Porody do vody- pětiletá retrospektivní studie

Under Water Deliveries - A Five-yearsRetrospective Study

Objectives of study:
Comparison of chosen parameters of the I. - III. stage of labour by women, whoconducted waterbirth (Group A) and by women,whodelivered conventionally in horizontal position(Group B) and comparison of perinatal and postnatal results of newborns in both groups.Design: Retrospective study.Setting: Department of Obstetrics and Gynecology, District Hospital Znojmo.Methods: Group A constitute 70 women, who delivered in the period 1. 1. 1998 - 30. 9. 2002 into thewater (fetus was expelled under water). Control group B formed 70 women, who delivered ina conventional (horizontal position) and in the same time they didnot have any contraindication towaterbirth. At first we compared the length of I. and II. stage of labour, the number of episiotomies,the number of some other kinds of injuries, the postpartal uterine hypotony and the volume of bloodloss. In the second phase we evaluated clinical condition of the newborn.Results:Waterbirth have chosen 1.95% of the women in our department during this period. There isno statistically significant difference in the duration of I. stage of labour in both groups. The II. stagewas prolonged to 9 against 6 minutes in group A, most probably because of hydroanalgetic effect ofwarm water, due to some inhibition of contractions and „no interference access“ to labour. There isno statistical difference in complications during and after the labour in both groups. By group A wefound statistically significant higher number of spontaneous, I. grade perineal ruptures, then ingroup B and we found reciprocal situation in number of episiotomies in both groups. There wereno somatic differences by the newborns in both groups after delivery and we didnot find higheroccurrence of postnatal pathology by the waterbith babies either.Conclusion: Waterbirth is type of alternative obstetrics, which the women in birth demand, butwhich the obstetritians and neonatologists are afraid of, and which they consider to be possiblyhazardous in the same time. There is documented evidence of much less performed episiotomies(nearly of 60%) and higher percentage deliveries without any injury (about of 9%).We didnot proveany life or health threatening complication by the women in birth or by their newborns. Newbornsfrom group A have completely comparable peri - and postnatal examination and investigationresults with group B. In our study group we didnot find higher occurrence of bleeding hypotonicuterus, infections or hypotension by the mother, comparing with the control group.There is often mentioned temporary bluish colour of the newborns by the critics of waterbith. Thisappearance we cannot comprehend as a cyanotic demonstration of fetal hypoxia but much more asthe consequence of slower transformation from fetal to neonatal blood circulation. The same effectwe can observe by the newborns, who were delivered conventionally in horizontal position and whoare afterwards longer time connected by umbilical cord. Clear evidence for this contention iscompletely physiological evaluation and postnatal examination of all newborns by neonatologistafter delivery and objective results of ABR and lactate from umbilical artery, which exclude fetalhypoxia too.As the conclusionwe can claim, that waterbirth nowadays is one of legitimate methods of alternativeobstetrics. The results of our study did confirm that this way of delivery doesnot represent any riskfor the mother or the newborn and that there is no reason for an anxiety of obstetritian andneonatologist.

Key words:
waterbirth, hydroanalgesia, peripartal complications and injuries, fetal hypoxia