Water births could offer pregnant women relief from pain and episiotomies during labor, new study finds

Six months after giving birth, a 35-year-old woman said she still felt pain in the region where she had an episiotomy – a surgical incision in the perineum (the region between the vagina and anus) meant to prevent heavy tears and needs help Delivery. Unfortunately, using the bathroom “felt like torture” for her. And the long-term effects of the procedure aren’t just physical, she told researchers in a 2020 paper: Her sex life and self-esteem have changed permanently.

“The psychological shadow might go away over time, but I don’t know yet,” she said.

Although the number of episiotomies in the US has declined since the American College of Obstetricians and Gynecologists discouraged their routine use in 2006, the procedure is still more common in the US than critics say, and remains widespread in other countries . In England, for example, about one birth in seven involves an episiotomy. And a study published last week found that BIPOC patients in the US were more than twice as likely as white patients to have an episiotomy.

A new analysis of dozens of studies published in the journal Tuesday BMJ open found an unlikely preventive measure against painful episiotomies: water births.

The term “water birth” describes a number of practices, but all involve immersion in water during some stage of the labor and delivery process. Jennifer Vanderlaan, a maternal health researcher at the University of Nevada Las Vegas School of Nursing and a co-author of the new paper, said the practice is comparable to sitting in a hot tub and is used to manage pain.

“It’s weird to me that we have to show this, but sitting in a hot tub relieves pain,” Vanderlaan told The Daily Beast.

The new study analyzed 36 papers published worldwide since 2000 and compared a range of outcomes and risks for those giving birth with and without water immersion. Vanderlaan and her team found that water birth significantly reduced the frequency of reported pain as well as the rate of episiotomy – “a procedure that provides no perineal or fetal benefit can increase postnatal pain and anxiety and negatively impact a woman’s birth experience,” says the newspaper. In addition, water births reduced the likelihood of postpartum hemorrhage, opioid injections, and epidural anesthesia. However, the study found that a water birth increases the likelihood of an umbilical cord avulsion, a complication in which the umbilical cord tears away from the placenta.

Vanderlaan said that an intact dam is associated with lower rates of episiotomy. In the studies analyzed, water births tended to reduce episiotomies the most in countries with the highest background rates of the procedure.

“Our hypothesis is that water birth will change standard practice when it is introduced in hospitals because the way patients are cared for is different when they are in water,” Vanderlaan said. Water births can make caregivers more present or alert and reduce the frequency of procedures that would need to be performed outside of the tub, such as B. an episiotomy.

Still, not everyone has the knowledge or resources to access a water birth — a practice more common among wealthier people. A 2021 study of over 46,000 births found that white women from higher socioeconomic backgrounds were more likely than other demographics to have had a water birth.

Labor is divided into three stages: dilatation of the cervix, delivery, and afterbirth (when the placenta is delivered). According to the American College of Obstetricians and Gynecologists, choosing to have a water birth during the first phase of labor “may be associated with shorter labor times and less use of spinal and epidural analgesia”; However, their recommendation on the subject indicates that more data is needed on the potential risks and benefits of water birth in the later stages of labor and delivery.

“Therefore, until such data are available, the college recommends that births take place on land rather than in water,” the report said.

Obtaining this data is not that easy or practical, Vanderlaan said, adding that the guidelines “definitely should be re-evaluated”. At the very least, this study should clarify some questions about the risks of water birth.

“We know it leads to fewer episiotomies,” she said. “We have enough evidence to say yes, this is a safe and effective method of pain control and it should be made available to women.”