Lukasse Mirjam, Rowe Rachel, Townend John, Knight Marian, Hollowell Jennifer
Department of Public Health and General Practice at the Faculty of Medicine, The Norwegian University of Science and Technology (NTNU), Håkon Jarls gate 11, N-7489 Trondheim, Norway.
BMC Pregnancy Childbirth. 2014 Feb 6;14:60. doi: 10.1186/1471-2393-14-60.
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.
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.
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.
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.
分娩期间浸入水中是一种重要的非药物性缓解分娩疼痛的方法，尤其是在助产主导的护理环境中，药物性方法有限。本研究调查了为缓解疼痛而浸入水中与产前转院及其他产妇结局之间的关联。
对2008年4月至2010年4月期间计划在英格兰家中、独立助产单元（FMU）或附属助产单元（AMU）分娩的16577名低风险初产妇进行了一项前瞻性队列研究。
为缓解疼痛而浸入水中的情况很常见；计划在家中分娩的产妇中有50%，在FMU中有54%，在AMU中有38%。对于计划在家中分娩的产妇，浸入水中与产前转院风险较低相关（调整后RR为0.88；95%CI为0.79 - 0.99），在FMU中（调整后RR为0.59；95%CI为0.50 - 0.70）以及在AMU中（调整后RR为0.78；95%CI为0.69 - 0.88）。对于计划在FMU分娩的产妇，浸入水中与产时剖宫产风险较低相关（RR为0.61；95%CI为0.44 - 0.84）以及顺产机会较高相关（RR为1.09；95%CI为1.04 - 1.15）。在计划在家中或AMU分娩的产妇中未观察到这些有益效果。
对于初产妇，为缓解疼痛而浸入水中与产前转院风险显著降低相关。总体而言，浸入水中与分娩期间较少的干预措施相关。这种效果在不同的分娩环境中有所不同，在计划在家中分娩时效果最小，而在计划在FMU分娩时观察到的效果更大。
