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Meta-Analysis
. 2018 May 16;5(5):CD000111.
doi: 10.1002/14651858.CD000111.pub4.

Immersion in water during labour and birth

Elizabeth R Cluett  1 , Ethel Burns, Anna Cuthbert
Affiliations
Meta-Analysis

Immersion in water during labour and birth

Elizabeth R Cluett et al. Cochrane Database Syst Rev. .

Abstract

Background: Water immersion during labour and birth is increasingly popular and is becoming widely accepted across many countries, and particularly in midwifery-led care settings. However, there are concerns around neonatal water inhalation, increased requirement for admission to neonatal intensive care unit (NICU), maternal and/or neonatal infection, and obstetric anal sphincter injuries (OASIS). This is an update of a review last published in 2011.

Objectives: To assess the effects of water immersion during labour and/or birth (first, second and third stage of labour) on women and their infants.

Search methods: We searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP) (18 July 2017), and reference lists of retrieved trials.

Selection criteria: We included randomised controlled trials (RCTs) comparing water immersion with no immersion, or other non-pharmacological forms of pain management during labour and/or birth in healthy low-risk women at term gestation with a singleton fetus. Quasi-RCTs and cluster-RCTs were eligible for inclusion but none were identified. Cross-over trials were not eligible for inclusion.

Data collection and analysis: Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. Two review authors assessed the quality of the evidence using the GRADE approach.

Main results: This review includes 15 trials conducted between 1990 and 2015 (3663 women): eight involved water immersion during the first stage of labour; two during the second stage only; four during the first and second stages of labour, and one comparing early versus late immersion during the first stage of labour. No trials evaluated different baths/pools, or third-stage labour management. All trials were undertaken in a hospital labour ward setting, with a varying degree of medical intervention considered as routine practice. No study was carried out in a midwifery-led care setting. Most trial authors did not specify the parity of women. Trials were subject to varying degrees of bias: the intervention could not be blinded and there was a lack of information about randomisation, and whether analyses were undertaken by intention-to-treat.Immersion in water versus no immersion (first stage of labour)There is probably little or no difference in spontaneous vaginal birth between immersion and no immersion (82% versus 83%; risk ratio (RR) 1.01, 95% confidence interval (CI) 0.97 to 1.04; 6 trials; 2559 women; moderate-quality evidence); instrumental vaginal birth (14% versus 12%; RR 0.86, 95% CI 0.70 to 1.05; 6 trials; 2559 women; low-quality evidence); and caesarean section (4% versus 5%; RR 1.27, 95% CI 0.91 to 1.79; 7 trials; 2652 women; low-quality evidence). There is insufficient evidence to determine the effect of immersion on estimated blood loss (mean difference (MD) -14.33 mL, 95% CI -63.03 to 34.37; 2 trials; 153 women; very low-quality evidence) and third- or fourth-degree tears (3% versus 3%; RR 1.36, 95% CI 0.85 to 2.18; 4 trials; 2341 women; moderate-quality evidence). There was a small reduction in the risk of using regional analgesia for women allocated to water immersion from 43% to 39% (RR 0.91, 95% CI 0.83 to 0.99; 5 trials; 2439 women; moderate-quality evidence). Perinatal deaths were not reported, and there is insufficient evidence to determine the impact on neonatal intensive care unit (NICU) admissions (6% versus 8%; average RR 1.30, 95% CI 0.42 to 3.97; 2 trials; 1511 infants; I² = 36%; low-quality evidence), or on neonatal infection rates (1% versus 1%; RR 2.00, 95% CI 0.50 to 7.94; 5 trials; 1295 infants; very low-quality evidence).Immersion in water versus no immersion (second stage of labour)There were no clear differences between groups for spontaneous vaginal birth (97% versus 99%; RR 1.02, 95% CI 0.96 to 1.08; 120 women; 1 trial; low-quality evidence); instrumental vaginal birth (2% versus 2%; RR 1.00, 95% CI 0.06 to 15.62; 1 trial; 120 women; very low-quality evidence); caesarean section (2% versus 1%; RR 0.33, 95% CI 0.01 to 8.02; 1 trial; 120 women; very low-quality evidence), and NICU admissions (11% versus 9%; RR 0.78, 95% CI 0.38 to 1.59; 2 trials; 291 women; very low-quality evidence). Use of regional analgesia was not relevant to the second stage of labour. Third- or fourth-degree tears, and estimated blood loss were not reported in either trial. No trial reported neonatal infection but did report neonatal temperature less than 36.2°C at birth (9% versus 9%; RR 0.98, 95% CI 0.30 to 3.20; 1 trial; 109 infants; very low-quality evidence), greater than 37.5°C at birth (6% versus 15%; RR 2.62, 95% CI 0.73 to 9.35; 1 trial; 109 infants; very low-quality evidence), and fever reported in first week (5% versus 2%; RR 0.53, 95% CI 0.10 to 2.82; 1 trial; 171 infants; very low-quality evidence), with no clear effect between groups being observed. One perinatal death occurred in the immersion group in one trial (RR 3.00, 95% CI 0.12 to 72.20; 1 trial; 120 infants; very low-quality evidence). The infant was born to a mother with HIV and the cause of death was deemed to be intrauterine infection.There is no evidence of increased adverse effects to the baby or woman from either the first or second stage of labour.Only one trial (200 women) compared early and late entry into the water and there were insufficient data to show any clear differences.

Authors' conclusions: In healthy women at low risk of complications there is moderate to low-quality evidence that water immersion during the first stage of labour probably has little effect on mode of birth or perineal trauma, but may reduce the use of regional analgesia. The evidence for immersion during the second stage of labour is limited and does not show clear differences on maternal or neonatal outcomes intensive care. There is no evidence of increased adverse effects to the fetus/neonate or woman from labouring or giving birth in water. Available evidence is limited by clinical variability and heterogeneity across trials, and no trial has been conducted in a midwifery-led setting.

PubMed Disclaimer

Conflict of interest statement

Elizabeth R Cluett: The first review author (E Cluett) is chief investigator of two trials related to the subject of this review (Cluett 2001; Cluett 2004); these trials were reviewed by E Burns and previous author Cheryl Nikodem. We excluded both trials.

Ethel Burns: none known.

Anna Cuthbert: I am a research associate working in the editorial base of Cochrane Pregnancy and Childbirth and am employed by the University of Liverpool. Cochrane Pregnancy and Childbirth receives infrastructure funding from the NIHR, UK.

