The Ohio State University College of Medicine, Columbus, Ohio.
Center for Research and Health Analytics, The Ohio State University College of Nursing, Columbus, Ohio.
J Midwifery Womens Health. 2020 Mar;65(2):216-223. doi: 10.1111/jmwh.13033. Epub 2019 Sep 6.
Although the safety of water immersion during labor is largely supported by evidence from research, the risks to women and neonates during waterbirth are not well established. The purpose of this study was to generate evidence regarding maternal and neonatal outcomes related to water immersion in labor and during birth.
A retrospective cohort study included a convenience sample of women receiving prenatal care at a nurse-midwifery practice. Participants were categorized into 3 groups: 1) waterbirth, 2) water labor, or 3) neither. Participant characteristics, maternal outcomes, and newborn outcomes were collected at time of birth and health record abstraction. At the 6-week postpartum visit, another maternal outcome, satisfaction with birth, was measured using the Care in Obstetrics: Measure for Testing Satisfaction (COMFORTS) scale. Analysis included effect size, descriptive statistics (sample characteristics), and maternal and neonatal group differences (analysis of variance and chi-square) with a significance level of P < .05.
Women in the waterbirth (n = 58), water labor (n = 61), and neither (n = 111) groups were primarily white, married, and college educated and did not differ by age or education. Women in the waterbirth group were more likely to be multiparous. Nulliparous women who had a waterbirth had a significantly shorter second stage of labor than nulliparous women who did not have a waterbirth (P = .03). The most commonly cited reasons for discontinuation of hydrotherapy were maternal choice (42.6%) and need for pain medication (29.5%). Significantly more women in the waterbirth group experienced a postpartum hemorrhage, compared with water labor or neither (n = 5, n = 3, n = 1, respectively; P = .045); there was no difference in related clinical measures. Neonatal outcomes were not significantly different. Maternal satisfaction was high across all groups.
The results of this study suggest that waterbirth, attended by qualified intrapartum care providers in hospital settings in the United States, is a reasonable option for low-risk women and their neonates.
尽管大量研究证据表明水中分娩是安全的，但水中分娩对产妇和新生儿的风险尚未得到充分证实。本研究旨在为与分娩期间水中分娩和水中待产相关的母婴结局提供证据。
这是一项回顾性队列研究，纳入了在一家助产士执业机构接受产前护理的便利样本女性。参与者分为三组：1）水中分娩，2）水中待产，或 3）两者都没有。在分娩时和病历摘录时收集参与者特征、产妇结局和新生儿结局。在产后 6 周就诊时，使用产科舒适度量表（COMFORTS）再次测量产妇对分娩的满意度。分析包括效应大小、描述性统计（样本特征）以及产妇和新生儿组差异（方差分析和卡方检验），显著性水平为 P <.05。
水中分娩组（n = 58）、水中待产组（n = 61）和两者都没有组（n = 111）的女性主要为白人、已婚、大学学历，且年龄和受教育程度无差异。水中分娩组的产妇多为经产妇。与未水中分娩的初产妇相比，水中分娩的初产妇第二产程明显更短（P =.03）。停止水中分娩治疗的最常见原因是产妇选择（42.6%）和需要止痛药（29.5%）。水中分娩组的产妇发生产后出血的比例明显高于水中待产组或两者都没有组（分别为 n = 5、n = 3、n = 1；P =.045）；但相关临床指标无差异。新生儿结局无显著差异。所有组的产妇满意度均较高。
本研究结果表明，在美国医院环境中，由合格的产时护理提供者提供的水中分娩，是低风险产妇及其新生儿的合理选择。
