Epidemiology Program, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA.
Department of Anthropology, Oregon State University, Corvallis, OR, USA.
BJOG. 2022 May;129(6):950-958. doi: 10.1111/1471-0528.17009. Epub 2021 Dec 1.
Investigate maternal and neonatal outcomes following waterbirth.
Retrospective cohort study, with propensity score matching to address confounding.
Community births, United States.
Medical records-based registry data from low-risk births were used to create waterbirth and land birth groups (n = 17 530 each), propensity score-matched on >80 demographic and pregnancy risk covariables.
Logistic regression models compared outcomes between the matched waterbirth and land birth groups.
Maternal: immediate postpartum transfer to a hospital, any genital tract trauma, severe (3rd/4th degree) trauma, haemorrhage >1000 mL, diagnosed haemorrhage regardless of estimated blood loss, uterine infection, uterine infection requiring hospitalisation, any hospitalisation in the first 6 weeks. Neonatal: umbilical cord avulsion; immediate neonatal transfer to a hospital; respiratory distress syndrome; any hospitalisation, neonatal intensive care unit (NICU) admission, or neonatal infection in the first 6 weeks; and neonatal death.
Waterbirth was associated with improved or no difference in outcomes for most measures, including neonatal death (adjusted odds ratio [aOR] 0.56, 95% CI 0.31-1.0), and maternal or neonatal hospitalisation in the first 6 weeks (aOR 0.87, 95% CI 0.81-0.92 and aOR 0.95, 95% CI 0.90-0.99, respectively). Increased morbidity in the waterbirth group was observed for two outcomes only: uterine infection (aOR 1.25, 95% CI 1.05-1.48) (but not hospitalisation for infection) and umbilical cord avulsion (aOR 1.57, 95% CI 1.37-1.82). Our results are concordant with other studies: waterbirth is neither as harmful as some current guidelines suggest, nor as benign as some proponents claim.
New study demonstrates #waterbirth is neither as harmful as some current guidelines suggest, nor as benign as some proponents claim. @TheUpliftLab @BovbjergMarit @31415926abc @NICHD_NIH.
研究水中分娩的母婴结局。
回顾性队列研究，采用倾向评分匹配来解决混杂因素。
美国社区分娩。
利用基于病历的低危分娩登记数据，创建水中分娩组和陆地分娩组（每组 17530 例），并在 80 多个人口统计学和妊娠风险协变量上进行倾向评分匹配。
使用逻辑回归模型比较匹配后的水中分娩组和陆地分娩组的结局。
产妇：产后立即转院、任何生殖道创伤、严重（3 度/4 度）创伤、出血>1000ml、无论估计失血量多少均诊断为出血、子宫感染、需要住院治疗的子宫感染、分娩后 6 周内任何住院治疗。新生儿：脐脱垂；新生儿立即转院至医院；呼吸窘迫综合征；分娩后 6 周内任何住院治疗、新生儿重症监护病房（NICU）入院或新生儿感染；新生儿死亡。
水中分娩与大多数结局的改善或无差异相关，包括新生儿死亡（调整后的优势比[aOR]0.56，95%CI0.31-1.0），以及产妇或新生儿在分娩后 6 周内住院（aOR0.87，95%CI0.81-0.92 和 aOR0.95，95%CI0.90-0.99）。仅观察到水中分娩组有两个结局的发病率增加：子宫感染（aOR1.25，95%CI1.05-1.48）（但不包括感染住院治疗）和脐脱垂（aOR1.57，95%CI1.37-1.82）。我们的结果与其他研究一致：水中分娩既不像一些现行指南所暗示的那样有害，也不像一些支持者所声称的那样无害。
