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    ACOG committee opinion recommends land not water birth

    Birth on land rather than water is the recommendation of the American College of Obstetricians and Gynecologists (ACOG) in a new committee opinion. While acknowledging the potential benefits of water immersion during the first stage of labor, the document points to insufficient data on benefits or risks of the technique in the second stage of labor and delivery.

    Also endorsed by the American Academy of Pediatrics, the committee opinion is based on a review of published dater on water immersion during labor and delivery, including a 2009 Cochrane systematic review. That analysis looked at 12 randomized controlled trials (RCT) of immersion during labor which included 3,243 women. In 9 of the trials, immersion was done during first-stage labor, in 2 trials, it was done in both first- and second-stage labor and in 1 RCT, immersion during the second stage was compared only with controls. The ACOG panel that reviewed the Cochrane data expressed concern about limitations of the 9 RCTs, such as lack of power, absence of blinding, and small sample size.

    In describing the Cochrane data on water immersion during first-stage labor, the committee opinion notes that it “may be associated with shorter labor and decreased use of spinal and epidural analgesia.” The document says that in that setting, it can be offered to healthy women with uncomplicated pregnancies between 37 0/7 and 41 6/7 weeks’ gestation. ACOG does not recommend that women give birth in water because of insufficient data on benefits and risks of water immersion during second-stage labor and delivery. “Several serious neonatal complications have been reported, but the actual incidence has not been determined in population-based analyses,” the authors said.

    Next: Don't fear the patient with a birth plan

    The committee opinion goes on to recommend that ob/gyns counsel women who want to give birth in water about the lack of data on maternal and perinatal benefits and risks of the technique and also let them know about the “rare but serious neonatal complications associated with this choice.” Those include case reports and case series documenting major infection with Pseudomonas aeruginosa and Legionella pneumophila as well as the potential for neonatal water aspiration. 

    Judith M. Orvos, ELS
    Judith M. Orvos, ELS, is a a BELS-certified medical writer and editor and an editorial consultant for Contemporary OB/GYN.

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