Figures

1
1
Study flow diagram.
2
2
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Immersion in water versus no immersion during first stage of labour, Outcome 1 Mode of birth (spontaneous vaginal birth).
1.2
1.2. Analysis
Comparison 1 Immersion in water versus no immersion during first stage of labour, Outcome 2 Mode of birth (instrumental vaginal births).
1.3
1.3. Analysis
Comparison 1 Immersion in water versus no immersion during first stage of labour, Outcome 3 Mode of birth (caesarean section).
1.4
1.4. Analysis
Comparison 1 Immersion in water versus no immersion during first stage of labour, Outcome 4 Use of analgesia (regional).
1.5
1.5. Analysis
Comparison 1 Immersion in water versus no immersion during first stage of labour, Outcome 5 Perineal trauma (third‐ or fourth‐degree tears).
1.6
1.6. Analysis
Comparison 1 Immersion in water versus no immersion during first stage of labour, Outcome 6 Admission to neonatal intensive care unit.
1.7
1.7. Analysis
Comparison 1 Immersion in water versus no immersion during first stage of labour, Outcome 7 Neonatal infection.
1.8
1.8. Analysis
Comparison 1 Immersion in water versus no immersion during first stage of labour, Outcome 8 Neonate temperature.
1.9
1.9. Analysis
Comparison 1 Immersion in water versus no immersion during first stage of labour, Outcome 9 Estimated blood loss (mL).
1.10
1.10. Analysis
Comparison 1 Immersion in water versus no immersion during first stage of labour, Outcome 10 Postpartum haemorrhage.
1.11
1.11. Analysis
Comparison 1 Immersion in water versus no immersion during first stage of labour, Outcome 11 Use of analgesia (pharmacological ‐ pethidine/narcotic).
1.12
1.12. Analysis
Comparison 1 Immersion in water versus no immersion during first stage of labour, Outcome 12 Use of any analgesia.
1.13
1.13. Analysis
Comparison 1 Immersion in water versus no immersion during first stage of labour, Outcome 13 Use of analgesia (pharmacological ‐ any).
1.14
1.14. Analysis
Comparison 1 Immersion in water versus no immersion during first stage of labour, Outcome 14 Maternal infection during labour/postnatal period (perineal, systemic, uterine or increase in temperature).
1.15
1.15. Analysis
Comparison 1 Immersion in water versus no immersion during first stage of labour, Outcome 15 Artificial rupture of membranes.
1.16
1.16. Analysis
Comparison 1 Immersion in water versus no immersion during first stage of labour, Outcome 16 Use of oxytocin for augmentation of labour.
1.17
1.17. Analysis
Comparison 1 Immersion in water versus no immersion during first stage of labour, Outcome 17 Use of non‐pharmacological analgesia (transcutaneous nerve stimulation (TENS).
1.18
1.18. Analysis
Comparison 1 Immersion in water versus no immersion during first stage of labour, Outcome 18 Duration of first stage (minutes).
1.19
1.19. Analysis
Comparison 1 Immersion in water versus no immersion during first stage of labour, Outcome 19 Duration of second stage (minutes).
1.20
1.20. Analysis
Comparison 1 Immersion in water versus no immersion during first stage of labour, Outcome 20 Duration of third stage (minutes).
1.21
1.21. Analysis
Comparison 1 Immersion in water versus no immersion during first stage of labour, Outcome 21 Duration of total labour (all three stages minutes).
1.22
1.22. Analysis
Comparison 1 Immersion in water versus no immersion during first stage of labour, Outcome 22 Perineal trauma (intact).
1.23
1.23. Analysis
Comparison 1 Immersion in water versus no immersion during first stage of labour, Outcome 23 Perineal trauma (second‐degree tears).
1.24
1.24. Analysis
Comparison 1 Immersion in water versus no immersion during first stage of labour, Outcome 24 Perineal trauma (episiotomy).
1.25
1.25. Analysis
Comparison 1 Immersion in water versus no immersion during first stage of labour, Outcome 25 Self reports pain score on visual analogue scale of 0‐10.
1.26
1.26. Analysis
Comparison 1 Immersion in water versus no immersion during first stage of labour, Outcome 26 Pain intensity (experience of moderate to severe pain).
1.27
1.27. Analysis
Comparison 1 Immersion in water versus no immersion during first stage of labour, Outcome 27 Systolic blood pressure.
1.28
1.28. Analysis
Comparison 1 Immersion in water versus no immersion during first stage of labour, Outcome 28 Diastolic blood pressure.
1.29
1.29. Analysis
Comparison 1 Immersion in water versus no immersion during first stage of labour, Outcome 29 Mean arterial blood pressure.
1.30
1.30. Analysis
Comparison 1 Immersion in water versus no immersion during first stage of labour, Outcome 30 Preference for care in subsequent labour (Does not wish to use bath with next labour/birth).
1.31
1.31. Analysis
Comparison 1 Immersion in water versus no immersion during first stage of labour, Outcome 31 Postpartum depression (EPDS more than 11).
1.32
1.32. Analysis
Comparison 1 Immersion in water versus no immersion during first stage of labour, Outcome 32 Abnormal fetal heart rate patterns.
1.33
1.33. Analysis
Comparison 1 Immersion in water versus no immersion during first stage of labour, Outcome 33 Presence of meconium‐stained liquor.
1.34
1.34. Analysis
Comparison 1 Immersion in water versus no immersion during first stage of labour, Outcome 34 Apgar score less than seven at five minutes.
1.35
1.35. Analysis
Comparison 1 Immersion in water versus no immersion during first stage of labour, Outcome 35 Apgar score at five minutes.
1.36
1.36. Analysis
Comparison 1 Immersion in water versus no immersion during first stage of labour, Outcome 36 Umbilical artery pH less than 7.20.
1.37
1.37. Analysis
Comparison 1 Immersion in water versus no immersion during first stage of labour, Outcome 37 Breastfeeding ‐ not breastfeeding after six weeks post birth.
2.1
2.1. Analysis
Comparison 2 Immersion in water versus no immersion during second stage of labour, Outcome 1 Mode of birth (spontaneous vaginal birth).
2.2
2.2. Analysis
Comparison 2 Immersion in water versus no immersion during second stage of labour, Outcome 2 Mode of birth (instrumental vaginal births).
2.3
2.3. Analysis
Comparison 2 Immersion in water versus no immersion during second stage of labour, Outcome 3 Mode of birth (caesarean section).
2.4
2.4. Analysis
Comparison 2 Immersion in water versus no immersion during second stage of labour, Outcome 4 Perinatal deaths.
2.5
2.5. Analysis
Comparison 2 Immersion in water versus no immersion during second stage of labour, Outcome 5 Admission to neonatal intensive care unit.
2.6
2.6. Analysis
Comparison 2 Immersion in water versus no immersion during second stage of labour, Outcome 6 Neonate temperature.
2.7
2.7. Analysis
Comparison 2 Immersion in water versus no immersion during second stage of labour, Outcome 7 Fever reported in first week.
2.8
2.8. Analysis
Comparison 2 Immersion in water versus no immersion during second stage of labour, Outcome 8 Postpartum haemorrhage more than 500 mL.
2.9
2.9. Analysis
Comparison 2 Immersion in water versus no immersion during second stage of labour, Outcome 9 Duration of second stage (minutes).
2.10
2.10. Analysis
Comparison 2 Immersion in water versus no immersion during second stage of labour, Outcome 10 Perineal trauma (episiotomy).
2.11
2.11. Analysis
Comparison 2 Immersion in water versus no immersion during second stage of labour, Outcome 11 Perineal trauma (second degree tear).
2.12
2.12. Analysis
Comparison 2 Immersion in water versus no immersion during second stage of labour, Outcome 12 Experience of moderate to severe pain.
2.13
2.13. Analysis
Comparison 2 Immersion in water versus no immersion during second stage of labour, Outcome 13 Preference for care in subsequent labour (Does not wish to use bath next birth).
2.14
2.14. Analysis
Comparison 2 Immersion in water versus no immersion during second stage of labour, Outcome 14 Satisfied with labour.
