Telaah Jurnal

Maternal and perinatal outcomes among low risk

women giving birth in water: a retrospective study in
a maternity & infant health hospital over 7 years

Oleh:
dr. Amsal Darmawan Dakhi
dr. Maulia Wisda Era Chresia
dr. Obby Saleh
dr. Satria Marrantiza
dr. Tri Yuni Harsih

Pembimbing:
dr. Putri Healthireza Novianesari, Sp.OG
 INTRODUCTION

The woman labors and

Definition delivers in a tub of warm
water,

- shorter duration of labor

- less dosage of analgesics
WATER BIRTH Advantages - less incidences of vaginal
- Less incidences perineal
lacerations

- neonatal aspiration
- possible drowning
Disadvantages
- umbilical cord avulsion
-infection rates for mothers
and newborns
Tabel Demografi
 METHODS
• Retrospective

• Department of Obstetrics in Shanghai Changning Maternity & Infant

Health Hospital, China,

• January 2010 to December 2016

• Sample 50,547 people

• SPSS 17.0

• Paired T Test
 METHODS con’t
Inclusion Criteria

•Gestation age ≥38 weeks;

•women without contraindications to vaginal delivery;
women without risk factors including infectious
diseases and pregnancy complications;
•women without dystocia risk factors

Exclusion Criteria

•women with pelvic canal stenosis;

•women with contraindications against vaginal delivery;
women had infectious diseases, including hepatitis B,
hepatitis C, syphilis and HIV infection;
•women with untreated vaginalinfections.
 METHODS con’t

- Clinical logs
Data collection : - Hospital admission books
Population - Labor, delivery, and infant
and medical records
Screened out who met
Sample
inclusion criteria
 METHODS con’t

Vaginal Infants
examination termoregulation

cervical dilation 4-5 cm Infants head

the parturient  brought to water
warmwater tube (35-38°C) surface immediately

Birth was allowed

10-15 minutes  fetal heart
to happen
measuring
spontaneously
 Methods con’t
Primary Outcomes Secondary Outcomes

• Visual Analog Scale • Maternal outcomes:

Evaluated 30 and 60 Duration, PPH, Perineal
minutes after a cervical laceration, Urine
dilatation of 3 cm by the retention, maternal
same obstetrician. infection, maternal
infection and the need for
the medical treatment.
• Neonatal outcome
neonatal asphyxia and
need to transfer to NICU
• Medical Intervention
 Methods con’t

Maternal Vaginal Bacterial Culture

• Steril swabs

• Two culture tubes

• Sheep blood agar plates

NB: Incubating with same environment and duration.

 Methods con’t

Medical Intervention

• Amniotomy is • for induction of • relief of the

administrated under labor symptoms of
these conditions: anxiety
there is a need of
monitoring of
internal fetal

Amniotomy Oxitocyn Valium

Methods con’t
Result

There were no significant differences in

age, maternal height, weight,
gestational age, and gravidity between
the two groups (Table 1).

The VAS pain scores in the conventional

delivery group were significantly higher
than those of the water birth group 30
and 60 min after cervical dilation of 3
cm. (Table 2).
Result

The incidences of degree II and III perineal

lacerations and postpartum urinary retention
were significantly lower in the water birth group
than those in the conventional delivery group
(Table 2)

The incidence of neonatal asphyxia was

significantly lower in the water birth group than
that in the conventional delivery group (Table 3)
Result

There were significantly less patients

who had Valium + Oxytocin, and
amniotomy + Valium + Oxytocin in the
water birth group compared with those
in the conventional delivery group
(Table 5).
The patients with all medical
interventions in the water birth group
were also significantly less than those in
the conventional delivery group. (Table
5).
Table 1. Characteristic of the study groups
Water birth Conventional P
delivery

(n=5,420) (n=45,154)
Age, years 27.57±3.07 26.87±2.96 0.270

Height (cm) 159.55±4.45 160.45±4.40 0.155

Weight (kg) 66.07±7.75 65.77±5.57 0.553
Gestational age 39.45±1.05 39.55±1.00 0.495
(week)
Gravidity (times) 1.39±0.55 1.51±0.82 0.289
Table 2. The comparison of intra- and postpartum outcomes
between the two group
Conventional delivery
Water birth P
Variable
n=5,420 (n=45,154)
VAS pain scores
Cervical dilation of 3 cm 10 (7, 10) 10 (8, 10) 0.777
30 min after cervical dilation 6 (5, 8) 10 (9, 10) <0.001
of 3 cm
60 min after cervical dilation 7 (6, 8) 10 (10, 10) <0.001
of 3 cm
The incidence of perineal laceration
I 10 (0.18) 15 (0.03) 0.002
II 11 (0.20) 207 (0.46) 0.003
III 3 (0.063) 72 (0.16) 0.001
The incidences of post 5 (0.092) 107 (0.24) 0.001
partum urinary retention
Duration of labor (min) 667.45±299.45 617.32±255.34 0.345
24 h postpartum bleeding 323.45±125.50 367.55±256.67 0.345
(ml)
Table 3. The comparison of neonatal outcomes
between the two groups
Water birth Conventional delivery P
Variables
(n=5,420) (n=45,154)
Neonatal asphyxia 17 (0.31%) 715 (1.58%) 0.025

