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Water Babies: Is Maternal Immersion During Labor and Delivery Safe?

March 20, 2014

Water Babies: Is Maternal Immersion During Labor and Delivery Safe?

  1. Diane J. Angelini, EdD, CNM, FACNM, FAAN, NEA-BC

Immersion during the second stage of labor is not recommended outside the setting of a clinical trial.

  1. Diane J. Angelini, EdD, CNM, FACNM, FAAN, NEA-BC

Water immersion during labor and delivery is controversial. Now, authors of a joint Committee Opinion from the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics review evidence, proposed benefits, and reported complications associated with this birthing mode. As noted in a 2009 Cochrane review of 12 randomized, controlled trials involving 3243 women, many studies were small, retrospective, observational, and did not clearly define immersion or indicate when during labor this intervention was used.

Some individual studies support benefits of immersion, although findings are inconsistent. Combined results indicate that immersion during the first stage of labor is associated with decreased use of epidural, spinal, or paracervical anesthesia (6 trials; risk ratio, 0.90; 95% confidence interval, 0.82–0.99) and no difference in risk for perineal trauma or tears; however, it is unclear whether other interventions (e.g., frequency of examinations) affected these outcomes. Reported complications associated with immersion during labor's second stage include maternal or neonatal infections (especially in the setting of ruptured membranes), compromised neonatal thermoregulation, umbilical cord avulsion or rupture if the infant is lifted incorrectly from the tub, and respiratory distress secondary to water aspiration.

Comment

I agree with the committee's conclusions that water immersion during the first stage of labor, while possibly diminishing maternal pain, does not seem to improve any other perinatal outcomes; and that immersion during second-stage labor should be limited to clinical trials because of its potential to cause neonatal complications. More large, randomized trials must be conducted. In the meantime, rigorous standards should be followed regarding maternal eligibility for first-stage immersion, infection control procedures, close monitoring of women during immersion, and protocols for emergency transfer.

  • Disclosures for Diane J. Angelini, EdD, CNM, FACNM, FAAN, NEA-BC at time of publication Editorial boards Journal of Perinatal and Neonatal Nursing

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