Epidural or water immersion? A prospective cohort study of maternal and neonatal outcomes in a tertiary hospital

Background: Providing evidence-based information on maternal and neonatal outcomes of epidural analgesia (EA) and water immersion (WI) is crucial for informed decision-making. Objective: To compare process outcomes, obstetric interventions, and maternal and neonatal outcomes in medium low-risk women based on their choice of analgesia: EA or WI. Methods: This prospective observational cohort study analysed 643 women from June 2020 to February 2023. Sociodemographic data, birth process characteristics, and outcomes were collected to compare 284 women who used EA and 319 who used WI (with 82.4% waterbirths). Additionally, 40 cases of women who switched from WI to EA were descriptively analysed. Propensity Score (PS) was applied to reduce selection bias in the comparative analysis. Findings: WI was associated with a higher probability of spontaneous vaginal birth (18.7%, E:0.187; SE:0.025; p <0.001 95% CI 0.138,0.235), shorter first stage (-259.532 min; SE:13.592; p < 0.00195%, 95% CI -286.171, -232.892), shorter second stage of labour (-17.829 min; SE:4.665; p <0.001 95% CI -26.973,-8.686) In terms of neonatal outcomes WI (with 82.4% of waterbirths) was associated with less neonatal ventilatory support (1.6% vs 9.5% p < 0.001,RR 0.028 95% CI 0.11-0.56), less birth distress (0.9% vs 7.7% p < 0.001,RR 0.22 95% CI 0.06-0.52), lower probability of neonatal admission rates (E:-0.102; SE 0.033, p = 0.002, 95% CI -0.166, -0.088), and higher probability of exclusive breastfeeding at discharge especially for multiparous women (E:0.114; SE 0.045 p = 0.01 95% CI 0.027, 0.202). Conclusion and Implication for practice: Water immersion for low-risk women emerges as a valid, evidence-based approach to supporting physiological childbirth and reducing unnecessary interventions. This study highlights the need to reinforce its availability in maternity care and to ensure women's informed decision-making.