A Retrospective Study of Maternal and Neonatal Outcomes Following Conventional and Water Birth in Ecuador

OBJECTIVES: Demonstrate maternal and neonatal complications reported in women giving birth in water birth compared to those conventional land births.

METHODS: An observational retrospective analysis of the incidence of maternal and neonatal outcomes among 358 women who deliver their newborns throughout conventional vaginal delivery and 308 women giving birth in water during 2013 in Quito, Ecuador. Maternal Age, Educational attainment, Neonatal weight, height, APGAR scores, vaginal tearing and the need to resuscitate a newborn were the variables matched for both groups.

RESULTS: Among 308 women who were scheduled to deliver their newborns in water, 73% successfully culminate in water vaginal births while 26 % required a C-section. Among the conventional birth group, only 47% ended their pregnancy vaginally as planned and 53% required a C-section.

The use of oxytocin (RR: 12.9 CI 7.9 to 20.9 p<0.0001) and intentional episiotomy (RR: 13.9 CI 5.1 to 37.9 p<0.0001) are much higher among conventional birth, however, the risk to have a vaginal tearing during water labor is 3 times higher than conventional birth (RR: 2.9 CI 2.12 to 4.2 p<0.0001). In the conventional delivery cohort 3 neonatal deaths were reported while water birth no deaths reported, however, no causality of these deaths was explored due to the absence of information.

CONCLUSIONS: We conclude that water birth is an effective method to deliver children as long as there is an adequate understanding of the risk and benefits of this procedure. Planning a water delivery seems to reduce the risk of using prophylactic uterotonic medication, prophylactic episiotomies and to perform unplanned C-sections. Due to higher incidence of vaginal tears, strict perianal protection during the third stage of labor is recommended.