Snapp Carol, Stapleton Susan Rutledge, Wright Jennifer, Niemczyk Nancy A, Jolles Diana
Prisma Health-Upstate, Greenville, South Carolina (Dr Snapp); American Association of Birth Centers, Perkiomenville, Pennsylvania (Dr Stapleton and Ms Wright); Department of Health Promotion and Development, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Niemczyk); and Frontier Nursing University, Hyden, Kentucky (Dr Jolles).
J Perinat Neonatal Nurs. 2020 Jan/Mar;34(1):16-26. doi: 10.1097/JPN.0000000000000450.
Consumer demand for water birth has grown within an environment of professional controversy. Access to nonpharmacologic pain relief through water immersion is limited within hospital settings across the United States due to concerns over safety. The study is a secondary analysis of prospective observational Perinatal Data Registry (PDR) used by American Association of Birth Center members (AABC PDR). All births occurring between 2012 and 2017 in the community setting (home and birth center) were included in the analysis. Descriptive, correlational, and relative risk statistics were used to compare maternal and neonatal outcomes. Of 26 684 women, those giving birth in water had more favorable outcomes including fewer prolonged first- or second-stage labors, fetal heart rate abnormalities, shoulder dystocias, genital lacerations, episiotomies, hemorrhage, or postpartum transfers. Cord avulsion occurred rarely, but it was more common among water births. Newborns born in water were less likely to require transfer to a higher level of care, be admitted to a neonatal intensive care unit, or experience respiratory complication. Among childbearing women of low medical risk, personal preference should drive utilization of nonpharmacologic care practices including water birth. Both land and water births have similar good outcomes within the community setting.
在专业领域存在争议的背景下，消费者对水中分娩的需求有所增长。由于对安全性的担忧，在美国各地的医院环境中，通过水浸获得非药物性疼痛缓解的方式受到限制。该研究是对美国分娩中心协会成员使用的前瞻性观察性围产期数据登记处（AABC PDR）进行的二次分析。分析纳入了2012年至2017年在社区环境（家庭和分娩中心）发生的所有分娩。使用描述性、相关性和相对风险统计数据来比较母婴结局。在26684名妇女中，水中分娩的妇女有更有利的结局，包括第一产程或第二产程延长、胎儿心率异常、肩难产、生殖器撕裂、会阴切开术、出血或产后转诊的情况更少。脐带撕裂很少发生，但在水中分娩中更常见。水中出生的新生儿需要转至更高护理级别的可能性较小，入住新生儿重症监护病房的可能性较小，或出现呼吸并发症的可能性较小。在低医疗风险的育龄妇女中，个人偏好应推动包括水中分娩在内的非药物护理方法的使用。在社区环境中，陆地分娩和水中分娩都有相似的良好结局。
