Journal of midwifery & women's health, 2010 Jan-Feb, 55(1):55-59 ISSN 1526-9523 Perceptions and practice of waterbirth: a survey of Georgia midwives. Meyer, S. L; Weible, CM; Woeber, K.; Emory University, Atlanta, GA, USA Abstract This study investigated the experience and perceptions of Georgia certified nurse-midwives about waterbirth and their level of support for establishing waterbirth in their work setting. A survey was distributed to a convenience sample of 119 certified nurse-midwives from the American College of Nurse Midwives, Georgia chapter; 45% of those surveyed responded. The majority of midwives had some exposure to waterbirth through self-education or through clinical practice. More than half supported the incorporation of waterbirth in their workplace setting. Maternal relaxation and reduced use of analgesia were perceived as the greatest benefit of waterbirth. Of 11 items related to disadvantages of waterbirth, certified nurse-midwives were moderately to severely concerned about none. The most concerning factors, with a mean of 2.4 to 2.5 on a scale of 1 (no worry) to 5 (severe worry), were maintenance of water temperature, physical stress on the midwife, and inability to see the perineum. Midwives' support for waterbirth focused mostly on the perceived benefits to the mother with little worry about the risks.
de Jonge A, van der Goes G, Ravelli A, Amelink-Verburg M, Mol B,
Nijhuis J, et al. Perinatal mortality and morbidity in a nationwide cohort of 529, 688 low-risk planned home and hospital births.
Reviewed by: Deanne R. Williams, CNM, MS.
There is little doubt that community-wide acceptance of and support for home birth cannot be expected until professionals can speak in unison about the risk factors that preclude a home birth. Unfortunately, the rapid increase in the number of primary cesarean deliveries and the lack of opportunity to have a vaginal birth after cesarean in the United States has made reaching these agreements more difficult. Some women now see birth outside the hospital as their only option if they wish to avoid the risks of multiple cesarean deliveries. It remains to be seen if the future of home birth in the United States rests in the hands of those who have staked out opposing positions or if new data will tip the discussion toward the provision of maternity care that is more inclusive than what currently exists (p. 334).
JOGNN-JOURNAL OF OBSTETRIC GYNECOLOGIC AND NEONATAL NURSING,vol.37, no.1, pp.116-122,2008 Observing position and movements in hydrotherapy: A pilot study Stark, MA; Rudell, B; Haus, G; MI, USA
Abstract: Objective: To observe and describe the positions and movements women choose while immersed in water during the first stage of labor. Design: Descriptive, observational pilot study. Setting: A rural community hospital that provided hydrotherapy in labor. Participants: Women (N = 7) who intended to use hydrotherapy in labor were recruited prenatally from a midwife-managed practice. Measures: For 15 minutes of each hour during the first stage of labor, position and movements of the participants were observed and recorded on a laptop computer. The observational tool was developed for this study from a review of the literature and interviews with nursing experts; 435 observations were recorded. Women were free to choose when and how long to use hydrotherapy and had no restriction on their positions and movements. Results: Only 3 of the 7 participants labored in the tub. Women demonstrated a greater range of positions and movements in the tub than in bed, both throughout labor and during late first-stage labor (7-10 cm of dilatation). Women had more contractions and made more rhythmic movements while in the tub than in bed. Conclusions: Hydrotherapy may encourage upright positions and movements that facilitate labor progress and coping, helping women avoid unnecessary interventions.
J Perinat Educ. 2008 Spring;17(2):4-8. Water birth at home: two perspectives. Angha AM, Scaer RM. Abstract In this column, a grandmother, with a long history as an author and activist for normal birth, and her daughter, a new mother, offer their unique experiences of a water birth at home, attended by family members and midwives. Their unique perspectives demonstrate the trust in the normal birth process that is possible for every birth.
