爱尔兰产科环境中分娩时浸水与标准护理的前瞻性队列研究。
Prospective cohort study of water immersion for labour and birth compared with standard care in an Irish maternity setting.
机构信息
Midwifery, Coombe Women and Infants University Hospital, Dublin, Ireland.
National Clinical Programme for Obstetrics & Gynaecology/National Women & Infants Health Programme, Coombe Women's Hospital, Dublin, Ireland.
出版信息
BMJ Open. 2020 Dec 4;10(12):e038080. doi: 10.1136/bmjopen-2020-038080.
OBJECTIVE
To examine the birth outcomes for women and babies following water immersion for labour only, or for labour and birth.
DESIGN
Prospective cohort study.
SETTING
Maternity hospital, Ireland, 2016-2019.
PARTICIPANTS
A cohort of 190 low-risk women who used water immersion; 100 gave birth in water and 90 laboured only in water. A control group of 190 low-risk women who received standard care.
METHODS
Logistic regression analyses examined associations between water immersion and birth outcomes adjusting for confounders. A validated Childbirth Experience Questionnaire was completed.
MAIN OUTCOME MEASURES
Perineal tears, obstetric anal sphincter injuries (OASI), postpartum haemorrhage (PPH), neonatal unit admissions (NNU), breastfeeding and birth experiences.
RESULTS
Compared with standard care, women who chose water immersion had no significant difference in perineal tears (71.4% vs 71.4%, adj OR 0.83; 95% CI 0.49 to 1.39) or in OASI (3.3% vs 3.8%, adj OR 0.91; 0.26-2.97). Women who chose water immersion were more likely to have a PPH ≥500 mL (10.5% vs 3.7%, adj OR 2.60; 95% CI 1.03 to 6.57), and to exclusively breastfeed at discharge (71.1% vs 45.8%, adj OR 2.59; 95% CI 1.66 to 4.05). There was no significant difference in NNU admissions (3.7% vs 3.2%, adj OR 1.06; 95% CI 0.33 to 3.42). Women who gave birth in water were no more likely than women who used water for labour only to require perineal suturing (64% vs 80.5%, adj OR 0.63; 95% CI 0.30 to 1.33), to experience OASI (3.0% vs 3.7%, adj OR 1.41; 95% CI 0.23 to 8.79) or PPH (8.0% vs 13.3%, adj OR 0.73; 95% CI 0.26 to 2.09). Women using water immersion reported more positive memories than women receiving standard care (p<0.01).
CONCLUSIONS
Women choosing water immersion for labour or birth were no more likely to experience adverse birth outcomes than women receiving standard care and rated their birth experiences more highly.
目的
研究仅用于分娩或分娩和分娩的水中浸泡对妇女和婴儿的分娩结果。
设计
前瞻性队列研究。
地点
爱尔兰的一家产科医院，2016-2019 年。
参与者
190 名低风险使用水浸的妇女；100 人在水中分娩，90 人仅在水中分娩。190 名接受标准护理的低风险对照组妇女。
方法
使用逻辑回归分析调整混杂因素后，检查水浸与分娩结果之间的关联。完成了经过验证的分娩体验问卷。
主要观察指标
会阴撕裂、产科肛门括约肌损伤（OASI）、产后出血（PPH）、新生儿病房入院（NNU）、母乳喂养和分娩体验。
结果
与标准护理相比，选择水浸的妇女会阴撕裂（71.4%对 71.4%，调整后 OR 0.83；95%CI 0.49 至 1.39）或 OASI（3.3%对 3.8%，调整后 OR 0.91；0.26 至 2.97）无显著差异。选择水浸的妇女更有可能发生 PPH≥500ml（10.5%对 3.7%，调整后 OR 2.60；95%CI 1.03 至 6.57），且出院时纯母乳喂养（71.1%对 45.8%，调整后 OR 2.59；95%CI 1.66 至 4.05）。NNU 入院（3.7%对 3.2%，调整后 OR 1.06；95%CI 0.33 至 3.42）无显著差异。在水中分娩的妇女与仅在水中分娩的妇女相比，需要会阴缝合的可能性更小（64%对 80.5%，调整后 OR 0.63；95%CI 0.30 至 1.33），发生 OASI（3.0%对 3.7%，调整后 OR 1.41；95%CI 0.23 至 8.79）或 PPH（8.0%对 13.3%，调整后 OR 0.73；95%CI 0.26 至 2.09）的可能性更小。使用水浸的妇女比接受标准护理的妇女报告了更多积极的记忆（p<0.01）。
结论
选择水浸分娩或分娩的妇女与接受标准护理的妇女相比，不良分娩结果的可能性没有增加，并且对分娩体验的评价更高。
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