Alternative delivery methods and changes in obstetric practice

Objective: In 1991 we instituted a new obstetric concept at our hospital to integrate water birth, alternative delivery positions and less invasive co nduct of labor into practice according to the wishes of the mother. The pre sent study analyzed which delivery methods were chosen and how the rate of obstetric interventions has changed. Methods: We, compared our recent data (12,041 deliveries between 1991 and 1 999) with data from our institution before introduction of the new concept (5602 deliveries between 1986 and 1991) and with data from a national datab ase (328,276 deliveries in Switzerland between 1986 to 1999). We compared b irth positions and rates of cesarean section, episiotomy, amniotomy, induct ion or augmentation of labor, and epidural anesthesia. Results: After 1991 the proportion of women delivered in bed declined to ab out 40% The rate of water births increased steadily to 49% of all spontaneo us deliveries. The episiotomy rate decreased from over 80% to under 10%. Th e cesarean section rate remained lower than that in the national database. Changes in other obstetric interventions were less pronounced. Conclusion: Alternative delivery methods, particularly water birth, have be come popular. This shift has helped keep the cesarean delivery rate low and decrease the episiotomy rate and has prompted more careful use of other ob stetric interventions.