Journal of Midwifery and Women's Health, vol. 50, no. 5, pp. 440-440, September, 2005 Underwater or on land: a descriptive analysis of the waterbirth population at Oregon Health & Science University M. Mack, A. Pechovnik, L. Andronici, N. Tallman, N.K. Lowe, Oregon Health & Science University,Portland, Oregon)
Abstract: Background: The purpose of this quality improvement project was to differentiate the characteristics of women whose planned waterbirths conclude in water from those whose do not. Methods: A retrospective, descriptive design was used. Data were extracted from a database maintained by the midwifery practice at OHSU yielding a sample of 309 women who planned waterbirths between 1998 and 2004. Variables of interest included parity, method of delivery, frequency, and method of induction and augmentation, reason for induction and augmentation, and frequency of use of regional and parenteral pain management. Results: Multiparas planning waterbirth were significantly more likely to deliver in water than nulliparas. Amongwomen augmented during labor (68, 22%), the trend was to birth conventionally. Women who delivered conventionally were significantly more likely to use pharmacologic pain relief (chi-square _ 49.23, df _ 2, P _ .05) and to have experienced problems in labor (chi-square _ 21.87, df _ 4, P _ _ .05). Conclusion: Important points include the following: 1) 33% of women planning to deliver in water actually did so; 2) greater percentages of multiparas delivered in water than nulliparas; and 3) women planning waterbirth demonstrate a low use of pharmacologic pain relief.
American Journal of Obstetrics and Gynecology, Volume 190, Issue 5, May 2004, Pages 1211-1215 The risks of underwater birth Pinette MG, Wax J, Wilson E.Department of Obstetrics and Gynecology, Maine Medical Center, Portland, ME Abstract: OBJECTIVE: we performed a retrospective review of the literature on the complications that could be associated potentially with water birth. STUDY DESIGN: We performed an extensive review of the medical literature using the Pub Med search engine, which is available through the National Library of Medicine. We also examined the Cochrane review on immersion in pregnancy, labor and birth. RESULTS: Our review revealed 74 articles regarding water births. We found 16 citations that described complications that were associated with underwater birth. Possible complications that were associated with water birth included fresh water drowning, neonatal hyponatremia, neonatal waterborne infectious disease, cord rupture with neonatal hemorrhage, hypoxic ischemic encephalopathy, and death. Our systematic review did not identify an adequately controlled trial of delivery underwater (second stage of labor underwater) compared with delivery in air. CONCLUSION: Water birth may be associated with potential complications that are not seen with land-based birth. The rates of these complications are likely to be low but are not well defined.
BACKGROUND: Enthusiasts for immersion in water during labour, and birth have advocated its use to increase maternal relaxation, reduce analgesia requirements and promote a midwifery model of supportive care. Sceptics are concerned that there may be greater harm to women and/or babies, for example, a perceived risk associated with neonatal inhalation of water and maternal/neonatal infection. OBJECTIVES: To assess the evidence from randomised controlled trials about the effects of immersion in water during pregnancy, labour, or birth on maternal, fetal, neonatal and caregiver outcomes. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register (September 2003). SELECTION CRITERIA: All randomised controlled trials comparing any kind of bath tub/pool with no immersion during pregnancy, labour or birth. DATA COLLECTION AND ANALYSIS: We assessed trial eligibility and quality and extracted data independently. One reviewer entered the data and another checked them for accuracy. MAIN RESULTS: : Eight trials are included (2939 women). No trials were identified that evaluated immersion versus no immersion during pregnancy, considered different types of baths/pools, or considered the management of third stage of labour. There was a statistically significant reduction in the use of epidural/spinal/paracervical analgesia/anaesthesia amongst women allocated to water immersion water during the first stage of labour compared to those not allocated to water immersion (odds ratio (OR) 0.84, 95% confidence interval (CI) 0.71 to 0.99, four trials). There was no significant difference in vaginal operative deliveries (OR 0.83, 95% CI 0.66 to 1.05, six trials), or caesarean sections (OR 1.33, 95% CI 0.92 to 1.91). Women who used water immersion during the first stage of labour reported statistically significantly less pain than those not labouring in water (40/59 versus 55/61) (OR 0.23, 95% CI 0.08 to 0.63, one trial). There were no significant differences in incidence of an Apgar score less than 7 at five minutes (OR 1.59, 95% CI 0.63 to 4.01), neonatal unit admissions (OR 1.05, 95% CI 0.68 to 1.61), or neonatal infection rates (OR 2.01, 95% CI 0.50 to 8.07). REVIEWERS' CONCLUSIONS: There is evidence that water immersion during the first stage of labour reduces the use of analgesia and reported maternal pain, without adverse outcomes on labour duration, operative delivery or neonatal outcomes. The effects of immersion in water during pregnancy or in the third stage are unclear. One trial explores birth in water, but is too small to determine the outcomes for women or neonates.