2.15
2.15. Analysis
Comparison 2 Immersion in water versus no immersion during second stage of labour, Outcome 15 Presence of meconium‐stained liquor.
2.16
2.16. Analysis
Comparison 2 Immersion in water versus no immersion during second stage of labour, Outcome 16 Apgar score less than seven (five minutes).
2.17
2.17. Analysis
Comparison 2 Immersion in water versus no immersion during second stage of labour, Outcome 17 Mean Apgar at five minutes.
2.18
2.18. Analysis
Comparison 2 Immersion in water versus no immersion during second stage of labour, Outcome 18 Umbilical artery pH less than 7.20.
3.1
3.1. Analysis
Comparison 3 Immersion in water versus no immersion during any stage of labour, Outcome 1 Mode of birth (spontaneous vaginal birth).
3.2
3.2. Analysis
Comparison 3 Immersion in water versus no immersion during any stage of labour, Outcome 2 Mode of birth (instrumental vaginal births).
3.3
3.3. Analysis
Comparison 3 Immersion in water versus no immersion during any stage of labour, Outcome 3 Mode of birth (caesarean section).
3.4
3.4. Analysis
Comparison 3 Immersion in water versus no immersion during any stage of labour, Outcome 4 Use of analgesia (regional).
3.5
3.5. Analysis
Comparison 3 Immersion in water versus no immersion during any stage of labour, Outcome 5 Perineal trauma (third‐ or fourth‐degree tears).
3.6
3.6. Analysis
Comparison 3 Immersion in water versus no immersion during any stage of labour, Outcome 6 Perinatal deaths.
3.7
3.7. Analysis
Comparison 3 Immersion in water versus no immersion during any stage of labour, Outcome 7 Admission to neonatal intensive care unit.
3.8
3.8. Analysis
Comparison 3 Immersion in water versus no immersion during any stage of labour, Outcome 8 Neonatal infection.
3.9
3.9. Analysis
Comparison 3 Immersion in water versus no immersion during any stage of labour, Outcome 9 Neonate temperature.
3.10
3.10. Analysis
Comparison 3 Immersion in water versus no immersion during any stage of labour, Outcome 10 Fever reported in first week.
3.11
3.11. Analysis
Comparison 3 Immersion in water versus no immersion during any stage of labour, Outcome 11 Antibiotics given to neonate.
3.12
3.12. Analysis
Comparison 3 Immersion in water versus no immersion during any stage of labour, Outcome 12 Estimated blood loss (mL).
3.13
3.13. Analysis
Comparison 3 Immersion in water versus no immersion during any stage of labour, Outcome 13 Postpartum haemorrhage.
3.14
3.14. Analysis
Comparison 3 Immersion in water versus no immersion during any stage of labour, Outcome 14 Use of analgesia (pharmacological ‐ pethidine/narcotic).
3.15
3.15. Analysis
Comparison 3 Immersion in water versus no immersion during any stage of labour, Outcome 15 Use of analgesia (pharmacological ‐ any).
3.16
3.16. Analysis
Comparison 3 Immersion in water versus no immersion during any stage of labour, Outcome 16 Use of any analgesia.
3.17
3.17. Analysis
Comparison 3 Immersion in water versus no immersion during any stage of labour, Outcome 17 Maternal infection during labour/postnatal period (perineal, systemic, uterine or increase in temperature).
3.18
3.18. Analysis
Comparison 3 Immersion in water versus no immersion during any stage of labour, Outcome 18 Artificial rupture of membranes.
3.19
3.19. Analysis
Comparison 3 Immersion in water versus no immersion during any stage of labour, Outcome 19 Use of oxytocin for augmentation of labour.
3.20
3.20. Analysis
Comparison 3 Immersion in water versus no immersion during any stage of labour, Outcome 20 Use of non‐pharmacological analgesia (transcutaneous nerve stimulation (TENS)).
3.21
3.21. Analysis
Comparison 3 Immersion in water versus no immersion during any stage of labour, Outcome 21 Duration of first stage (minutes).
3.22
3.22. Analysis
Comparison 3 Immersion in water versus no immersion during any stage of labour, Outcome 22 Duration of second stage (minutes).
3.23
3.23. Analysis
Comparison 3 Immersion in water versus no immersion during any stage of labour, Outcome 23 Duration of third stage (minutes).
3.24
3.24. Analysis
Comparison 3 Immersion in water versus no immersion during any stage of labour, Outcome 24 Duration of total labour (all three stages).
3.25
3.25. Analysis
Comparison 3 Immersion in water versus no immersion during any stage of labour, Outcome 25 Perineal trauma (none‐ intact).
3.26
3.26. Analysis
Comparison 3 Immersion in water versus no immersion during any stage of labour, Outcome 26 Perineal trauma (first‐ and second‐degree tears).
3.27
3.27. Analysis
Comparison 3 Immersion in water versus no immersion during any stage of labour, Outcome 27 Perineal trauma (episiotomy).
3.28
3.28. Analysis
Comparison 3 Immersion in water versus no immersion during any stage of labour, Outcome 28 Self reports pain score on visual analogue scale of 0‐10.
3.29
3.29. Analysis
Comparison 3 Immersion in water versus no immersion during any stage of labour, Outcome 29 Pain intensity (experience of moderate to severe pain).
3.30
3.30. Analysis
Comparison 3 Immersion in water versus no immersion during any stage of labour, Outcome 30 Maternal temperature.
3.31
3.31. Analysis
Comparison 3 Immersion in water versus no immersion during any stage of labour, Outcome 31 Systolic blood pressure.
3.32
3.32. Analysis
Comparison 3 Immersion in water versus no immersion during any stage of labour, Outcome 32 Diastolic blood pressure.
3.33
3.33. Analysis
Comparison 3 Immersion in water versus no immersion during any stage of labour, Outcome 33 Mean arterial blood pressure.
3.34
3.34. Analysis
Comparison 3 Immersion in water versus no immersion during any stage of labour, Outcome 34 Preference for care in subsequent labour (Does not wish to use bath with next labour/birth).
3.35
3.35. Analysis
Comparison 3 Immersion in water versus no immersion during any stage of labour, Outcome 35 Satisfied with labour.
3.36
3.36. Analysis
Comparison 3 Immersion in water versus no immersion during any stage of labour, Outcome 36 Satisfied with labour on scale.
3.37
3.37. Analysis
Comparison 3 Immersion in water versus no immersion during any stage of labour, Outcome 37 Postpartum depression (EPDS more than 11).
3.38
3.38. Analysis
Comparison 3 Immersion in water versus no immersion during any stage of labour, Outcome 38 Abnormal fetal heart rate patterns.
3.39
3.39. Analysis
Comparison 3 Immersion in water versus no immersion during any stage of labour, Outcome 39 Presence of meconium‐stained liquor.
3.40
3.40. Analysis
Comparison 3 Immersion in water versus no immersion during any stage of labour, Outcome 40 Apgar score less than seven at five minutes.
3.41
3.41. Analysis
Comparison 3 Immersion in water versus no immersion during any stage of labour, Outcome 41 Apgar score at five minutes.
3.42
3.42. Analysis
Comparison 3 Immersion in water versus no immersion during any stage of labour, Outcome 42 Umbilical artery pH less than 7.20.
3.43
3.43. Analysis
Comparison 3 Immersion in water versus no immersion during any stage of labour, Outcome 43 Breastfeeding.
3.44
3.44. Analysis
Comparison 3 Immersion in water versus no immersion during any stage of labour, Outcome 44 Not breastfeeding after six weeks post birth.
4.1
4.1. Analysis
Comparison 4 Early versus late immersion in water, Outcome 1 Use of pharmacological analgesia (epidural/spinal analgesia/paracervical block).
4.2
4.2. Analysis
Comparison 4 Early versus late immersion in water, Outcome 2 Neonatal infection.
4.3
4.3. Analysis
Comparison 4 Early versus late immersion in water, Outcome 3 Use of oxytocin.
4.4
4.4. Analysis
Comparison 4 Early versus late immersion in water, Outcome 4 Abnormal fetal heart rate patterns.
4.5
4.5. Analysis
Comparison 4 Early versus late immersion in water, Outcome 5 Apgar score less than seven at one minute.
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Update of

