospitals are starting to become more open to the idea of waterbirth (St. Joseph's Memorial Hospital) due to the evolving information becoming available. I think that studies like this one help to pave the way for more people to have options and for more providers to become comfortable with the idea of waterbirth.

References

Bovbjerg, M. L., Cheyney, M. & Everson, C. (2016) Maternal and newborn outcomes following waterbirth: The midwives alliance of north america statistics project, 2004 to 2009 cohort. Journal of Midwifery & Womens Health. 61, 11-20. doi: 10.1111/jmwh12394