title: An economic evaluation of water birth: the cost-effectiveness of mother well-being.
abstract: OBJECTIVE
  To assess the cost-effectiveness of water compared with normal land delivery.
  
  
  METHODS
  A retrospective controlled study was conducted over a two-year period in a Northern Italian hospital. The cohort included all the 110 women who completed a water birth and 110 women who had a land birth during the same period. The two groups were compared with respect to labour duration, perineal tear and newborn's health status. The economic evaluation adopted a cost-effectiveness approach in relation to presence/absence of perineal tears.
  
  
  RESULTS
  In the water delivery group 58 women (52.7%) experienced at least one perineal tear versus 80 (72.7%) in the traditional delivery group. The mean duration of labour was similar in the two groups. Neonatal well-being, expressed as Apgar score, did not differ significantly among the two groups at the first minute (9.48 vs. 9.28) and was slightly higher at 5 minutes in the water delivery group (9.95 vs. 9.84; P = 0.0269). Water delivery was found to be both more costly [ΔC = €279; 95% confidence interval (CI): 262-296] and more effective in terms of avoided perineal tears. The incremental health care cost per avoided perineal tear because of water delivery was estimated of €1395.7 (95% CI: 1049.2-3608.5).
  
  
  CONCLUSIONS
  Water birth, as compared with traditional delivery, allows for an increase in maternal well-being and is cost-effective.
authors.affiliation: Unit of Cancer Epidemiology, University of Turin, CERMS and CPO-Piemonte, Turin, Italy. evapagano@yahoo.com
authors.forename: Eva
authors.initials: E
authors.lastname: Pagano
authors.forename: Barbara
authors.initials: B
authors.lastname: De Rota
authors.forename: Alberto
authors.initials: A
authors.lastname: Ferrando
authors.forename: Michele
authors.initials: M
authors.lastname: Petrinco
authors.forename: Franco
authors.initials: F
authors.lastname: Merletti
authors.forename: Dario
authors.initials: D
authors.lastname: Gregori
mesh_terms: D000328:Adult; D001034:Apgar Score; D003362:Cost-Benefit Analysis; D036861:Delivery, Obstetric / Q000191:economics* / Q000379:methods*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007558:Italy; D008297:Male; D009035:Mothers / Q000523:psychology*; D010502:Perineum / Q000293:injuries; D010549:Personal Satisfaction; D012189:Retrospective Studies; D014867:Water; D055815:Young Adult
chemical_list: D014867:Water