Hospital Waterbirth Tied to Less Pain, Increased Patient Satisfaction

SAN FRANCISCO -- People with low-risk pregnancies who opted for an inpatient waterbirth reported reduced pain and higher satisfaction, interim trial results revealed.

In the randomized controlled trial, people who had the option to give birth in an inflatable tub in a hospital room had lower levels of epidural or IV narcotic analgesia use compared to land birth (37.3% vs 82.8%, P<0.0001), reported Emily M. Malloy, PhD, CNM, of Advocate Aurora Health in Milwaukee, in a poster presentation at the American College of Obstetricians and Gynecologists (ACOG) annual meeting.

The waterbirth group also reported significantly higher levels of birth satisfaction, with a median score of 33 compared to land birth at a median of 29 (P=0.009) on the U.S. Birth Satisfaction Scale Revised, which is a 10-question scale, using a 5-point Likert scale, with answers ranging from "strongly agree" to "strongly disagree."

"A lot of birthing people who don't want to use more traditional medications, like an epidural or an IV, do want some option for pain relief -- and warm water can be a great pain reliever," Malloy told MedPage Today.

Malloy and colleagues wanted to see if waterbirth was feasible in a hospital setting. Malloy said hospital waterbirth is "something patients have been asking us for" but the hospital does not yet offer, in part because ACOG does not endorse it.

ACOG's current recommendations is that births occur on land, not water, since "there are insufficient data on which to draw conclusions regarding the relative benefits and risks of immersion in water during the second stage of labor and delivery."

Malloy said her group "wanted to do a patient-centered study that could contribute some information," about waterbirth, especially since most research has been retrospective and non-randomized.

Ultimately, the preliminary results "suggest that when offered to low-risk laboring people, hospital water birth reduces pain and increases satisfaction without leading to adverse events [AEs]," the researchers stated.

"People in waterbirth group were very satisfied with having the option, even if they didn't use it, and we had significantly less epidural use and IV narcotic use," Malloy said.

People with low-risk pregnancies between 25 and 34 weeks' gestation were enrolled beginning in January 2022. Of the 182 people enrolled, 157 have given birth and there have been no AEs thus far.

Participants were randomized 2:1 to either waterbirth or land birth. Land birth involved routine care with midwives and obstetricians, and waterbirth involved that same care plus the option to have a give birth in an inflatable tub in a hospital room. About half in the waterbirth group ended up actually giving birth in the water (52.2%).

Patients could opt for different pain relief at any point. If the patient developed risk factors such as hypertension, preterm labor, or non-vertex presentation, they were excluded. This left a total of 96 participants, with 67 in the waterbirth and 29 in the land-birth group.

Participants answered a validated satisfaction questionnaire postpartum. The primary outcome was intrapartum analgesia and anesthesia use and secondary outcomes were maternal and neonatal outcomes as well as maternal satisfaction.

Malloy said the single-study site and non-blind nature of the intervention, as well as only including patients who were open to the idea of waterbirth, were the primary study limitations. The estimated study completion date is December 2025.

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