Participant sample and setting
A convenience sampling approach was taken. Within the Birthing Suite of the XXXXXXXXX Hospital, all women intending a vaginal birth and eligible to enter the birth pool (warm water immersion +/-water birth) between April 2019 through to April 2020 were included. The study site is a tertiary, publicly funded maternity unit with approximately 3600 births per year, in a coastal region of Queensland Australia.
Inclusion criteria (which were guided by the local Workplace Instruction on Warm Water Immersion and Water Birth (14)) were applied, including:
Exclusion criteria:
The initial aim of this study was to compare the outcomes of women who birthed in water with those that had birthed on land. It is not possible to have a waterbirth and a caesarean section, hence women who underwent caesarean were excluded to ensure that we had homogeneity amongst the two groups. Following data collection, it became clear that we should evaluate labour outcomes amongst women who used WWI during labour but did not have a waterbirth. We decided that caesarean sections would continue to be excluded given that our primary area of interest was the outcomes of women achieving vaginal birth. In addition, according to the recent 2018 Cochrane Review, there is no evidence that WWI affects caesarean section rates (6).