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Perceived Barriers to Waterbirth: A Survey of Members of the American College of Nurse-Midwives


Introduction: Maternity care providers around the world offer warm water immersion for pain relief in labor and birth, but there are scant data regarding waterbirth availability, utilization, and outcomes in the United States. A 2014 joint committee opinion by the American Academy of Pediatrics and American College of Obstetricians and Gynecologists called for restricting waterbirth to experimental settings; the impact of this statement was explored in this survey.

Methods: 7,374 members of the American College of Nurse-Midwives were invited to take an online survey about experiences with waterbirth, including barriers to and concerns about waterbirth, perceived colleague support for intrapartum immersion, and practice changes resulting from the 2014 AAP-ACOG committee opinion. Surveys were administered over 4 weeks, with weekly reminder emails to the membership; items varied according to respondents’ answers to questions about their current clinical practice.

Results: 1,827 individuals accepted the study invitation and 1,565 met inclusion criteria, for a net response rate of 20.9%. Respondents reported high levels of exposure to waterbirth (81% have seen at least one) and low levels of concern about it (medians 1-2 on a 5-point Likert scale). They also reported moderate to significant barriers to waterbirth, mainly in lack of support from medical and administrative colleagues, and commonly linked to the AAP-ACOG statement. Midwives who currently attend waterbirths perceived lower barriers, higher colleague support, and lower concerns related to waterbirth than providers who do not currently attend waterbirths.

Discussion: Survey results are consistent with the social amplification of risk framework, in that respondents’ perceptions of barriers to, support for, and concerns about waterbirth vary with their current practices. The AAP-ACOG statement reinforced some existing barriers to waterbirth, whereas day-to-day experience of clinicians currently providing waterbirth reinforces their perception of it as a reasonable practice. Respondents would like ACNM to engage actively in waterbirth research, education, and development of practice guidelines, generating an authoritative source of pro-hydrotherapy knowledge.

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