INTRODUCTION 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. METHODS 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. RESULTS 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. DISCUSSION 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.

Water immersion is a valuable comfort measure in labor, that can be used during the first or second stage of labor. Case reports of adverse outcomes create suspicion about water birth safety, which restricts the availability of water birth in the United States. The objective of this study was to synthesize the information from case reports of adverse water birth events to identify practices associated with these outcomes, and to identify patterns of negative outcomes. The research team conducted a systematic search for cases reports of poor neonatal outcomes with water immersion. Eligible manuscripts reported any adverse neonatal outcome with immersion during labor or birth; or excluded if no adverse outcome was reported or the birth reported was unattended. A qualitative narrative synthesis was conducted to identify patterns in the reports. There were 47 cases of adverse outcomes from 35 articles included in the analysis. There was a pattern of cases of Pseudomonas and Legionella, but other infections were uncommon. There were cases of unexplained neonatal hyponatremia following water birth that need further investigation to determine the mechanism that contributes to this complication. The synthesis was limited by reporting information of interest to pediatricians with little information about water birth immersion practices. These data did not support concerns of water aspiration or cord rupture, but did identify other potential risks. Water immersion guidelines need to address infection risk, optimal management of compromised water-born infants, and the potential association between immersion practice and hyponatremia.

Background The increasing demand for childbirth care based on physiological principles has led official bodies to encourage health centers to provide evidence-based care aimed at promoting women’s participation in informed decision-making and avoiding excessive medical intervention during childbirth. One of the goals is to reduce pain and find alternative measures to epidural anesthesia to enhance women’s autonomy and well-being during childbirth. Currently, water immersion is used as a non-pharmacological method for pain relief. This review aimed to identify and synthesize evidence on women’s and midwives’ experiences, values, and preferences regarding water immersion during childbirth. Methods A systematic review and thematic synthesis of qualitative evidence were conducted. Databases were searched and references were checked according to specific criteria. Studies that used qualitative data collection and analysis methods to examine the opinions of women or midwives in the hospital setting were included. Non-qualitative studies, mixed-methods studies that did not separately report qualitative results, and studies in languages other than English or Spanish were excluded. The Critical Appraisal Skills Program Qualitative Research Checklist was used to assess study quality, and results were synthesized using thematic synthesis. Results Thirteen studies met the inclusion criteria and were included in this review. The qualitative studies yielded three key themes: 1) reasons identified by women and midwives for choosing a water birth, 2) benefits experienced in water births, and 3) barriers and facilitators of water immersion during childbirth. Conclusions The evidence from qualitative studies indicates that women report benefits associated with water birth. From the perspective of midwives, ensuring safe water births requires adequate resources, midwives training, and rigorous standardized protocols to ensure that all pregnant women can safely opt for water immersion during childbirth with satisfactory results.

Abstract Background Water immersion during labour can provide benefits including reduced need for regional analgesia and a shorter labour. However, in the United Kingdom a minority of women use a pool for labour or birth, with pool use particularly uncommon in obstetric-led settings. Maternity unit culture has been identified as an important influence on pool use, but this and other possible factors have not been explored in-depth. Therefore, the aim of this study was to identify factors influencing pool use through qualitative case studies of three obstetric units and three midwifery units in the UK. Methods Case study units with a range of waterbirth rates and representing geographically diverse locations were selected. Data collection methods comprised semi-structured interviews, collation of service documentation and public-facing information, and observations of the unit environment. There were 111 interview participants, purposively sampled to include midwives, postnatal women, obstetricians, neonatologists, midwifery support workers and doulas. A framework approach was used to analyse all case study data. Results Obstetric unit culture was a key factor restricting pool use. We found substantial differences between obstetric and midwifery units in terms of equipment and resources, staff attitudes and confidence, senior staff support and women’s awareness of water immersion. Generic factors influencing use of pools across all units included limited access to waterbirth training, sociodemographic differences in desire for pool use and issues using waterproof fetal monitoring equipment. Conclusions Case study findings provide new insights into the influence of maternity unit culture on waterbirth rates. Access to pool use could be improved through midwives based in obstetric units having more experience of waterbirth, providing obstetricians and neonatologists with information on the practicalities of pool use and improving accessibility of antenatal information. In terms of resources, recommendations include increasing pool provision, ensuring birth room allocation maximises the use of unit resources, and providing pool room environments that are acceptable to midwives.

