Dr Jane Carpenter

Introduction

Research to understand factors associated with normal physiological birth (unassisted vaginal birth, spontaneous labor onset without epidural, spinal or general anaesthetic, without episiotomy) is required. Laboring and/or giving birth in water has been shown to be associated with a high proportion of physiologic birth, but with little understanding of factors which may influence this outcome.  This study explored factors associated with normal physiological birth for women who labored in water.

Methods

We conducted a secondary analysis of a UK-based prospective observational study of 8,064 women at low risk of childbirth complications who labored in water. Consecutive women were recruited from birth settings in England, Scotland, and Northern Ireland. Planned place of birth, maternal characteristics, intrapartum events, maternal and neonatal outcomes were measured. Univariable and multivariable logistic regression modelling explored factors associated with normal physiological birth.

Results

In total, 5758 (71.4%) of women who labored in water had a normal physiological birth. Planned birth in the community [aOR 2.58, 95% CI 2.22-2.99] or at an alongside midwifery unit [aOR 1.21, 95% CI 1.04-1.41] was positively associated with normal physiological birth compared with planned birth in an obstetric unit. Duration of second stage [aOR 0.66, 95% CI 0.62–0.70], duration in the pool [aOR 0.93, 95% CI 0.90–0.96] and birth weight of the neonate [aOR 0.74, 95% CI 0.65–0.85] were negatively associated with normal physiological birth. Parity was not associated with normal physiological birth in multivariate analyses.

Discussion

Our findings largely reflected wider research, both in and out of water. We found midwifery-led birth settings may increase the likelihood of normal physiological birth among healthy women who labor in water, irrespective of parity. This association supports growing evidence demonstrating the importance of planned place of birth on reducing intervention rates, and adds to research on labor and birth in water.

According to national midwifery-specific and healthcare profession strategy, embedding research into the professions, including creating researcher leaders, is a priority. Evidence shows that this provides benefit for the people we care for, the employing organisation and the individual employee. However, developing the knowledge to undertake or lead research can seem overwhelming. The Professional Doctorate is one pathway available to support people in the development of research knowledge and skills. This five-year part-time course is completed alongside clinical work. Initial taught content develops knowledge and skills, before leading on to completion of independent research, with appropriate supervision throughout.

Globally, 5-30% of children have eczema; this could be partly attributable to skin cleansing routines. Evidence-based international guidance on this topic is lacking and dated national UK guidelines may not reflect best practice. We conducted a mixed method, UK-wide (England, Scotland, Northern Ireland and Wales) cross-sectional survey to investigate parental cleansing of their newborn’s skin; 973 responses were suitable for inclusion. 60% of participants delayed first cleansing after birth for 48 hours and 79.4% of participants cleansed their newborn’s nappy area with each change.  Participants from Scotland were more likely to cleanse their newborn within the first 48 hours (X22 = 29.3, p

Introduction and Hypothesis: Obstetric Anal Sphincter Injury (OASI) during childbirth is associated with urino-genital pain and dysfunction. Waterbirth is a popular birth choice for women, but controversy remains around the risk of OASI during waterbirth. This study reports on the incidence of OASI, and factors associated with OASI, for a cohort of women who gave birth in water. Methods: This secondary analysis used prospectively collected data from 2,908 women who gave birth in water in the hospital setting. Incidence of OASI was calculated. Univariable and multivariable logistic regression analysis evaluated factors associated with OASI.
Results: The incidence of OASI was 1.9% (95% CI 1.4, 2.4) for all women. In nulliparae it was higher (3.2%, 95% CI 2.3, 4.3), than for multiparae (0.9%, 95% CI 0.5, 1.4). In the multivariable analysis two variables were associated with OASI; multiparity was negatively associated with OASI (aOR 0.24, 95% CI 0.12, 0.50, p