Neonatal Outcomes of Water Delivery versus Land Delivery: A Retrospective Propensity Score Weighted Study

Abstract Objective  Recent evidence has shown that water delivery is safe for the mother, but high-quality evidence is not available for the newborn. Therefore, obstetric guidelines do not support it. This retrospective study aimed to contribute to the available evidence on maternal and neonatal outcomes associated with water delivery. Study Design  Retrospective cohort study from prospectively collected birth registry data from 2015 to 2019. A total of 144 consecutive water deliveries and 265 land deliveries eligible for waterbirth were identified. The inverse probability of treatment weighting (IPTW) method was applied to address for confounders. Results  We identified 144 women who delivered in water (water group) and 265 women who delivered on land (land group). One (0.7%) neonatal death was observed in the water delivery group. After IPTW adjustment, water delivery was significantly associated with a higher risk of maternal fever in puerperium (odds ratio [OR]: 4.98; 95% confidence interval [CI]: 1.86–17.02; p  = 0.004), of neonatal cord avulsion (OR: 20.73; 95% CI: 2.63–2,674; p  = 0.001), and of positive neonatal C-reactive protein (CRP > 5 mg/L; OR: 2.59; 95% CI: 1.05–7.24; p  = 0.039); delivering in water was associated with lower maternal blood loss (mean difference: 110.40 mL; 95% CI: 191.01–29.78; p  = 0.007), a lower risk of major (≥1,000 mL) postpartum hemorrhage (OR: 0.96; 95% CI: 0.92–0.99; p  = 0.016), lower risk of manual placenta delivery (OR: 0.18; 95% CI: 0.03–0.67; p  = 0.008) and curettage (OR: 0.24; 95% CI: 0.08–0.60; p  = 0.002), lower use of episiotomy (OR: 0.02; 95% CI: 0–0.12; p  < 0.001), and lower risk of neonatal ward admission (OR: 0.35; 95% CI: 0.25–0.48; p  < 0.001). Conclusion  The present study showed that differences are present between water and land delivery, and among them is the risk of cord avulsion, a severe and potentially fatal event. In women choosing to deliver in water, a trained staffmust be present and immediate recognition of cord avulsion is key for a prompt management to avoid possible serious complications. Key Points High-quality evidence is not available for neonatal safety of waterbirth; therefore, retrospective studies still represent the main body of evidence. Differences are present between water and land delivery, and among them, the increased risk of cord avulsion is a potentially fatal event. A trained staff must assist women who chose to deliver in water and cord avulsion must be promptly recognized and managed to avoid severe neonatal complications.