Need for transfer to NICU 50 (10.15%) 7089 (15.70%) 0.455

 Table 4. Maternal bacterial culture results

Water birth Conventional delivery P

Variables
(n=5,420) (n=45,154)
Total positive (n, %) 161 (2.97) 1,290 (2.86) 1.000
Gram-positive bacilli (n) 65 553
Streptococcus agalactiae (n) 32 0
Escherichia coli/Enterococcus 32 0
faecalis (n)
Fungi (n) 32 369
Staphylococcus lugdunensis (n) 0 184

Group B Streptococcus (n) 0 184

Table 5. Medical interventions between the two groups

Water birth Conventional delivery P

Variables
(n=5,420) (n=45,154)
Amniotomy (n, %) 445 (8.21) 1,937 (4.29) 0.455
Valium + Oxytocin (n, %) 309 (5.71) 4,195 (9.29) 0.002
Amniotomy + Valium + 1,723 (31.79) 35,960 (79.64) 0.002
Oxytocin (n, %)
All medical 2,477 (45.71) 42,092 (93.22 0.001
interventions (n, %)
Without medical 2,943 (54.29) 3,062 (6.78) 0.001
nterventions (n, %)
Discussion

Increased uterine blood flow and accelerate cervical dilatation.

Warmth signal can reduce or block the pain signal, VAS pain scores were
significantly lower in the birth in water group at 30 and 60 min after a
cervical dilatation of 3 cm

The incidence of degree I perineal laceration was significantly greater in

the water birth group The incidences of degree II and III perineal
lacerations were significantly lower in the water birth group

The incidence of neonatal asphyxia was significantly lower in the water

birth group than that in the conventional delivery group (P<0.05). There
were no differences in need for transfer to NICU between the two
groups
Discussion (Con’t)
Bodner et al. Zanetti- Cluett et al.
Daellenbach et
al.
•The incidence of •Found that the •The process of water
maternal infection maternal immersion
in the water infections labor and birth did
birth in water were similar not increase the
group was between the two incidences
significantly lower groups. of maternal infections
Discussion (Con’t)

there was no significant

difference in the positive rate of
postnatal vaginal culture between
the two groups.

There were significantly less

patients who need medical
interventions in the water birth.
Limitations

The present study was

conducted in a single
institution

Didn’t conduct follow up to

ensure the short and long-
term maternal and neonatal
outcomes
Conclusions
• Birth water can reduce maternal pain and decrease
the incidence of degree II and III perineal lacerations,
postpartum urinary retention and neonatal asphyxia.
• Birth water doesn’t increase the rate of maternal
infections. .
• Birth water is an intrapartum service model that is
worthy of promotion and application.
 Result
Question Answer
What are the Birth in water is an intrapartum service model that
results of this is worthy of promotion and application. (conclusion
study? sub-section , p.6)
How precise Quite valuable because it has significant p value
are the and has a large confidence interval.
results? (method and results sub-section, p. 2-3)
Do you Yes, because the design and analysis of the research
believe the has been adjusted in such a way that the bias can
results? be minimized.
(methods and discussions sub-sections , p 2
 Validity
Question Answer Reason
1. Did the Yes • Researchers have clearly defined the study
study address a population
clearly focused The population in this study were all healthy
issue?? primipara with singleton pregnancies and
cephalic presentation who were admitted at
Department of Obstetrics in Shanghai Changning
Maternity & Infant Health Hospital, China,
(sub-section method, p. 2)

2. Did the Yes • This research is a retrospective analyzing

authors use an Appropriate to find out the clinical data of 50,574
appropriate healthy primipara with singleton pregnancies and
method to cephalic presentation from January 2010 to
answer their December 2016 in a maternity & infant health
question? hospital in Shanghai, China. (sub-section method,
p. 2)
 Validity

Question Answer Reason

3. Were the Yes • Have inclusion and exclusion criteria

cases recruited • Having a representative sample,
in an • Have enough research time, and
acceptable • Have sufficient number of samples
way? (method and result sub-section , p. 2)

4. Is the data Yes The screening process was conducted by

collected in researchers using a self-developed data
accordance collection sheet and it involved the use of
with the clinical logs, hospital admission books, labor,
purpose of delivery, and infant records, and medical
research? records.
Validity
Question Answer Reason
5. Were the Yes • Comparison outcomes between the two
two groups groups with the same variables.
cared for in (methods, sub-section, p-3)
similar way of
treatment?
 Important
Question Answer

7. Is this study Because birth in water can reduce maternal pain and
important? decrease the incidences of degree II and III perineal
lacerations, postpartum urinary retention and neonatal
asphyxia, meanwhile, does not increase the rate of
maternal infections. (Discussion sub-section , p.6)
Applicable
Question Answer Reason
10 . Can the Yes birth in water is an intrapartum service
results be model that is worthy of promotion and
applied to the application.(discussion sub-section, p. 6)
local
population?
 Validity
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This
Journal
Important Applicable
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