References

References to studies included in this review

Cammu 1994 {published data only}
    1. Cammu H, Clasen K, Wettere L. Is having a warm bath during labour useful?. Journal of Perinatal Medicine 1992;20(Suppl 1):104.
    1. Cammu H, Clasen K, Wettere L, Derde M. 'To bathe or not to bathe' during the first stage of labor. Acta Obstetricia et Gynecologica Scandinavica 1994;73:468‐72. - PubMed
Chaichian 2009 {published data only}
    1. Chaichian S, Akhlaghi A, Rousta F, Safavi M. Experience of water birth delivery in Iran. Archives of Iranian Medicine 2009;12(5):468‐71. - PubMed
Da Silva 2006 {published data only}
    1. Silva FM, Oliveira SM. The effect of immersion baths on the length of childbirth labor [O efeito do banho de imersao na duracao do trabalho de parto]. Revista da Escola de Enfermagem da USP 2006;40(1):57‐63. - PubMed
    1. Silva FMB, Olivera SMJV, Nobre MRC. A randomised controlled trial evaluating the effect of immersion bath on labour pain. Midwifery 2009; Vol. 25, issue 3:286‐94. - PubMed
Eckert 2001 {published data only}
    1. Eckert K, Turnbull D, MacLennan A. Immersion in water in the first stage of labor: a randomised controlled trial. Birth 2001;28(2):84‐93. - PubMed
    1. Eckert KA, MacLennan AH, Turnbull DA. Immersion in water in the first stage of labour: a randomised controlled trial. 4th Annual Congress of the Perinatal Society of Australia & New Zealand; 1998 March 30‐April 4; Alice Springs, Australia. 1998.
Eriksson 1997 {published data only}
    1. Eriksson M, Mattson L, Ladfors L. Early or late bath during the first stage of labour: a randomised study of 200 women. Midwifery 1997;13:146‐8. - PubMed
    1. Ladfors L, Mattsson I, Eriksson M. Early or late tub bath during the first stage of labor: a randomized study of 200 women. American Journal of Obstetrics and Gynecology 1997;176(1 Pt 2):S141. - PubMed
Gayiti 2015 {published data only}
    1. Gayiti MR, Zulifeiya AK, Zhao TN. Comparison of the effects of water and traditional delivery on birthing women and newborns. European Reviews for Medical and Pharmacological Sciences 2015;19:1554‐8. - PubMed
Ghasemi 2013 {published data only}
    1. Ghasemi M, Tara F, Hami A. Comparison between water birth and land birth in terms of fetal and neonatal outcomes. Iranian Journal of Neonatology 2014;8(5):4‐5.
    1. Ghasemi M, Tara F, Hami A. Maternal‐fetal and neonatal complications of water‐birth compared with conventional delivery. Iranian Journal of Obstetrics, Gynecology and Infertility 2013;16(70):9‐15.
Kuusela 1998 {published data only}
    1. Kuusela P, Koivisto A‐M, Heinonen PK. Warm tub bath during opening phase of labor [Lammin kylpy synnytyksen avautumisvaiheessa]. Suomen Laakarilehti 1998;11:1217‐21.
Nikodem 1999 {published data only}
    1. Nikodem C, Hofmeyr GJ, Nolte AGW, Jager M. The effects of water on birth: a randomized controlled trial. Proceedings of the 14th Conference on Priorities in Perinatal Care in South Africa; 1995 March 7‐10; South Africa. 1995:163‐6.
    1. Nikodem VC. Immersion in Water During Birth: a Randomized Controlled Trial [thesis]. South Africa: University of Witwatersrand, 1999.
    1. Nikodem VC. Guidelines for underwater deliveries: evidence from randomized controlled trial. Fifteenth Conference on Priorities in Perinatal Care in South Africa; March 5‐8; Goudini Spa, South Africa. 1996.
Ohlsson 2001 {published and unpublished data}
    1. Ohlsson G, Buchhave P, Leandersson U, Nordstrom L, Rydhstrom H, Sjolin I. Warm tub bathing during labor: maternal and neonatal effects. Acta Obstetricia et Gynecologica Scandinavica 2001;80:311‐4. - PubMed
    1. Rydhstrom H. Trial to test the effect of bathing vs no bathing in labour on transfer to neonatal intensive care. Personal communication 1994.
Rush 1996 {published data only}
    1. Rush J, Burlock S, Lambert K, Loosley‐Millman M, Hutchison B, Enkin M. The effects of whirlpool baths in labor: a randomized controlled trial. Birth 1996;23:136‐43. - PubMed
    1. Rush JPB. A Randomized Controlled Trial of the Effects of the Bath in Labour [thesis]. University of Toronto, 1999.
Schorn 1993 {published data only}
    1. Schorn MN, McAllister JL, Blanco JD. Water immersion and the effect on labor. Journal of Nurse‐Midwifery 1993;38(6):336‐42. - PubMed
Taha 2000 {unpublished data only}
    1. Jager M, Nolte AGW, Hofmeyr GJ, Nikodem VC. Immersion in water during first stage of labour. A randomised controlled trial. Personal communication 2001.
    1. Taha M. The Effects of Water on Labour: a Randomised Controlled Trial [thesis]. Johannesburg: Rand Afrikaans University, 2000.
    1. Taha M, Nolte AGW, Hofmeyr GJ, Dorfling CS. Water as a method of pain relief: a randomised controlled trial. 20th Conference on Priorities in Perinatal Care in Southern Africa; 2001 March 6‐9; KwaZulu‐Natal, South Africa. 2001.
Torkamani 2010 {published data only}
    1. Akbari S, Rashidi N, Changavi F, Janani F, Tarrahi MJ. The effect of water birth on the duration of labor and pain level in comparison with land birth. Yafte Journal of Medical Sciences 2008;10(3):39‐46.
    1. Torkamani SA, Kangani F, Janani F. The effects of delivery in water on duration of delivery and pain compared with normal delivery. Pakistan Journal of Medical Sciences 2010;26(3):551‐5.
Woodward 2004 {published data only}
    1. Woodward J, Kelly SM. A pilot study for a randomised controlled trial of waterbirth versus land birth. BJOG: an international journal of obstetrics and gynaecology 2004;111:537‐45. - PubMed
    1. Woodward JL. The Challenge of Conducting a Waterbirth Randomised Controled Trial [thesis]. Birmingham: University of Birmingham, 2011.

