TitleMaternal and neonatal outcomes following waterbirth: a cohort study of 17,530 waterbirths and 17,530 propensity score-matched land births.
Publication TypeJournal Article
Year of Publication2021
AuthorsBovbjerg, ML, Cheyney, M, Caughey, AB
Date Published11/2021

OBJECTIVE: Investigate maternal and neonatal outcomes following waterbirth.

DESIGN: Retrospective cohort study, with propensity score matching to address confounding.

SETTING: Community births, United States.

SAMPLE: Medical records-based registry data from low-risk births were used to create waterbirth and land birth groups (n=17,530 each), propensity score-matched on >80 demographic and pregnancy risk covariables METHODS: Logistic regression models compared outcomes between the matched waterbirth and land birth groups MAIN OUTCOME MEASURES: Maternal: immediate postpartum transfer to a hospital, any genital tract trauma, severe (3 /4 degree) trauma, haemorrhage >1000 cc, diagnosed haemorrhage regardless of estimated blood loss, uterine infection, uterine infection requiring hospitalisation, any hospitalisation in the first 6 weeks. Neonatal: umbilical cord avulsion; immediate neonatal transfer to a hospital; respiratory distress syndrome; any hospitalisation, neonatal intensive care unit (NICU) admission, or neonatal infection in the first 6 weeks; and neonatal death.

RESULTS: Waterbirth was associated with improved or no difference in outcomes for most measures, including neonatal death (aOR 0.56 [95% CI, 0.31 - 1.0]), and maternal or neonatal hospitalisation in the first 6 weeks (0.87 [0.81 - 0.92] and 0.95 [0.90 - 0.99], respectively). Increased morbidity in the waterbirth group was observed for two outcomes only: uterine infection (1.25 [1.05 - 1.48]) (but not hospitalisation for infection) and umbilical cord avulsion (1.57 [1.37 - 1.82]). Our results are concordant with other studies: waterbirth is neither as harmful as some current guidelines suggest, nor as benign as some proponents claim.

Alternate JournalBJOG
PubMed ID34773367