Epidural or water immersion? A prospective cohort study of maternal and neonatal outcomes in a tertiary hospital

IF 2.6 3区医学 Q1 NURSING

Midwifery Pub Date : 2025-03-20 DOI:10.1016/j.midw.2025.104392

Soledad CARREGUI-VILAR , Eva M. MOYA-ARTUÑEDO , Ricardo CHALMETA , Lucia ROCCA-IHENACHO , Eladio J. COLLADO-BOIRA

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引用次数: 0

Abstract

Background

Providing evidence-based information on maternal and neonatal outcomes of epidural analgesia (EA) and water immersion (WI) is crucial for informed decision-making.

Objective

To compare process outcomes, obstetric interventions, and maternal and neonatal outcomes in medium low-risk women based on their choice of analgesia: EA or WI.

Methods

This prospective observational cohort study analysed 643 women from June 2020 to February 2023. Sociodemographic data, birth process characteristics, and outcomes were collected to compare 284 women who used EA and 319 who used WI (with 82.4% waterbirths). Additionally, 40 cases of women who switched from WI to EA were descriptively analysed. Propensity Score (PS) was applied to reduce selection bias in the comparative analysis.

Findings

WI was associated with a higher probability of spontaneous vaginal birth (18.7%, E:0.187; SE:0.025; p < 0.001 95% CI 0.138,0.235), shorter first stage (-259.532 min; SE:13.592; p < 0.00195%, 95% CI -286.171, -232.892), shorter second stage of labour (-17.829 min; SE:4.665; p < 0.001 95% CI -26.973,-8.686) In terms of neonatal outcomes WI (with 82.4% of waterbirths) was associated with less neonatal ventilatory support (1.6% vs 9.5% p < 0.001,RR 0.028 95% CI 0.11–0.56), less birth distress (0.9% vs 7.7% p < 0.001,RR 0.22 95% CI 0.06–0.52), lower probability of neonatal admission rates (E:-0.102; SE 0.033, p = 0.002, 95% CI -0.166, -0.088), and higher probability of exclusive breastfeeding at discharge especially for multiparous women (E:0.114; SE 0.045 p = 0.01 95% CI 0.027, 0.202).

Conclusion and Implication for practice

Water immersion for low-risk women emerges as a valid, evidence-based approach to supporting physiological childbirth and reducing unnecessary interventions. This study highlights the need to reinforce its availability in maternity care and to ensure women's informed decision-making.

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来源期刊

Midwifery 医学-护理

CiteScore

4.50

自引率

7.40%

发文量

221

审稿时长

13.4 weeks

期刊介绍： Midwifery publishes the latest peer reviewed international research to inform the safety, quality, outcomes and experiences of pregnancy, birth and maternity care for childbearing women, their babies and families. The journal’s publications support midwives and maternity care providers to explore and develop their knowledge, skills and attitudes informed by best available evidence. Midwifery provides an international, interdisciplinary forum for the publication, dissemination and discussion of advances in evidence, controversies and current research, and promotes continuing education through publication of systematic and other scholarly reviews and updates. Midwifery articles cover the cultural, clinical, psycho-social, sociological, epidemiological, education, managerial, workforce, organizational and technological areas of practice in preconception, maternal and infant care. The journal welcomes the highest quality scholarly research that employs rigorous methodology. Midwifery is a leading international journal in midwifery and maternal health with a current impact factor of 1.861 (© Thomson Reuters Journal Citation Reports 2016) and employs a double-blind peer review process.