<h4>Aim</h4>To explore the effect of hydrotherapy applied in the first stage of labour on the health of mother and newborn.<h4>Methods</h4>This systematic review and meta-analysis was carried out by following PRISMA. The studies were obtained by scanning EBSCO, PubMed, Science Direct, Ovid, Web of Science and Scopus electronic databases. Twenty studies published between 2013 and 2023 were included.<h4>Results</h4>The total sample size of the studies was 8254 (hydrotherapy: 2953, control: 5301). Meta-analyses showed that the perception of pain decreased, comfort level and vaginal birth rate were higher and assisted vaginal birth rate and APGAR scores in the first minute were lower in women who underwent hydrotherapy. There was no difference between groups in terms of the duration of the first and second stage of labour, episiotomy, perineal trauma, intrapartum and postpartum bleeding amounts, use of pain medication and labour augmentations, APGAR scores in the fifth minute, positive neonatal bacterial culture and neonatal intensive care unit need.<h4>Conclusion</h4>This study revealed that the results that hydrotherapy decreased the perception of pain and assisted birth, increased the rate of vaginal birth and comfort level and did not adversely affect the health of the mother and baby during the birth process.

Background/Objectives: The current trend in maternal health is to foster more natural and less medicalized therapies, with increasing interest in complementary therapies. This study has analyzed the benefits of complementary therapies during pregnancy, delivery and the postpartum period. Methods: A paired systematic review was carried out (PROSPERO: CRD42024543981). The following databases were consulted: PubMed, Scopus, Web of Science and CINAHL. Inclusion criteria were randomized clinical trials about complementary therapies in women during pregnancy, delivery and/or the postpartum period. The risk of bias of the clinical trials was evaluated using the revised Cochrane Risk of Bias tool for randomized trials version 2 (RoB-2). Results: A total of 1684 studies were found, with a final selection of 17. The most studied symptom was pain. Hydrotherapy, perinatal Swiss ball exercises, acupressure, virtual reality and foot reflexology provided a significant reduction in pain during labor. Similarly, aromatherapy, electroacupuncture and massage have shown significant benefits in pain management after Cesarean. Yoga, when practiced during pregnancy, effectively reduces anxiety and depression, with similar benefits observed when practiced during the postpartum period. Conclusions: Complementary therapies improve pain, anxiety and depression management across maternal health phases.

. 2019; [ 12 ] Lewis et al. 2018; [ 13 ] Ulfsdottir et al. 2018; [ 14 ] Antonakou et al. 2018; [ 15 ] McKenna et al. 2013; [ 16 ] Carlsson et al. 2020; [ 17 ] Milosevic et al. 2019; [ 19 ] Lewis et al. 2018 (midwives) Table 6. Barriers and facilitators to water immersion during childbirth Barriers to water immersion during childbirth Source Safety concerns Potential risks associated with waterbirth after cesarean section [ 15 ] Obstetric complications [ 12 ] Cultural factors Lack of support from family members and health professionals [ 10 ] Limited resources Lack of necessary equipment or facilities to support waterbirth [ 12 ] Facilitators of water immersion in childbirth Resources Availability of bathtubs and appropriate usage techniques [ 17 ] Availability of cardiotocographic equipment compatible with water immersion [ 17 ] A culture of support for water immersion during childbirth Clear and consistent eligibility criteria for water immersion during childbirth [ 17 ] Promoting a natural childbirth experience without unnecessary medical interventions [ 15 , 17 ] Support for the mother Support from health professionals [ 10 , 12 , 14 , 17 , 20 ] Support for partners during water immersion childbirth, including emotional and physical support [ 14 ] Training and support for healthcare professionals who attend water immersion childbirths, including proper techniques and safety precautions Learning through observation of successful water immersion childbirths to improve technique and confidence [ 12 ] Professional waterbirth training and senior staff support [ 17 , 18 , 20 ] Positive impact of coworker presence during water immersion childbirths on patient outcomes and healthcare provider satisfaction [ 20 ] Confidence to improve with the experience of attending such births [ 18 , 20 ] Provision of clear and accurate information to pregnant women about the benefits and risks of water immersion childbirths Promotion of water immersion through education [ 16 , 17 ] Ope