{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T17:19:06Z","timestamp":1791825546157,"version":"4.3.4"},"reference-count":34,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2024,6,10]],"date-time":"2024-06-10T00:00:00Z","timestamp":1717977600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","award":["16\/149\/01"],"award-info":[{"award-number":["16\/149\/01"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Warm water immersion during labour provides women with analgesia and comfort. This cohort study aimed to establish among women using intrapartum water immersion analgesia, without antenatal or intrapartum risk factors, whether waterbirth is as safe for them and their babies as leaving the water before birth.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Cohort study with non\u2010inferiority design.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Twenty\u2010six UK NHS maternity services.<\/jats:p><\/jats:sec><jats:sec><jats:title>Sample<\/jats:title><jats:p>A total of 73\u2009229 women without antenatal or intrapartum risk factors, using intrapartum water immersion, between 1 January 2015 and 30 June 2022. The analysis excluded 12\u2009827 (17.5%) women who received obstetric or anaesthetic interventions before birth.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Non\u2010inferiority analysis of retrospective and prospective data captured in NHS maternity and neonatal information systems.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Maternal primary outcome: obstetric anal sphincter injury (OASI) by parity; neonatal composite primary outcome: fetal or neonatal death, neonatal unit admission with respiratory support or administration of antibiotics within 48\u2009hours of birth.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Rates of the primary outcomes were no higher among waterbirths compared with births out of water: rates of OASI among nulliparous women (waterbirth: 730\/15\u2009176 [4.8%] versus births out of water: 641\/12\u2009210 [5.3%]; adjusted odds ratio [aOR] 0.97, one\u2010sided 95% CI, \u2212\u221e to 1.08); rates of OASI among parous women (waterbirth: 269\/24\u2009451 [1.1%] versus births out of water 144\/8565 [1.7%]; aOR 0.64, one\u2010sided 95% CI \u2212\u221e to 0.78) and rates of the composite adverse outcome among babies (waterbirth 263\/9868 [2.7%] versus births out of water 224\/5078 [4.4%]; aOR 0.65, one\u2010sided 95% CI \u2212\u221e to 0.79).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Among women using water immersion during labour, remaining in the pool and giving birth in water was not associated with an increase in the incidence of adverse primary maternal or neonatal outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.17878","type":"journal-article","created":{"date-parts":[[2024,6,11]],"date-time":"2024-06-11T00:02:57Z","timestamp":1718064177000},"page":"1650-1659","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Maternal and neonatal outcomes among spontaneous vaginal births occurring in or out of water following intrapartum water immersion: The POOL cohort study"],"prefix":"10.1111","volume":"131","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5712-9989","authenticated-orcid":false,"given":"Julia","family":"Sanders","sequence":"first","affiliation":[{"name":"School of Healthcare Sciences Cardiff University  Cardiff UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5759-0310","authenticated-orcid":false,"given":"Christy","family":"Barlow","sequence":"additional","affiliation":[{"name":"Centre for Trials Research Cardiff University  Cardiff UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9950-6751","authenticated-orcid":false,"given":"Peter","family":"Brocklehurst","sequence":"additional","affiliation":[{"name":"Birmingham Clinical Trials Unit University of Birmingham  Birmingham 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