To give birth in water

Abstract: 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.