Journal of Nurse-Midwifery (July 1989), 34 (4), pg. 198-205 Water birth: The newest form of safe, gentle, joyous birth K. Daniels Abstract: This paper underscores the serious problems facing institutionalized obstetrics in the United States (demonstrated by alarming cesarean rates) and provides information about a new, safe, gentle birth alternative that uses water during labor and delivery. Pioneered by doctors, nurses, and midwives to lower cesarean rates and increase possibilities for natural childbirth, water birth assists the mother in achieving deep relaxation during labor and thereby alleviates much of the pain and stress of birth for both mother and baby. Water birth may be a safe, helpful, and easy to implement method of improving obstetrical statistics in the U.S. and should be investigated by those health care providers concerned with promoting humanistic childbirth practices.
The Case of Pediatrics An Official Journal of the American Academy of Pediatrics
PEDIATRICS Vol. 116 No. 2 August 2005, pp. 522-523 (doi:10.1542/peds.2005-1334)
Strong Opinions Versus Science in Water-Birth Controversy
Sandra Hess, CPM “The pediatric community, through the journal Pediatrics, deservesto be treated in kind regard of their intelligence and in theircapabilities to discern "fads" from evidence-based practices,even new practices, such as water birth.A serious attack was published in Pediatrics in October 2003. Pediatricshas repeatedly been negative and condemning of water birth.I must question how the research for these articles, includingthe May 2005 commentary, concluded with this opinion that waterbirth is a dangerous childbirth practice. Many providers and parents, including pediatricians and theAmerican College of Nurse Midwives, have tried to respond with theirown commentaries, but Pediatrics has not printed one positiveword about water birth. Is Pediatrics refusing to print anythingpositive about water birth? The silent nature of Pediatricson the benefits of water birth leads to a deep question of theethics involved in editorship of the journal." More
PEDIATRICS Vol. 115 No. 5 May 2005, pp. 1413-1414 (doi:10.1542/peds.2004-1738)
Underwater Births Committee on Fetus and Newborn, 2004–2005 Daniel G. Batton, MD, FAAP Department of Pediatrics , William Beaumont Hospital , Royal Oak, MI 48073 Lillian R. Blackmon, MD, FAAP Department of Pediatrics, Division of Neonatology, University of Maryland School of Medicine, Baltimore, MD 21201 David H. Adamkin, MD, FAAP Department of Pediatrics, University of Louisville, Louisville, KY 40202 Edward F. Bell, MD, FAAP Department of Pediatrics, University of Iowa, Iowa City, IA 52242 Susan Ellen Denson, MD, FAAP Department of Pediatrics-Neonatology, University of Texas, Houston, TX 77030 William Allan Engle, MD, FAAP Department of Pediatrics, Indiana University Medical Center, Riley Hospital for Children Indianapolis, IN 46202 Gilbert Ira Martin, MD, FAAP Citrus Valley Medical Center, West Covina, CA 91790 Ann R. Stark, MD, FAAP Department of Neonatology, Baylor College of Medicine, Houston, TX 77030 Keith J. Barrington, MD Department of Neonatology, Royal Victoria Hospital, Montreal, QC, Canada H3A 1A1 Tonse N.K. Raju, MD, DCH, FAAP Pregnancy and Perinatology Branch, National Institute of Child Health and Human Development National Institutes of Health, Bethesda, MD 20847 Laura Riley, MD Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA 02114 Kay Marie Tomashek, MD, MPH, FAAP Maternal and Infant Health Branch, Centers for Disease Control and Prevention, Atlanta, GA 30333 Carol Wallman, MSN, RNC, NNP National Association of Neonatal Nurses, Wellington, CO 80549 Jim Couto, MA American Academy of Pediatrics, Division of Hospital and Surgical Services, Elk Grove Village, IL 60007 _________________
PEDIATRICS Vol. 115 No. 4 April 2005, pp. 1116-1117 (doi:10.1542/peds.2005-0108)
Department of Pediatrics Division of Perinatal-Neonatal Medicine Stony Brook University School of Medicine; Stony Brook, NY 11794
________________
PEDIATRICS Vol. 114 No. 3 September 2004, pp. 855-858 (doi:10.1542/peds.2004-0145)
Water Births: A Naked Emperor Ken Schroeter, DO, FAAP Department of Pediatrics Division of Perinatal-Neonatal Medicine Stony Brook University School of Medicine Stony Brook, NY 11794
Sarah Nguyen, MBChB, FRANZCR*, Carl Kuschel, MBChB, FRACP, Rita Teele, MD, FRANZCR*, Claire Spooner, MBChB, FRACP * Department of Radiology Newborn Services, National Women’s Hospital, Auckland, New Zealand Department of Neurology, Starship Children’s Hospital, Grafton, Auckland, New Zealand
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