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To give birth in water
Sophiahemmet University.
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim of this thesis was to study waterbirth in a Swedish context and to bring focus on clinical outcomes and women’s experiences associated with waterbirth. The literature describes advantages for women giving birth in water like relaxation and a positive birth experience. Still, waterbirth is controversial in Sweden and has not been offered at hospitals until recently.

Study I compared birth characteristics and outcomes of waterbirths with conventional uncomplicated births at the two clinics in Sweden providing waterbirth, from March 2014 to November 2015 (n=306+306). We found an association with fewer perineal tears of second degree among women giving birth in water and that these women were exposed to significantly less interventions such as amniotomy and oxytocin infusion intrapartum. There were no differences in Apgar scores or admissions to the neonatal intensive care unit, but three cases of umbilical cord rupture occurred among the waterbirths. Women having a waterbirth ranked their experience of childbirth higher in a numeric rating scale indicating a more positive birth experience.

Study II was a qualitative study based on 20 in-depth interviews describing women’s experience of giving birth in water. The interviews, which took place 3-5 months postpartum were analyzed with qualitative content analysis. The overall theme emerging from the analysis was “Like an empowering microhome” describing the effect of being strengthened, enabled and authorized in the birth process. The limited space of a bathtub was described to give a relaxed and homelike feeling of privacy. Three categories were identified: “Synergy between body and mind”, “Privacy and discretion” and “Natural and pleasant”.

In Study III we explored the experience, knowledge and attitudes regarding waterbirth among midwives, obstetricians/gynecologists and neonatologists in a cross-sectional study. Using a web- via The Swedish Association of Midwives and the Heads of department of all Swedish maternity wards between April and June 2016, yieleded 1609 responses. The questionnaire contained a Likert Scale and open-ended questions which were analyzed with descriptive statistics and quantitative content analysis. We found that midwives had amore positive attitude to waterbirth as well as towards providing and implementing waterbirth, compared to physicians. Strong opinions wereheld about waterbirth, which to some extent were based on subjective attitudes secondary to knowledge, experience and evidence.

In Study IV we compared childbirth experience between women having a waterbirth (n=111) and women having an uncomplicated conventional birth (n=104) using the validated Childbirth Experience Questionnaire (CEQ). The 22-item questionnaire assessed four domains: Own capacity, Professional support, Perceived safety and Participation. Further, supplementary questions about the second stage of labour were added to the web-questionnaire. The total CEQ score did not differ between the groups, while women having a waterbirth scored significantly higher in the domain, “Own capacity” and lower in the domain, “Professional support”. Women having a waterbirth rated significantly less pain and higher scores of being in control in the second stage of labour.

Place, publisher, year, edition, pages
Karolinska institutet , 2019. , p. 57
National Category
Nursing
Identifiers
URN: urn:nbn:se:shh:diva-3413ISBN: 978-91-7831-451-5 (print)OAI: oai:DiVA.org:shh-3413DiVA, id: diva2:1331941
Public defence
2019-06-13, Erfors- och Weitnersalen, Sophiahemmet Högskola, Valhallavägen 91, Hus R, plan 2, Stockholm, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2019-06-27 Created: 2019-06-27 Last updated: 2019-06-27Bibliographically approved
List of papers
1. Waterbirth in Sweden - a comparative study
Open this publication in new window or tab >>Waterbirth in Sweden - a comparative study
2018 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 97, no 3, p. 341-348Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: The literature describes advantages for mothers giving birth in water, but waterbirth is controversial in Sweden and has not been offered at hospitals until recently. This study aimed to describe and compare the characteristics and outcome of waterbirths with spontaneous vaginal births at the same clinics.

MATERIAL AND METHODS: A retrospective cohort study was conducted on all waterbirths at two maternity units in Sweden from March 2014 to November 2015 (n=306), and a consecutively selected comparison group of 306 women having conventional spontaneous vaginal births. Logistic regression was used to analyze the primary outcome; second-degree perineal tears.

RESULTS: Women giving birth in water had a lower risk of second-degree perineal tears (adj. OR 0.6 [95% CI 0.4-0.9]). Their labor was shorter (6:03 hrs. vs 7:52 hrs.) and there were significantly less interventions than in the comparison group; amniotomy (13.7% vs. 35.3%), internal cardiotocography (11.1% vs.56.8%), and augmentation with oxytocin (5.2% vs.31.3%). There were no differences in Apgar scores or admissions to neonatal intensive care unit. The experience of childbirth, measured with a numeric rating scale, was higher in the waterbirth group indicating a more positive birth experience. Three newborns born in water had an umbilical cord avulsion.

