Women's experiences with water birth: A matched groups prospective study.

BACKGROUND: Water birth has become an increasingly popular childbirth option, but has also come under scrutiny because of its possible risks and benefits. The primary objective of this study was to explore potential benefits of water birth by comparing the experiences of women who gave birth in water versus conventionally. We also compared maternal and newborn outcomes. METHODS: We performed a prospective study of 66 women who had water births and 132 who had conventional births. Data collected included demographics, labor and birth characteristics, perinatal outcomes, and maternal scores on the Childbirth Experience Questionnaire (CEQ). Groups were matched for variables known to influence CEQ scores. RESULTS: Women in the water birth group had more positive childbirth experiences compared with the conventional birth group (P < .001), and also compared with the subgroup of women who had epidural anesthesia (P = .002). After controlling for potential confounders, water birth was associated with a decreased likelihood of perineal lacerations requiring repair (P = .001) and a higher rate of breastfeeding initiation in the delivery room (P < .001). Adverse outcomes such as neonatal intensive care unit admission, blood loss >500 mL, 3rd/4th degree lacerations, and perinatal infections were rare. The study was not sufficiently powered to detect differences in rare outcomes. CONCLUSION: Water birth was associated with more positive maternal childbirth experiences as represented by CEQ scores. Adverse outcomes were rare in both the water birth and conventional birth groups.

Simulation-based learning for midwives: background and pilot implementation.

Simulation-based learning is an emerging learning modality with promising potential for certified nurse-midwife (CNM) and certified midwife (CM) education. Unlike standard didactic methods, simulation-based learning affords opportunities to address multiple domains of learning and performance. Unlike standard clinical education, simulation-based learning provides learners exposure to events that are rare in the clinical setting, and allows learners to assume leadership roles in emergencies. Simulation-based learning is consistent with constructivist learning principles, which promote retention, understanding, and active use of skills. A simulation-based shoulder dystocia learning module was implemented on a pilot basis in a class of four student nurse-midwives. Student nurse-midwives self-assessed their preparedness to manage a shoulder dystocia in the cognitive, psychomotor, and affective domains before and after the simulation-based learning exercise. Feedback from student evaluations was promising. Although the small sample precluded statistical analysis, student self-assessment scores appeared to be higher after the simulation-based learning exercise. Open-ended student feedback was unanimous that simulation-based learning should be incorporated into the curriculum. Further implementation and evaluation of simulation-based learning in CNM and CM education is warranted.