References to studies excluded from this review

Bastide 1990 {unpublished data only}
    1. Bastide A. A randomised controlled trial of the effects of a whirlpool bath on labour, birth and postpartum. Personal communication 1990.
Benfield 2001 {published data only}
    1. Benfield RD. The Effects of Hydrotherapy in Labor; a Psychophysiological Study [thesis]. South Carolina, USA: University of South Carolina, 1993.
    1. Benfield RD, Herman J, Katz VL, Wilson SP, Davis JM. Hydrotherapy in labor. Research in Nursing and Health 2001;24:57‐67. - PubMed
Cai 2005 {published data only}
    1. Cai HX, Xu Y, Lin Y‐M, Zhou Y‐P. The effects of waterbirth on mother and newborn. Chinese Journal of Nursing 2005;40(3):200‐1.
    1. Xu H. Effect of labor on the mother and newborn. Chinese Journal of Nursing 2005; Vol. 40, issue 3:200‐1.
Calvert 2000 {unpublished data only}
    1. Calvert I. The evaluation of the use of herbal substances in the bath water of labouring women. Personal communication 2000.
Cluett 2001 {published data only}
    1. Cluett ER, Pickering RM, Brooking JI. An investigation into the feasibility of comparing three management options (augmentation, conservative and water) for nulliparae with dystocia in the first stage of labour. Midwifery 2001;17(1):35‐43. - PubMed
Cluett 2004 {published data only}
    1. Cluett ER, Pickering RM, Getliffe G, Saunders NJ. Randomised controlled trial of labouring in water compared with standard of augmentation for the management of dystocia in first stage of labour. BMJ 2004;328(7435):314‐20. - PMC - PubMed
Henrique 2015 {published data only}
    1. Henrique A, RBR‐84xprt. Review of non‐pharmacological interventions for pain relief in labor. http://www.ensaiosclinicos.gov.br/rg/RBR‐84xprt/ (date received 19 March 2015).
    1. Henrique AJ, Gabrielloni MC, Cavalcanti ACV, Souza Melo P, Barbieri M. The influence on the labor evolution using hot bath and birth ball exercises. 31st International Confederation of Midwives Triennial Congress. Midwives ‐ Making a Difference in the World; 2017 June 18‐22; Toronto, Canada. 2017:Abstract no: P1.056.
    1. Henrique AJ, Gabrielloni MC, Fustinoni SM, Albuquerque RS, Barbieri M. Use of hydrotherapy and the birth ball in the management of labor pain and stress. 31st International Confederation of Midwives Triennial Congress. Midwives ‐ Making a Difference in the World; 2017 June 18‐22; Toronto, Canada. 2017:Abstract no: P1.055.
Irion 2011 {published data only}
    1. Irion JM, Irion GL. Water immersion to reduce peripheral edema pregnancy. Journal of Women's Health Physical Therapy 2011;35(2):46‐9.
Kashanian 2013 {published data only}
    1. Kashanian M, IRCT2012111811505N1. Comparison of "nutrition, bath and anointment" as a package in Iranian traditional medicine with current method in pregnant women on duration of active phase of labour. http://en.search.irct.ir/view/11507 (date received 15 June 2013).
Khadijeh 2015 {published data only}
    1. Khadijeh P, IRCT201110017676N1. The effect of hydrotherapy on labor and delivery process in Alzahra teaching hospital. http://en.search.irct.ir/view/7307 (date received 15 February 2015).
Labrecque 1999 {published data only}
    1. Labrecque M, Nouwen A, Bergeron M, Rancourt JF. A randomized controlled trial of nonpharmacologic approaches for relief of low back pain during labor. Journal of Family Practice 1999;48(4):259‐63. - PubMed
Lee 2013 {published data only}
    1. Lee SL, Liu CY, Lu YY, Gau ML. Efficacy of warm showers on labor pain and birth experiences during the first labor stage. Journal of Obstetric, Gynecologic, and Neonatal Nursing 2013;42(1):19‐28. - PubMed
Malarewicz 2005 {published data only}
    1. Malarewicz A, Wydrzynski G, Szymkiewicz J, Adamczyk‐Gruszka O. The influence of water immersion on the course of first stage of parturition in primiparous women [Wplyw immersji wodnej na przebieg i okresu porodu u pierwiastek]. Medycyna Wieku Rozwojowego 2005;9(4):773‐80. - PubMed
Zou 2008 {published data only}
    1. Zou WX, Zhu NH. The influence of water birth to delivery process. Clinical and Experimental Medicine 2008;7(6):137.

References to ongoing studies

Dabiri 2016 {published data only}
    1. Dabiri F, IRCT2015111725002N2. Effect of water immersion during the first stage of labor on pain and the outcome of labor of primipara women attending to Khaleej‐e‐ fars hospital in Bandar Abbas. en.search.irct.ir/view/26876 (first received 12 January 2016).

