Perinatal mortality and morbidity among babies delivered in water: surveillance study and postal survey

Aim To compare perinatal morbidity and mortality for babies delivered in wa ter with rates for babies delivered conventionally (not in water). Design Surveillance study (of all consultant paediatricians) and postal sur vey (of all NHS maternity units). Setting British Isles (surveillance study); England and Wales (postal surve y). Subjects Babies born in the British Isles between April 1994 and March 1996 who died perinatally or were admitted for special care within 48 hours of birth after delivery in water or after labour in water followed by conventi onal delivery (surveillance study); babies delivered in water in England an d Wales in the same period (postal survey). Main outcome measures Number of deliveries in water in the British Isles th at resulted in perinatal death or in admission to special care within 48 ho urs of birth; and proportions (of such deliveries) of all water births in E ngland and Wales. Results 4032 deliveries (0.6% of all deliveries) in England and Wales occur red in water. Perinatal mortality was 1.2/1000 (95% confidence interval 0.4 to 2.9) live births; 8.4/1000 (5.8 to 11.8) live births were admitted for special care. No deaths were directly attributable to delivery in water, bu t 2 admissions were for water aspiration. UK reports of mortality and speci al care admission rates for babies of women considered to be at low risk of complications during delivery who delivered conventionally ranged from 0.8 /1000 (0.2 to 4.2) to 4.6/1000 (0.1 to 25) live births and from 9.2 (1.1 to 33) to 64/1000 (58 to 10) live births respectively. Compared with regional data for low risk, spontaneous, normal vaginal deliveries at term, the rel ative risk for perinatal mortality associated with delivery in water was 0. 9 (99% confidence interval 0.2 to 3.6). Conclusions Perinatal mortality is not substantially higher among babies de livered in water than among those born to low risk women who delivered conv entionally. The data are compatible with a small increase or decrease in pe rinatal mortality for babies delivered in water.