Table 2 Study characteristics
Author, date, country and setting | Aim (s) | Design/theoretical perspective and/or methodology | Sample selection method | Sample size and characteristics | Data collection and analysis | Quality grade | |
|---|---|---|---|---|---|---|---|
1 | Almoghrabi, H, 2018 US online | To generate scientific knowledge regarding the US CNM’s/ CM’s and student midwife’s Knowledge, Attitude, and Practice (KAP) of water birth (WB) | Quantitative Theory of Planned Behavior (TPB) Quantitative descriptive survey | Purposive Eligibility—ACNM membership—CM’s (Certified Midwives), CNM (Certified Nurse Midwives), and midwifery Students | 764 midwives, 197 midwifery students | Survey Descriptive statistics of central tendency, frequencies and percentages Open-ended questions, thematic analysis | B |
2 | Baba, K., et al., 2016 Japan Urbanized Kanto region of Japan, which includes Tokyo, Kanagawa, Saitama and Chiba | To survey the policy implementation regarding care during the second stage of labor at Japanese hospitals, clinics, and midwifery birth centers, and to compare those policies with the recommendations in guidelines for midwives | Quantitative Cross-sectional survey | Purposive Eligibility—institutions with an obstetric ward, clinics and midwifery birth centers | 255 maternity institutions 118 hospitals, 66 clinics, 71 midwifery birth centers | Survey Statistical quantities and frequency distributions Chi-square and Fisher’s exact test < 0.05 statistically significant | C |
3 | Barasinski, C., et al., 2018 France | To describe the practices reported by French midwives during labor (first stage and passive phase of the second stage) | Quantitative Cross-sectional internet questionnaire | Purposive Eligibility—Midwives who attended at least one childbirth in 2013 and who performed deliveries in equipped facilities legally required for providing deliveries (i.e., not home deliveries) were eligible | 1496 midwives (from 377 maternity units) | Internet questionnaire Chi-square or Fisher’s exact test to compare qualitative variables. Student T for quantitative variables P < 0.05 | B |
4 | Baxter L., 2006 UK One maternity unit | To share audits comparing ‘pool users’ with ‘pool births’ and reflects on the experience of the midwives | Audit | Purposive Eligibility—Midwives working at the unit | Unreported | Clinical audit and discussion following implementation of installed birthing pools | N/A |
5 | Bayes, S., et al., 2019 Australia | To investigate midwives’ experiences of leading practice change | Qualitative Glaserian Grounded Theory methodology | Purposive sampling Eligibility—Midwives who had led practice change initiatives | 16 Australian midwife change leaders | Single in-depth semi-structured interview conducted in person Grounded theory techniques | A/B |
6 | Carolan-Olah, M., et al., 2015 Australia One maternity unit | To explore midwives' experiences and views of the factors that facilitate or impede normal birth in a hospital setting | Qualitative Interpretative Phenomenological approach (IPA) | Purposive sampling Eligibility—Registered Midwives working on the birthing suite | 22 midwives | In-depth interviews approximately one hour Smith and Osborn's (2008) IPA approach | A/B |
7 | Chapman, B., 2004 New Zealand (North Island only) | Review of protocols for waterbirth obtained from five North Island hospitals in New Zealand compared against available literature | Qualitative Evaluation and comparison of hospital protocols against literature findings | Purposive Eligibility- all maternity hospitals in the North Island | 5/ 17 hospital protocols were received and included | North Island (NZ) hospital water immersion protocols Common elements were grouped into the following major elements | B/C |
8 | Cooper, M., McCutcheon, H., and Warland, J., 2017a Australia | To determine how water immersion policies and/or guidelines are informed, who interprets the evidence to inform policies/guidelines and to what extent the policy/ guideline facilitates the option for labour and birth | Mixed methods (convergent parallel design) Phase 1 qualitative component Critical theory and critical discourse analysis | Purposive Eligibility—All maternity hospitals in Australia | 25 WI for labour and/or birth policies were sourced - eight were policies and 17 were guidelines | Hospital policies and guidelines Parker’s ten criteria and Fairclough’s three-dimensional model for analysis of text, discourse and society | A/B |
9 | Cooper, M., McCutcheon, H., and Warland, J., 2019a Australia | To determine how water immersion policies and/or guidelines are informed and to what extent the policy/guideline facilitates the option of water immersion for labour and birth with respect to women’s choice and autonomy | Mixed methods (convergent parallel design) Phase 2 Qualitative component Critical, post-structural interpretive interactionism | Purposive Eligibility—Individuals who had been involved in the development of policies and /or guidelines for WI during labour and/or birth | 12 participants, 11 midwives, 1 obstetrician | Semi-structured, open-ended interviews Seven steps of critical, post-structural interpretive interactionism | A |
10 | Cooper, M., McCutcheon, H., and Warland, J., 2020a Australia | Determining the extent to which midwives felt they were able facilitate WI and more, their views of women’s choice and autonomy with respect to the option | Mixed methods (convergent parallel design) Phase 3 Quantitative component Critical, post-structural interpretive interactionism Survey | Purposive and snowballing Eligibility—Midwives who were members of Australian College of Midwives (ACM) | 233 midwives | Online survey adapted from Meyer et al., 2010 including open text responses Steps 4–7 of critical, post-structural interpretive interactionism | A |
