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Immersion in water for pain relief and the risk of intrapartum transfer among low risk nulliparous women: secondary analysis of the Birthplace national prospective cohort study

Mirjam Lukasse12*, Rachel Rowe3, John Townend3, Marian Knight3 and Jennifer Hollowell3

Author Affiliations

1 Department of Public Health and General Practice at the Faculty of Medicine, The Norwegian University of Science and Technology (NTNU), Håkon Jarls gate 11, N-7489 Trondheim, Norway

2 Department of Health, Nutrition and Management, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Postboks 364 Alnabru, N-0614 Oslo, Norway

3 National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, England

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BMC Pregnancy and Childbirth 2014, 14:60  doi:10.1186/1471-2393-14-60

Published: 6 February 2014



Immersion in water during labour is an important non-pharmacological method to manage labour pain, particularly in midwifery-led care settings where pharmacological methods are limited. This study investigates the association between immersion for pain relief and transfer before birth and other maternal outcomes.


A prospective cohort study of 16,577 low risk nulliparous women planning birth at home, in a freestanding midwifery unit (FMU) or in an alongside midwifery unit (AMU) in England between April 2008 and April 2010.


Immersion in water for pain relief was common; 50% in planned home births, 54% in FMUs and 38% in AMUs. Immersion in water was associated with a lower risk of transfer before birth for births planned at home (adjusted RR 0.88; 95% CI 0.79–0.99), in FMUs (adjusted RR 0.59; 95% CI 0.50–0.70) and in AMUs (adjusted RR 0.78; 95% CI 0.69–0.88). For births planned in FMUs, immersion in water was associated with a lower risk of intrapartum caesarean section (RR 0.61; 95% CI 0.44–0.84) and a higher chance of a straightforward vaginal birth (RR 1.09; 95% CI 1.04–1.15). These beneficial effects were not seen in births planned at home or AMUs.


Immersion of water for pain relief was associated with a significant reduction in risk of transfer before birth for nulliparous women. Overall, immersion in water was associated with fewer interventions during labour. The effect varied across birth settings with least effect in planned home births and a larger effect observed for planned FMU births.

Immersion in water; Midwifery-led care; Nulliparous women; Low risk; Pain management in labour; Intrapartum transfer, Intrapartum caesarean section