Additional references

Aird 1997
    1. Aird IA, Luckas MJM, Buckett WM, Bousfielf P. Effects of intrapartum hydrotherapy on labour parameters. Australian and New Zealand Journal of Obstetrics and Gynaecology 1997;37(2):137‐42. - PubMed
Alderdice 1995
    1. Alderdice F, Renfrew M, Marchant S, Ashurst H, Hughes PM, Berridge G, et al. Labour and birth in water in England and Wales: survey report. British Journal of Midwifery 1995;3(7):376‐82. - PMC - PubMed
Anderson 1996
    1. Anderson B, Gyhagen M, Neilse NTF. Warm bath during labour: effects on labour duration and maternal and fetal infectious morbidity. Journal of Obstetrics and Gynaecology 1996;16:326‐30.
Anim‐Somuah 2005
    1. Anim‐Somuah M, Smyth Rebecca MD, Howell Charlotte J. Epidural versus non‐epidural or no analgesia in labour. Cochrane Database of Systematic Reviews 2005, Issue 4. [DOI: 10.1002/14651858.CD000331.pub2] - DOI - PubMed
Barragán 2011
    1. Barragán LIM, Solà I, Juandó PC. Biofeedback for pain management during labour. Cochrane Database of Systematic Reviews 2011, Issue 6. [DOI: 10.1002/14651858.CD006168.pub2] - DOI - PubMed
Benfield 2010
    1. Benfield RD, Hortobagyi T, Tanner CJ, Swanson M, Heitkemper MM, Newton ER. The effects of hydrotherapy on anxiety, pain, neuroendocrine responses, and contraction dynamics during labor. Biological Research for Nursing 2010;12(1):28‐36. - PMC - PubMed
Birthplace Collaboration 2011
    1. Birthplace in England Collaborative Group. Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study. BMJ 2011;343:d7400. - PMC - PubMed
Bohren 2017
    1. Bohren MA, Hofmeyr GJ, Sakala C, Fukuzawa RK, Cuthbert A. Continuous support for women during childbirth. Cochrane Database of Systematic Reviews 2017, Issue 7. [DOI: 10.1002/14651858.CD003766.pub6] - DOI - PMC - PubMed
Bovbjerg 2016
    1. Bovbjerg ML, Cheyney M, Everson C. Maternal and newborn outcomes following waterbirth: the Midwives Alliance of North America Statsitics Project 2004 to 2009 cohort. Journal of Midwifery and Women's Health 2016;61(1):11‐20. - PubMed
Burke 1995
    1. Burke E, Kilfoyle A. A comparative study: waterbirths and bed births. Midwives 1995;108(1284):3‐7.
Burns 2012
    1. Burns EE, Boulton MG, Cluett E, Cornelius VR, Smith LA. Characteristics, interventions, and outcomes of women who used a birthing pool: a prospective observational study. Birth 2012;39(3):192‐202. - PubMed
Carpenter 2012
    1. Carpenter L, Weston P. Neonatal respiratory consequences from water birth. Journal of Paediatrics and Child Health 2012;48(12):419‐23. - PubMed
Cefalo 1978
    1. Cefalo RC, Andre U, Hellgers E. The effects of maternal hyperthermia on maternal and fetal cardiovascular and respiratory function. American Journal of Obstetrics and Gynecology 1978;131(6):687‐94. - PubMed
Cortes 2011
    1. Cortes E, Basra R, Kelleher C. Waterbirth and pelvic floor injury: a retrospective study and postal survey using ICIQ modular long form questionnaires. European Journal of Obstetrics, Gynecology, and Reproductive Biology 2011;155:27‐30. - PubMed
Cro 2002
    1. Cro S, Preston J. Cord snapping at waterbirth delivery. British Journal of Midwifery 2002;10(8):494‐7.
Dahlen 2013
    1. Dahlen H, Dowling H, Tracy M, Schmied V, Tracy. Maternal and perinatal outcomes amongst low risk women giving birth in water compared to six birth positions on land. A descriptive cross sectional study in a birth centre over 12 years. Midwifery 2013;29(7):759‐764. - PubMed
Deans 1995
    1. Deans AC, Steer PH. Temperature of pool is important. BMJ 1995;311:390‐1. - PMC - PubMed
Department of Health 1993
    1. Department of Health. Changing Childbirth. HMSO, 1993.
Derry 2012
    1. Derry S, Straube S, Moore RA, Hancock H, Collins SL. Intracutaneous or subcutaneous sterile water injection compared with blinded controls for pain management in labour. Cochrane Database of Systematic Reviews 2012, Issue 1. [DOI: 10.1002/14651858.CD009107.pub2] - DOI - PMC - PubMed
Dodwell 2010
    1. Dodwell M, Newburn M. Normal birth as a measure of the quality of care. Evidence on safety, effectiveness and women’s experiences. National Childbirth Trust, London. www.nct.org.uk/sites/default/files/related_documents/Normalbirthasameasu... 2010.
Dowswell 2009
    1. Dowswell T, Bedwell C, Lavender T, Neilson James P. Transcutaneous electrical nerve stimulation (TENS) for pain relief in labour. Cochrane Database of Systematic Reviews 2009, Issue 2. [DOI: 10.1002/14651858.CD007214.pub2] - DOI - PMC - PubMed
Edlich 1987
    1. Edlich RF, Towler MA, Goitz RJ, Wilder RP, Buschbacher LP, Morgan RF, et al. Bioengineering principles of hydrotherapy. Journal of Burn Care and Rehabilitation 1987;8(6):580‐4. - PubMed
Garland 2000
    1. Garland D, Jones. Waterbirths: supporting practice with clinical audit. MIDIRS Midwifery Digest 2000;10(3):333‐6.
Garland 2006
    1. Garland D. On the crest of a wave. Completion of a collaborative audit MIDIRS. Midwifery Digest 2006;16(1):81‐5.
Garland 2010
    1. Garland D. Revisting Waterbirth: an attitude to care. Revisting Waterbirth: An Attitude to Care. London: Palgrave and MacMillan, 2010.
Geissbuehler 2000
    1. Geissbuehler V, Eberhard J. Waterbirths a comparative study. A prospective study on more than 2,000 waterbirths. Fetal Diagnosis and Therapy 2000;15(5):291‐300. - PubMed
Geissbuehler 2004
    1. Geissbuehler V, Stein S, Eberhard J. Waterbirths compared with landbirths: an observational study of nine years. Journal of Perinatal Medicine 2004;32(4):308‐14. - PubMed
Gibbons 2010
    1. Gibbons L, Belizán J, Lauer J, Betrán A, Meriald M, Althabe F. The Global Numbers and Costs of Additionally Needed and Unnecessary Caesarean Sections Performed per Year: Overuse as a Barrier to Universal Coverage. WHO Health Report. http://www.who.int/healthsystems/topics/financing/healthreport/30C‐secti... 2010.
Gilbert 1999
    1. Gilbert R, Tookey P. Perinatal mortality and morbidity among babies delivered in water: surveillance study and postal survey. BMJ 1999;319:483‐7. - PMC - PubMed
Ginesi 1998a
    1. Ginesi L, Niescierowicz R. Neuroendocrinology and birth 1: stress. British Journal of Midwifery 1998;6(10):659‐63.
