DESCRIPTION OF TOPIC:
Background: Waterbirth is a method of intrapartum pain relief. In the United States, controversy exists about the use of waterbirth. Objective: To compare intravenous analgesia and anesthesia, composite maternal and neonatal outcomes, and satisfaction with waterbirth and land birth participants. Methods: Low-risk pregnant adults were offered study participation between 25 and 34 weeks of gestation during routine prenatal care. Participants who met the inclusion criteria were consented, enrolled, and randomly assigned to waterbirth or land birth in a 2:1 unblinded fashion. A sample size of n=186 (124 waterbirth: 62 land birth) was sought. Participants in both arms were excluded if they developed intrapartum risk factors prior to delivery. Study participants received routine intrapartum care, including all available pain relief options. Only those assigned to the waterbirth group were given the option of giving birth in the water. Following delivery, participants completed a validated satisfaction tool, the US Birth Satisfaction Scale Revised, prior to discharge. Results: From January 2022 to December 2023, 186 participants were enrolled (n=124 waterbirth, n=62 land birth). Following enrollment, 106 participants (n=74 waterbirth, and n=32 land birth) remained eligible for the study. Compared to the land birth group, waterbirth participants were significantly less likely to use intravenous narcotics [Relative Risk 0.36 (95% confidence interval 0.17-0.75), p < 0.01] and epidural analgesia [Relative Risk 0.38 (95% confidence interval 0.24-0.58), p < 0.01]. Maternal and neonatal outcomes were not significantly different between groups. Waterbirth participants experienced higher overall birth satisfaction [median difference 3.50 (95% confidence interval 1.00-5.00), p = 0.01].Conclusion: Waterbirth participants were significantly less likely to use intravenous narcotics and epidural anesthesia, had similar maternal and neonatal outcomes, and experienced greater overall birth satisfaction.

RELEVANCE TO MIDWIFERY:
Waterbirth should be considered as an option for pain relief in the hospital setting for low-risk birthing people. Spanish - respectful care (including three-minute presentation competition)