Understanding Research on Waterbirth

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Rachel and Baby Waterbirth
Rachel in the water shortly after childbirth.

I just finished watching Rebecca Dekkan’s (from evidencebasedbirth.com) webinar on “How to Debunk the ACOG/AAP Statement on Waterbirth.”  For those who are not familiar with it, you can find the full text here.  Having just had a waterbirth, this has been at topic of interest to me.  So I thought I’d share a little of what she talked about.

Dekkan (who has a PhD in nursing research) goes about showing how the research used to form the statement was outdated and did not include references that were relevant.   A good part of what ACOG (American Congress of Obstetricians and Gynecologists) used to form this statement was based on case studies(which are lower levels of evidence), and may have had underlying motives or biases.  Below are the questions she asks us to think about and the answers she found.

Are there any errors?

Dekkan found major errors with 9 of the references used by ACOG.  Four of them were inaccurate or had nothing to do with waterbirth.  Of note was one that was research on laboratory rats that were just immersed in water and did not give birth in water at all.  ACOG also reported that there were drownings or near drownings in another one.  This is false information.  There were no drownings or near drownings.

Two studies had that had adverse outcomes had to do with a contaminated water supply in the hospital.  This is more of a sanitation problem than waterbirth problem and would have caused problems in many different arenas.

In two, there was no information on whether safety precautions were followed and both infants with adverse outcomes recovered completely.

Another literature review referenced had major flaws in it, including poor quality and methods employed to collect research were not disclosed.

Is there any evidence that waterbirth is safe?

There is prospective data from the American Association of Birth Centers that includes 4,000 waterbirths with no drownings or near drownings reported.

There was a high-quality, systemic review published in 2014 in the Journal of Midwifery and Women’s Health.  In this review, they found that earlier studies had significant limitations.  They also found numerous benefits to waterbirth including: decreased episiotomies, decreased rates of 3rd and 4th degree tears, decreased blood loss, decreased use of medications, and increased satisfaction.  They also found no differences in APGAR scores, newborn infection rates, NICU admission rates, and perinatal mortality rates.

What can we use instead of ACOG?

-ACNM (American College of Nurse-Midwifes) position statement:

“Labor and birth in water can be safely offered to women with uncomplicated pregnancies and should be made available by qualified maternity care providers”.

-RCOG/RCM (Royal College of Midwifes – UK) guidelines:

“Women who make an informed choice to give birth in water should be given every opportunity and assistance to do so by attendants who have appropriate experience”.

Resources

Evidence Based birth webinar on waterbirth

ACNM Statement

RCM Waterbirth Statement

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