Ginesi 1998b
    1. Ginesi L, Niescierowicz R. Neuroendocrinology and birth 2: The role of oxytocin. British Journal of Midwifery 1998;6(12):791‐6.
Green 1998
    1. Green JM, Coupland VA, Kitzinger JV. Great Expectations: a Prospective Study of Women's Expectations and Experiences of Childbirth. 2nd Edition. Cheshire: Books for Midwives, 1998.
Green 2007
    1. Green JM, Baston HA. Have women become more willing to accept obstetric interventions and does this relate to mode of birth? Data from a prospective study. Birth 2007;34(1):6‐13. - PubMed
Hall 1998
    1. Hall SM, Holloway IM. Staying in control: women's experiences of labour in water. Midwifery 1998;14(1):30‐6. - PubMed
Hawkins 1995
    1. Hawkins S. Water versus conventional birth: infections rates compared. Nursing Times 1995;91(15):38‐40. - PubMed
Henderson 2014
    1. Henderson J, Burns EE, Regalia AL, Casarico G, Boulton MG, Smith LA. Labouring women who used a birthing pool in obstetric units in Italy: prospective observational study. BMC Pregnancy and Childbirth 2014;14:17. - PMC - PubMed
Higgins 2011
    1. Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Hodnett 2012
    1. Hodnett ED, Downe S, Walsh D. Alternative versus conventional institutional settings for birth. Cochrane Database of Systematic Reviews 2012, Issue 8. [DOI: 10.1002/14651858.CD000012.pub4] - DOI - PMC - PubMed
Hodnett 2013
    1. Hodnett ED, Gates S, Hofmeyr GJ, Sakala C. Continuous support for women during childbirth. Cochrane Database of Systematic Reviews 2013, Issue 7. [DOI: 10.1002/14651858.CD003766.pub5] - DOI - PubMed
Johanson 2002
    1. Johanson R, Newburn M, Macfarlane A. Has the medicalisation of childbirth gone too far?. BMJ 2002;324:892. - PMC - PubMed
Johnson 1996
    1. Johnson P. Birth under water ‐ to breathe or not to breathe. British Journal of Obstetrics and Gynaecology 1996;103:202‐8. - PubMed
Jones 2011
    1. Jones L, Dou L, Dowswell T, Alfirevic Z, Neilson JP. Pain management for women in labour: generic protocol. Cochrane Database of Systematic Reviews 2011, Issue 6. [DOI: 10.1002/14651858.CD009167] - DOI - PMC - PubMed
Jones 2012
    1. Jones L, Othman M, Dowswell T, Alfirevic Z, Gates S, Newburn M, Jordan S, Lavender T, Neilson JP. Pain management for women in labour: an overview of systematic reviews. Cochrane Database of Systematic Reviews 2012, Issue 3. [DOI: 10.1002/14651858.CD009234.pub2] - DOI - PMC - PubMed
Kassim 2005
    1. Kassim Z, Sellars M, Greenough A. Underwater birth and neonatal respiratory distress. BMJ 2005;330(7499):1071‐2. - PMC - PubMed
Klomp 2012
    1. Klomp T, Poppel M, Jones L, Lazet J, Nisio M, Lagro‐Janssen ALM. Inhaled analgesia for pain management in labour. Cochrane Database of Systematic Reviews 2012, Issue 9. [DOI: 10.1002/14651858.CD009351.pub2] - DOI - PMC - PubMed
Lukasse 2014
    1. Lukasse M, Rowe R, Townend J, Knight M, Hollowell J. Immersion in water for pain relief and the risk of intrapartum transfer among low risk nulliparous women: secondary analysis of the Birthplace national prospective cohort study. BMC Pregnancy and Childbirth 2014;14:60. - PMC - PubMed
Madden 2016
    1. Madden K, Middleton P, Cyna AM, Matthewson M, Jones L. Hypnosis for pain management during labour and childbirth. Cochrane Database of Systematic Reviews 2016, Issue 5. [DOI: 10.1002/14651858.CD009356.pub3] - DOI - PMC - PubMed
Mammas 2009
    1. Mammas IN, Thiagarajan P. Water aspiration syndrome at birth ‐ report of two cases. Journal of Maternal‐Fetal and Neonatal Medicine 2009;22(4):365‐7. - PubMed
Maternity Care Working Party 2007
    1. Maternity Care Working Party. Making Normal Birth a Reality. London: NCT, RCM, RCOG, 2007.
Maude 2007
    1. Maude RM, Foureur MJ. It's beyond water: stories of women's experience of using water for labour and birth. Women and birth. journal of the Australian College of Midwives 2007;20(1):17‐24. - PubMed
McLachlan 2012
    1. McLachlan H, Forster D, Davey M, Farrell T, Gold L, Biro M, et al. Effects of continuity of care by a primary midwife (caseload midwifery) on caesarean section rates in women of low obstetric risk: the COSMOS randomised controlled trial. BJOG: an international journal of obstetrics and gynaecology 2012;119(12):1483‐92. - PubMed
Meyer 2012
    1. Meyer S. Control in childbirth: a concept analysis and synthesis. Journal of Advanced Nursing 2012;69(1):218‐28. - PubMed
Moneta 2001
    1. Moneta J, Okninska A, Wielgos M, Przybos A, Szymusik I, Marianowski L. Patient's preferences concerning the course of labor. Ginekologia Polska 2001;72(12):1010‐8. - PubMed
National Childbirth Trust 2011
    1. National Childbirth Trust. NCT Briefing for Journalists: Caesarean Birth. National Childbirth Trust, http://www.nct.org.uk/sites/default/files/related_documents/B3%20Caesare....
New Zealand College of Midwives 2017
    1. New Zealand College of Midwives. Consensus Statement: The Use of Water for Labour and Birth. New Zealand College of Midwives, file:///C:/Users/p0036376/Downloads/The%20use%20of%20Water%20for%20Labour%20and%20Birth.pdf 2017.
Nguyen 2002
    1. Nguyen S, Kuschel C, Teele R, Spooner C. Water birth‐‐a near‐drowning experience. Pediatrics 2002;110(2 Pt 1):411‐3. - PubMed
NHS 2014
    1. NHS Health Education England. Five Year Forward View. https://www.england.nhs.uk/wp‐content/uploads/2014/10/5yfv‐web.pdf 2014.
NICE 2014
    1. National Institute for Clinical Excellence. Intrapartum care: care of healthy women and their babies during childbirth. Clinical guideline 190. https://www.nice.org.uk/guidance/cg190/resources/guidance‐intrapartum‐ca... 2014. - PubMed
NMC 2012
    1. Nursing and Midwifery Council. Midwives Rules and Standards 2012. http://www.nmc.org.uk/globalassets/sitedocuments/nmc‐publications/midwiv... 2012.
Novikova 2011
    1. Novikova N, Cluver C. Local anaesthetic nerve block for pain management in labour. Cochrane Database of Systematic Reviews 2011, Issue 7. [DOI: 10.1002/14651858.CD009200] - DOI - PMC - PubMed
Odent 1983
    1. Odent M. Birth under water. Lancet 1983;2:1476‐7. - PubMed
Othman 2011
