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Is the evidence on waterbirth watertight?

02 November 2014
9 min read
Volume 22 · Issue 11

Abstract

Waterbirth has been promoted as an effective means to control pain and improve comfort in labour (Royal College of Midwives/Royal College of Obstetricians and Gynaecologists (RCM/RCOG), 2006). Proponents for waterbirth show boundless enthusiasm for the practice, citing the benefits in terms of good clinical outcomes and increased levels of women's satisfaction. Its opponents, however, demonstrate the same level of fervour, portraying waterbirth as a folly with grave potential for both mother and baby. Interestingly, the quality of literature that supports the incongruent sides of the waterbirth debate varies greatly. This article reviews the existing body of literature on waterbirth.

Waterbirth has been recognised as a clinically effective means to reduce the intensity of pain during normal physiological labour and increase women's satisfaction with their birth experiences (National Institute for Health and Care Excellence (NICE), 2007; Jones et al, 2012; Lui et al, 2014; Henderson et al, 2014). A joint statement from the Royal College of Midwives (RCM) and the Royal College of Obstetricians and Gynaecologists (RCOG) 2006 extolled the benefits of waterbirth, but noted that (RCM/RCOG, 2006: 2):

‘The evidence to support underwater birth is less clear but complications are seemingly rare.’

The Nursing and Midwifery Council urges every registrant to ensure that any advice that they give is evidence-based (NMC, 2008) but in light of the joint RCM/RCOG statement, the question must be asked as to whether waterbirth and, or the care of women who choose to labour in water, creates a paradox for midwives and midwifery practice. This article explores this issue further by analysing the contemporary evidence that pertains to waterbirth.

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