CONCLUSIONS: In this low-risk population, waterbirth is associated with positive effects on perineal tears, the frequency of interventions, the duration of labor and women's birth experience. Midwives handling waterbirth should be aware of the risk of umbilical cord avulsion. This article is protected by copyright. All rights reserved.

Keywords
birth, experience of childbirth, perineal tears, water immersion, waterbirth
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:shh:diva-2868 (URN)10.1111/aogs.13286 (DOI)29288489 (PubMedID)
Available from: 2018-01-15 Created: 2018-01-15 Last updated: 2019-06-27Bibliographically approved
2. Like an empowering micro-home: A qualitative study of women's experience of giving birth in water
Open this publication in new window or tab >>Like an empowering micro-home: A qualitative study of women's experience of giving birth in water
2018 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 67, p. 26-31, article id S0266-6138(18)30277-8Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To describe women´s experiences and perceptions of giving birth in water.

DESIGN: A qualitative study with in-depth interviews three to five months after the birth. A content analysis of the interviews was made.

SETTING: One city-located hospital in Stockholm, offering waterbirth to low risk women.

PARTICIPANTS: 20 women, 12 primiparas and 8 multiparas, aged 27-39.

MEASUREMENTS AND FINDINGS: The overall theme emerging from the analysis was, "Like an empowering micro-home", which describes the effect of being strengthened, enabled and authorized in the birth process. Three categories were found: "Synergy between body and mind", "Privacy and discretion", and "Natural and pleasant".

KEY CONCLUSIONS: The immersion in warm water provided the women with conditions that helped them to cope and feel confident during labour and birth. The homelike and limited space of a bathtub helped give a relaxed feeling of privacy, safety, control and focus for the women.

IMPLICATIONS FOR PRACTICE: This study contributes to a deeper understanding of what waterbirth offers to women. For some women, waterbirth may be a way to accomplish an empowering and positive birth experience, and could work as a tool that preserves the normality of, and increases self-efficacy in, childbirth.

Keywords
Birth, Content Analyses, Empowerment, Experience of childbirth, Water immersion, Waterbirth
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:shh:diva-3116 (URN)10.1016/j.midw.2018.09.004 (DOI)30223104 (PubMedID)
Available from: 2018-09-18 Created: 2018-09-18 Last updated: 2019-06-27Bibliographically approved
3. Testing the waters: A cross-sectional survey of views about waterbirth among Swedish health professionals
Open this publication in new window or tab >>Testing the waters: A cross-sectional survey of views about waterbirth among Swedish health professionals
2019 (English)In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, article id S1871-5192(18)31645-7Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND: For women with low risk births, waterbirth is an alternative that is requested and provided in approximately a hundred countries. However, in some countries, including Sweden, waterbirth is not generally available.

AIM: To explore the experiences, knowledge and attitudes regarding waterbirth among midwives, obstetricians/gynaecologists and neonatologists.

METHODS: A cross-sectional study was conducted in Sweden, using a web-based survey distributed via The Swedish Association of Midwives and the Heads of department of all Swedish maternity wards between April and June 2016. The respondents (n = 1609) answered a combination of Likert-scale and open-ended questions. The responses were analysed with descriptive statistics and quantitative content analyses.

FINDINGS: Both midwives and physicians stated a lack of experience, knowledge and clinical guidelines related to attending and assisting waterbirths. Overall, midwives had more positive attitudes to waterbirth (38.8% vs 4.5%) as well as towards providing and implementing waterbirth, compared to physicians (71.0% vs 14.9%). Midwives stated significantly more benefits and fewer risks for women and babies, compared to physicians who requested more evidence.

CONCLUSIONS: Opinions regarding waterbirth are to some extent based on attitudes rather than actual experience and knowledge. There are diverse interpretations of the strength of evidence and a lack of updating in the research field of waterbirth. As waterbirth is requested by women, health professionals need to update their knowledge in this topic in order to give coherent and evidence-based information and care to prospective parents.

Keywords
Birth, Midwifery, Training, Water immersion, Waterbirth
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:shh:diva-3306 (URN)10.1016/j.wombi.2019.04.003 (DOI)31054879 (PubMedID)
Available from: 2019-05-09 Created: 2019-05-09 Last updated: 2019-06-27Bibliographically approved
4. Women's experiences of waterbirth and conventional uncomplicated births
Open this publication in new window or tab >>Women's experiences of waterbirth and conventional uncomplicated births
(English)Manuscript (preprint) (Other academic)
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:shh:diva-3412 (URN)
Available from: 2019-06-27 Created: 2019-06-27 Last updated: 2019-06-27Bibliographically approved

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