Maternal and neonatal outcome of 306 waterbirths in Sweden- a comparative study

Background Waterbirth is controversial in Sweden and has not been offered in hospitals until recently. For birthing women, benefits of analgesia, relaxation and buoyancy effects of water immersion are described. The outcome on... [ view full abstract ]

Background Waterbirth is controversial in Sweden and has not been offered in hospitals until recently. For birthing women, benefits of analgesia, relaxation and buoyancy effects of water immersion are described. The outcome on perineal tears in waterbirth is inconclusive and more research is demanded. The objective of this study was to evaluate waterbirth in Swedish context and to compare waterbirth with conventional births with perineal tears as primary outcome.

Methods A retrospective cohort study was performed on all waterbirths at two maternity units in Stockholm during March 2014-November 2015, n=306. The two maternity units provided continuous support during labor and offered waterbirth to women at low risk. A comparison group of 306 women having conventional spontaneous vaginal birth was selected consecutively at the same clinics and was matched for parity as both primi- and multiparas were included.

Results The women giving birth in water had a lower risk for perineal tear of second degree. The births taken place in water had a shorter first stage of labor and less interventions than the non- waterbirth group. All women had access to nitrous oxide, but it was used significantly more by women in the non-waterbirth group. The outcome of the neonates was equal in the two groups. The experience of childbirth measured with NRS-scale was significantly higher in the waterbirth group which indicates a more positive birth experience. Three newborns in the waterbirth group had an umbilical cord avulsion.

Conclusions Waterbirth had a protective effect on second degree tear and was associated with fewer interventions compared with conventional births. Waterbirth can be used along with the Swedish guidelines for CTG-surveillance. All midwives handling waterbirth should be aware of the risk of umbilical cord avulsion.