Department of Clinical Science and Education, Karolinska Institute, Stockholm, Sweden.
Sophiahemmet University, Stockholm, Sweden.
Acta Obstet Gynecol Scand. 2018 Mar;97(3):341-348. doi: 10.1111/aogs.13286. Epub 2018 Jan 17.
The literature describes advantages for mothers giving birth in water, but waterbirth is controversial in Sweden and has not been offered at hospitals until recently. This study aimed to describe and compare the characteristics and outcome of waterbirths with those of spontaneous vaginal births at the same clinics.
A retrospective cohort study was conducted on all waterbirths at two maternity units in Sweden from March 2014 to November 2015 (n = 306), and a consecutively selected comparison group of 306 women having conventional spontaneous vaginal births. Logistic regression was used to analyze the primary outcome; second-degree perineal tears.
Women giving birth in water had a lower risk of second-degree perineal tears [adjusted odds ratio (aOR) 0.6, 95% confidence interval (CI) 0.4-0.9]). Their labor was shorter (6 h 3 min vs. 7 h 52 min) and there were significantly fewer interventions than in the comparison group; amniotomy (13.7 vs. 35.3%), internal cardiotocography (11.1 vs. 56.8%), and augmentation with oxytocin (5.2 vs. 31.3%). There were no differences in Apgar scores or admissions to neonatal intensive care unit. The experience of childbirth, measured with a numeric rating scale, was higher in the waterbirth group indicating a more positive birth experience. Three newborns born in water had an umbilical cord avulsion.
In this low-risk population, waterbirth is associated with positive effects on perineal tears, the frequency of interventions, the duration of labor and women's birth experience. Midwives handling waterbirth should be aware of the risk of umbilical cord avulsion.
文献描述了母亲水中分娩的优势，但在瑞典，水中分娩颇具争议，直到最近才在医院提供。本研究旨在描述和比较同一诊所的水中分娩与自然阴道分娩的特征和结局。
对瑞典两家产科单位 2014 年 3 月至 2015 年 11 月期间所有的 306 例水中分娩（n=306）进行了回顾性队列研究，并对连续选择的 306 例自然阴道分娩的常规对照组进行了比较。采用逻辑回归分析主要结局：二度会阴撕裂。
水中分娩的女性发生二度会阴撕裂的风险较低[调整后的优势比（aOR）0.6，95%置信区间（CI）0.4-0.9]。她们的分娩时间更短（6 小时 3 分钟 vs. 7 小时 52 分钟），干预措施明显少于对照组；人工破膜（13.7% vs. 35.3%）、内胎心监护（11.1% vs. 56.8%）和催产素引产（5.2% vs. 31.3%）。两组新生儿的 Apgar 评分或新生儿重症监护病房入院率均无差异。采用数字评分量表测量的分娩体验在水中分娩组更高，表明分娩体验更为积极。3 名在水中分娩的新生儿发生脐带脱垂。
在这一低风险人群中，水中分娩与会阴撕裂程度、干预频率、分娩时间和产妇分娩体验的积极影响相关。处理水中分娩的助产士应意识到脐带脱垂的风险。
