title: Waterbirths compared with landbirths: an observational study of nine years.
abstract: OBJECTIVE
  This study compares neonatal and maternal morbidity and mortality between waterbirths and landbirths (spontaneous singleton births in cephalic presentation, vacuum extractions are excluded).
  
  
  METHODS
  In this observational study covering nine years, standardized questionnaires were used to document 9,518 spontaneous singleton cephalic presentation births, of which 3,617 were waterbirths and 5,901 landbirths.
  
  
  RESULTS
  Landbirths show higher rates of episiotomies as well as third and fourth degree perineal lacerations. Waterbirths show a higher rate of births "without injuries", first and second-degree perineal lacerations, vaginal and labial tears. After a waterbirth, there is an average loss of 5.26 g/l blood; this is significantly less than landbirths where there is an 8.08 g/l blood loss on average. In 69.7% waterbirths required no analgesic, compared to 58.0% for landbirths. Water and landbirths do not differ with respect to maternal and neonatal infections. After landbirths, there was a higher rate of newborn complications with subsequent transfer to an external NICU. During the study, there were neither maternal nor neonatal deaths related to spontaneous labor.
  
  
  CONCLUSIONS
  Waterbirths are associated with low risks for both mother and child when obstetrical guidelines are followed.
authors.affiliation: Department of Obstetrics and Gynecology, Cantonal Hospital, Frauenfeld, Switzerland. verena.geissbuehler@stgag.ch
authors.forename: Verena
authors.initials: V
authors.lastname: Geissbuehler
authors.forename: Sonja
authors.initials: S
authors.lastname: Stein
authors.forename: Jakob
authors.initials: J
authors.lastname: Eberhard
mesh_terms: D000328:Adult; D036861:Delivery, Obstetric / Q000379:methods* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007101:Immersion; D007231:Infant, Newborn; D011247:Pregnancy; D011256:Pregnancy Outcome; D011795:Surveys and Questionnaires; D013557:Switzerland / Q000453:epidemiology