    1. Othman M, Jones L, Neilson JP. Non‐opioid drugs for pain management in labour. Cochrane Database of Systematic Reviews 2011, Issue 7. [DOI: 10.1002/14651858.CD009223] - DOI - PMC - PubMed
Otigbah 2000
    1. Otigbah CM, Dhanjal MK, Harmsworth G. A retrospective comparison of water births and conventional vaginal deliveries. European Journal of Obstetrics & Gynecology and Reproductive Biology 2000;91(1):15‐20. - PubMed
Pinette 2004
    1. Pinette MG, Wax J, Wilson E. The risks of underwater birth. American Journal of Obstetrics and Gynecology 2004;5:1211‐5. - PubMed
Rawal 1994
    1. Rawal J, Shah A, Stirk F, Mehtar S. Waterbirth and infection in babies. BMJ 1994;309:511. - PMC - PubMed
RCM 1994
    1. Royal College of Midwives. The Use of Water During Birth. Position Statement 1a. London: Royal College of Midwives, 1994.
RCM 2016
    1. Royal College of Midwives. Better Births. Going digital for Women and Families in maternity care. Royal College of Midwives. https://www.rcm.org.uk/sites/default/files/Going_Digital_Summary_Februar... 2016.
RCOG 2011
    1. Royal College of Obstetricians and Gynaecologists. Expert Advisory Report. High Quality Women's Health Care. http://www.rcog.org.uk/files/rcog‐corp/HighQualityWomensHealthcarePropos... 2011.
Reid Campion 1990
    1. Reid‐Campion M. Adult Hydrotherapy. A Practical Approach. 1st Edition. Oxford: Heinemann, 1990.
Reid‐Campion 1997
    1. Reid‐Campion M. Hydrotherapy: Principles and Practice. 2nd Edition. Oxford: Butterworth Heineman, 1997.
RevMan 2014 [Computer program]
    1. The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014.
Richmond 2003
    1. Richmond H. Women's experiences of waterbirth. Practising Midwife 2003;6(3):26‐31. - PubMed
Robertson 1998
    1. Robertson PA, Huang LJ, Croughan‐Minihane MS, Kilpatrick SJ. Is there an association between water baths during labour and the development of chorioamnionitis or endometritis?. American Journal of Obstetrics and Gynecology 1998;178(6):1215‐21. - PubMed
Rosevear 1993
    1. Rosevear SK, Fox R, Marlow N, Stirrat GM. Birthing pools and the fetus. Lancet 1993;342:1048‐9. - PubMed
Rosser 1994
    1. Rosser J. Is water birth safe? The facts behind the controversy. Midwifery Digest 1994;4:4‐6.
Russell 2011
    1. Russell K. Struggling to get into the pool room? A critical discourse analysis of labor ward midwives experiences of waterbirth. International Journal of Childbirth 2011;1(1):52‐60.
Schroeter 2004
    1. Schroeter K. Water births: a naked emperor. Pediatrics. 2004;114(3):855‐8. - PubMed
Simmons 2007
    1. Simmons SW, Cyna AM, Dennis AT, Hughes D. Combined spinal‐epidural versus epidural analgesia in labour. Cochrane Database of Systematic Reviews 2007, Issue 3. [DOI: 10.1002/14651858.CD003401.pub2] - DOI - PubMed
Smith 2011a
    1. Smith CA, Collins CT, Crowther CA. Aromatherapy for pain management in labour. Cochrane Database of Systematic Reviews 2011, Issue 7. [DOI: 10.1002/14651858.CD009215] - DOI - PubMed
Smith 2011b
    1. Smith CA, Levett KM, Collins CT, Crowther CA. Relaxation techniques for pain management in labour. Cochrane Database of Systematic Reviews 2011, Issue 12. [DOI: 10.1002/14651858.CD009514] - DOI - PubMed
Smith 2011c
    1. Smith CA, Collins CT, Crowther CA, Levett KM. Acupuncture or acupressure for pain management in labour. Cochrane Database of Systematic Reviews 2011, Issue 7. [DOI: 10.1002/14651858.CD009232] - DOI - PubMed
Smith 2012
    1. Smith CA, Levett KM, Collins CT, Jones L. Massage, reflexology and other manual methods for pain management in labour. Cochrane Database of Systematic Reviews 2012, Issue 2. [DOI: 10.1002/14651858.CD009290.pub2] - DOI - PubMed
Smith 2013
    1. Smith L, Price N, Simonite V, Burns E. Incidence of risk factors for perineal trauma: a prospective observational study. BMC Pregnancy and Childbirth 2013;13:59. [DOI: ] - PMC - PubMed
Sotiridou 2012
    1. Sotiridou E, Mukhopadhyay S, Clarke P. Neonatal aspiration syndrome complicating a water birth. Journal of Obstetrics and Gynaecology 2010;30(6):631‐3. - PubMed
Sufang 2007
    1. Sufang G, Padmadas S, Fengmin Z, Brown J, Stones R. Delivery settings and caesarean section rates in China. Bulletin of the World Health Organization 2007;85(10):755‐62. - PMC - PubMed
Taylor 2016
    1. Taylor H, Kleine I, Bewley S, Loucides E, Sutcliffe A. Neonatal outcomes of waterbirth: a systematic review and meta‐analysis. Archives of Disease in Childhood. Fetal and Neonatal Edition 2016;101(4):F357‐F365. - PubMed
Thoeni 2005
    1. Thoeni A, Zech N, Moroder L, Ploner F. Review of 600 water births. Does water birth increase the risk of neonatal infection?. Journal of Maternal‐Fetal and Neonatal Medicine 2005;17(5):357‐61. - PubMed
UKCC 1994
    1. United Kingdom Central Council for Nursing, Midwifery and Health Visiting. Position Statement on Waterbirths. Annexe 1 to Registrar's letter 16/1994. London: UKCC, 1994.
Ullman 2010
    1. Ullman R, Smith Lesley A, Burns E, Mori R, Dowswell T. Parenteral opioids for maternal pain relief in labour. Cochrane Database of Systematic Reviews 2010, Issue 9. [DOI: 10.1002/14651858.CD007396.pub2] - DOI - PMC - PubMed
Zanetti‐Daellenbach 2007
    1. Zanetti‐Daellenbach RA, Tschudin S, Zhong XZ, Holzgreve W, Lapaire O, Hösli I. Maternal and neonatal infection and obstetrical outcome in water birth. European Journal of Obstetrics & Gynecology and Reproductive Biology 2007;134(1):37‐43. - PubMed

References to other published versions of this review

Cluett 2002
    1. Cluett E R, Nikodem VC, McCandlish RE, Burns EE. Immersion in water in pregnancy, labour and birth. Cochrane Database of Systematic Reviews 2002, Issue 2. [DOI: 10.1002/14651858.CD000111.pub2] - DOI - PubMed
Cluett 2009
    1. Cluett ER, Burns E. Immersion in water in labour and birth. Cochrane Database of Systematic Reviews 2009, Issue 2. [DOI: 10.1002/14651858.CD000111.pub3] - DOI - PMC - PubMed
Nikodem 1997
    1. Nikodem VC. Immersion in water in pregnancy, labour and birth. Cochrane Database of Systematic Reviews 1997, Issue Not specified. [DOI: 10.1002/14651858.CD000111] - DOI - PubMed

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