Safety of water immersion during the second stage of labour in non- and low-risk pregnant women: a multicenter quasi-experimental study

Abstract

BACKGROUND: Natural birth consists in giving birth with full control of the body through the vagina. It has been gaining popularity recently as non- and low-risk pregnant women seem to be fleeing from over-medicalised births. More and more women are asking about the option of involving a birth pool on their birth experience, but they don't get the same response in all hospitals: some refuse, others offer to spend the first stage of labour there, and few dare to let them have an underwater delivery. This heterogeneity in supply is due to the dearth of quality data about waterbirth (WB); although water immersion (WI) in the first stage of labour is considered a safe and cost-effective method of pain management, concerns still linger as to the safety of this technique during delivery. Demonstrating that WB can have minimal complications for both mother and child would eventually mean that the technique is not only physiological and non-medicalised, but also safe. Only in this way will WB become an option available to all women who, once the indication is fulfilled, choose it. OBJECTIVE: The main objective is to assess the safety of WI during the second stage of labour in women considered to be at non- or low-risk of complications, in a hospital setting. In doing so, the presence of maternal and/or neonatal complication(s) will be taken into account. DESIGN AND SETTING: This study is designed as a quasi-experimental study, aiming to compare two different modes of natural birth: WB versus landbirth (LB). It will be conducted in 8 different hospitals of different Health Regions over Catalunya. PARTICIPANTS AND METHODS: 908 participants will be enrolled using a consecutive sampling, and the time of recruitment will be of 1.5 years. Women will be divided by choosing where they want to give birth at the onset of labour, creating this way two groups: the intervention group (WB) and the control group (LB). Data about maternal and neonatal complications, epidural analgesia, prolonged labour and obstetric intervention will be collected after the baby is born and childbirth experience will be evaluated through Childbirth Experience Questionnaire spanish version (CEQ-E) 6 weeks after the delivery