Adverse Outcomes From Vaginal Delivery During Immersion in Water Versus Traditional Vaginal Delivery [25C]

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At our institution, our Certified Nurse Midwife practice has been practicing vaginal deliveries via immersion in water since 2008. In light of the ACOG committee opinion 594, we conducted a matched-pair analysis to compare the frequency of adverse events during immersion in water versus traditional vaginal delivery.


A retrospective chart review was conducted for deliveries occurring at a single urban hospital from 2010–2014. Deliveries were grouped into waterbirths and landbirths. Women who had a waterbirth were matched by parity and gestational age to women having a traditional vaginal delivery. Adverse outcomes assessed included lacerations, episiotomy, hemorrhage, APGAR score, shoulder dystocia, and NICU admission. Conditional logistic regression was used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (95% CI).


Of the 149 matched pairs assessed, the median age was 28; 71% were Caucasian and 20% were Hispanic. Women were similar across delivery groups in age, race, chronic conditions, and number of previous preterm births. The odds of a laceration during waterbirth delivery were observed to be 90% lower when compared with landbirth (aOR 0.10, 95% CI 0.01–0.78). Likewise, a poor 1 minute APGAR (<7) was inversely associated with waterbirth, but the association was not statistically significant (aOR=0.40, 95% CI: 0.80–2.61). There was little to no difference in shoulder dystocia, hemorrhage, or NICU admissions across delivery groups.


This study suggests that there were fewer lacerations and higher 1-minute APGAR scores among waterbirth deliveries.

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