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Re: water and birthFrom: Jason Gardosi (jason.gardosi@nottingham.ac.uk)Mon Oct 16 09:53:30 1995
Michael Klein writes on 13 Oct 1995: >At this point, as we attempt to determine what is known and what is >not known, what kind of studies need to be done, we would very much >appreciate input regarding positive and negative experiences with >both water labour and water birth. > >As well, we would very much appreciate any ideas that people might >have regarding what should be measured, what outcomes. We look >forward to hearing from you. ________________________
________________________ Good to hear that someone is proposing to take a thorough look at this, at last! The BMJ had recently a short report of a survey by F Alderdice et al from the NPEU: 'Labour and birth in water in England and Wales', BMJ 1995;310:837. The correspondent author was Mary Renfrew, professor of midwifery studies in Leeds. The results were inconclusive as to benefits and hazards and any retrospective survey needs to be viewed with caution, as also stated by the authors. The report highlighted in my mind how yet another technique can be introduced without proper validation, and worse still, how it can be continued without proper audit. We seemed to have learned nothing from recent decades. I have nothing against - and often recommend - labour in water: its analgesic effect is remarkable. But DELIVERY in water is a new invention, and in my readings of birthing methods in different cultures and ages (for my thesis on maternal posture) I have never come across any society which subscribed to this nonsense. It is a very recent fad, and gives natural childbirth a bad name. The onus of proof for safety should be on the proponents, BEFORE wide scale introduction, and of course include randomised multicentre trials. The principal endpoints should be nothing less than the usual indicators of perinatal morbidity and - yes - mortality. Understandably, choices in childbirth are difficult to randomise and self-selection and cross overs are likely to be major problems, hence analysis will need to be by intention to treat and perhaps Zelen's method of consenting the study group only. Another way to quasi-randomise would be to alternate the times (say one week on, one week off) when the birthing pool is encouraged to be used during the duration of the trial, although that may get the back up of some brown envelope conservatives. Good luck! jason.gardosi@nottingham.ac.uk Ob/Gyn, Queen's Medical Centre University of Nottingham, UK
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