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Original research
Prospective cohort study of water immersion for labour and birth compared with standard care in an Irish maternity setting
  1. Paula L Barry1,
  2. Lean E McMahon2,
  3. Ruth AM Banks1,
  4. Ann M Fergus1,
  5. Deirdre J Murphy3,4
  1. 1Midwifery, Coombe Women and Infants University Hospital, Dublin, Ireland
  2. 2National Clinical Programme for Obstetrics & Gynaecology/National Women & Infants Health Programme, Coombe Women's Hospital, Dublin, Ireland
  3. 3Obstetrics & Gynaecology, Trinity College Dublin, Dublin, Ireland
  4. 4Obstetrics, Coombe Women and Infants University Hospital, Dublin, Ireland
  1. Correspondence to Professor Deirdre J Murphy; MURPHYD4{at}


Objective To examine the birth outcomes for women and babies following water immersion for labour only, or for labour and birth.

Design Prospective cohort study.

Setting Maternity hospital, Ireland, 2016–2019.

Participants A cohort of 190 low-risk women who used water immersion; 100 gave birth in water and 90 laboured only in water. A control group of 190 low-risk women who received standard care.

Methods Logistic regression analyses examined associations between water immersion and birth outcomes adjusting for confounders. A validated Childbirth Experience Questionnaire was completed.

Main outcome measures Perineal tears, obstetric anal sphincter injuries (OASI), postpartum haemorrhage (PPH), neonatal unit admissions (NNU), breastfeeding and birth experiences.

Results Compared with standard care, women who chose water immersion had no significant difference in perineal tears (71.4% vs 71.4%, adj OR 0.83; 95% CI 0.49 to 1.39) or in OASI (3.3% vs 3.8%, adj OR 0.91; 0.26–2.97). Women who chose water immersion were more likely to have a PPH ≥500 mL (10.5% vs 3.7%, adj OR 2.60; 95% CI 1.03 to 6.57), and to exclusively breastfeed at discharge (71.1% vs 45.8%, adj OR 2.59; 95% CI 1.66 to 4.05). There was no significant difference in NNU admissions (3.7% vs 3.2%, adj OR 1.06; 95% CI 0.33 to 3.42). Women who gave birth in water were no more likely than women who used water for labour only to require perineal suturing (64% vs 80.5%, adj OR 0.63; 95% CI 0.30 to 1.33), to experience OASI (3.0% vs 3.7%, adj OR 1.41; 95% CI 0.23 to 8.79) or PPH (8.0% vs 13.3%, adj OR 0.73; 95% CI 0.26 to 2.09). Women using water immersion reported more positive memories than women receiving standard care (p<0.01).

Conclusions Women choosing water immersion for labour or birth were no more likely to experience adverse birth outcomes than women receiving standard care and rated their birth experiences more highly.

  • epidemiology
  • obstetrics
  • perinatology

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  • Contributors DJM (guarantor) had the original idea for the study and together with PB, RB and AF designed the study. PB was responsible for piloting the project, recruiting patients and collecting the data. PB, LEM and DJM were responsible for data cleaning, recoding and performing the analyses. PB, LEM and DJM drafted the manuscript and all authors contributed to the final manuscript.

  • Funding Funding was received by the Nursing and Midwifery Practice Development Unit to support Paula Barry in her role as midwifery researcher. Grant 2016:01

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval was granted by the Hospitals Research Ethics Committee in October 2015 (Study No 33–2015).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as online supplemental information.