The past decade has seen quite a lot written about whether giving birth in water is good or bad for women’s perineums. The UK seems to have been the hotspot for these discussions. In today’s blog post, I’m going summarise a new piece of research that has kicked off another round of letters to the editor.
How was the research done?
This new, just published trial is the POOL cohort study (Sanders et al., 2024). The aim of the study was to report on severe perineal trauma*, and a neonatal composite outcome (death, NICU admission with respiratory support, antibiotics). This was not a randomised controlled trial. Previous research has shown that only a minority of women would accept being randomised in a trail about water birth (Allen et al., 2022), so a cohort study approach was used instead – pulling routinely collected data from hospital records for women who met the eligibility criteria: an absence of antenatal or intrapartum risk factors, and no obstetric or anaesthetic interventions in labour. Notably, women who used continuous CTG monitoring were excluded. Outcomes for women who gave birth in water and those who did not (regardless of place of birth – home birth and births in midwifery led units were included) were then compared.
What did they find?
Data from 39,627 women giving birth in water, and 20,775 women not giving birth in water were analysed, broken down into those giving birth the first time and those with one to three previous births. Looking at severe perineal trauma – for women giving birth the first time whether in water or not, the rates were not significantly different (4.8% in water, 5.3% not in water); while for women who had given birth before water birth was protective (1.1% in water, 1.7% not in water, a significant difference). When you add both groups together, water birth came out as protective overall for severe perineal trauma.
For outcomes for the baby – water birth was also protective, with the composite outcome occurring for 2.7% in the water birth group compared to 4.4% in the group not born in water, a significant difference. This remained the same whether it was the woman’s first birth or not. As has been seen previously in research, water birth was associated with a higher rate of the umbilical cord snapping – 1% compared to 0.3% for births not in water (a significant difference).
So what is the fuss about?
The study seems straight forward enough. Even though the paper was only made public in June 2024, and has not yet made it to a print edition of the journal, it has already prompted further discussions in the letters section – and it is the perineal trauma outcomes people are talking about. Stay tuned and I’ll be back to pick up on this in a few weeks time!
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References
Allen J, Gao Y, Dahlen H, Reynolds M, Beckmann M, Cooper C, et al. (2022). Is a randomized controlled trial of waterbirth possible? An Australian Feasibility Study. Birth, 49, 697–708. https://doi.org/10.1111/birt.12635
Sanders, J., Barlow, C., Brocklehurst, P., Cannings-John, R., Channon, S., Cutter, J., Hunter, B., et al. (2024). Maternal and neonatal outcomes occurring in or out of water following intrapartum water immersion: The POOL cohort study. British Journal of Obstetrics and Gynaecology, in press. https://doi.org/10.1111/1471-0528.17878
* The authors use the term Obstetric Anal Sphincter Injury (OASI), but I remain steadfast in my decision to not use this language. It isn’t the obstetrician’s anal sphincter at risk, and severe perineal trauma involves more than the anal sphincter. I’ll stick with severe perineal trauma as a way to communicate anything that would be classed as third or fourth degree trauma.
Categories: New research
Tags: Perineal trauma, water birth
Birth Small Talk 
Fab. Typo by omission to sort – ‘not’ missing from one result – women who had given birth before.
Catherine
Sent from my iPad
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Another interesting newsletter Kirsten. Thank you.
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