11 | Cooper, M., Warland, J., and McCutcheon, H., 2018a Australia | To explore midwives’ knowledge, experiences and support for the option of water immersion for labour and birth in practice and their involvement, if any, in development of policy and guidelines pertaining to the option | Mixed methods (convergent parallel design) Phase 3 (part 2) Quantitative component Web-based survey | Purposive and snowballing Midwives who were members of Australian College of Midwives (ACM) (distribution of e-bulletin) | 234 midwives | Online survey Statistical and visual analysis through SPSS 20. Descriptive statistics %, mean and median. Chi-square tests with monte-carlo exact and Friedman test | A/B |
12 | Cooper, M., Warland, J., and McCutcheon, H., 2019a Australia | To examine how accreditation requirements are reflected in policy and guideline documents, how those that were involved in the process of develop and implementation viewed the need for additional training and finally, how midwives’ viewed accreditation requirements with respect to their ability to uphold women’s autonomy and choice surrounding the practice | Mixed methods (convergent parallel design) Phase 3 (part 3) Qualitative component Critical, poststructural interpretive interactionism | Purposive and snowball sampling Eligibility— P1 And/all Australian WI policies or guidelines in P 2 and 3: Practicing maternity staff | P1: Australian policies and guidelines pertaining to the use of water P2: 12 participants—11 midwives, 1 obstetrician P3: 234 Australian midwives | P1: Policy documents P2: Semi-structured open-ended interviews P3: Online survey P1: Critical discourse analysis P2: Critical, poststructural interpretive interactionism P3: Statistical and thematic analysis | A |
13 | Freeman, L. M. and K. Griew, 2007 Australia | To show that the allocation of an active voice to the woman within practice guidelines serves the interest of all parties within the health care relationship. To illustrate women’s involvement in decision making within a clinical practice guideline the ‘Use of the Bath in Labour and Birth’ | Qualitative Shared decision-making conceptual framework | Purposive Eligibility- Clinical practice guidelines in Australia and New Zealand | Unclear | Policy/guideline documents Comparison of policy against shared decision-making conceptual framework | C/D |
14 | Hammond, A., et al., 2014 Australia One birth centre and two labour wards | To explore the impacts of physical and aesthetic design of hospital birth rooms on midwives | Qualitative Video ethnographic study, thematic analysis of midwives interviews | Purposive and convenience sampling Eligibility – women and staff working within the hospitals who consented to be filmed | 7 midwives, 1 midwifery student (6 women, 6 birth partners) | Individual video-reflexive, unstructured interviews Thematic analysis | B |
15 | Jessiman, W. C. and H. Bryers, 2000 Scotland One maternity unit | To examine the professional and educational issues surrounding the installation of the facility (water in labour) in Inverness, and the findings of an audit of the first two years of its use | Audit | Purposive Eligibility—Midwives working at the maternity unit | 58 midwives | Audit tool was adapted from Burns and Greenish (1993) was gathered Frequency against Likert scale Words used to describe water immersion | N/A |
16 | Lewis L., et al., 2018 Australia Tertiary public maternity hospital with AMU | To examine midwives' education, knowledge and practice around immersion in water for labour or birth | Mixed methods A cross-sectional design: survey/qualitative descriptive | Purposive Eligibility—Midwives working in either Midwifery Group Practice (MGP) and Community Midwifery Program (CMP) who facilitated water immersion in the unit | Phase 1- 29 midwives Phase 2 –12 midwives (two focus groups) | Phase 1—Questionnaire Phase 2—45 min focus group Phase 1—means, interquartile ranges for continuous data, frequency for categorical data via SPSS, scenarios scored by four researchers Phase 2—Thematic analysis of transcribed focus groups | B |
16 | Madden, K. L., et al., 2013 Australia Large tertiary referral centre and country wide for survey | To compare the personal preferences of pregnant women, midwives and obstetricians regarding a range of physical, psychosocial and pharmacological methods of pain relief for childbirth | Quantitative Self-completed questionnaires | Purposive Eligibility—Obstetricians publicly listed as practicing obstetrics on the Royal Australian and New Zealand College of Obstetricians and Gynaecologists Practicing midwives at research sites (400 women booked into the hospital) | 242 obstetricians 210 midwives (123 women) | Questionnaires Proportions were used to describe categorical data, means for continuous data and medians for ordinal data Participants’ preferences for pain relief methods used non-parametric tests, Kruskal–Wallis (H) and Mann–Whitney (U) to compare between groups using the Monte-Carlo method Findings statistically significant at p < 0.05 | B |
18 | Mercredi, A., 2020 (THESIS) Canada Acute care facility (hospitals | To understand the level of support for waterbirth and explore the overall perceptions and experiences of childbirth HCPs in terms of perceived benefits, risks and barriers | Quantitative Nonexperimental, cross-sectional online survey | Purposive and snowballing sampling Eligibility – Currently practicing maternity professionals involved with childbirth care | 214 registered nurses, 38 registered midwives, 41 physicians, and 11 obstetricians | Survey Descriptive statistics | B |
19 | Meyer, S. L., Weible, C. M., and Woeber, K., 2010 US Georgia statewide | To examine the perceptions, exposure to, and experience of a sample of Georgia CNMs with Waterbirth | Quantitative Survey questionnaire | Purposive Eligibility—Currently or recently active CNMs in Georgia | 119 Certified Nurse-Midwives | Survey Descriptive statistics | C |
20 | Milosevic, S., et al., 2020a UK Three obstetric units and three midwifery units | To identify factors influencing pool use through qualitative case studies of three obstetric units and three midwifery units in the UK | Mixed methods cohort study Phase 2 and 3 Qualitative component Case studies | Purposive sampling Eligibility—Women and maternity staff working at the study sites | 111 participants including 57 midwives, 12 student midwives, 8 obstetricians, 4 pediatrician/ neonatologist, 7 midwifery support workers, and 2 doulas (21 postnatal women) | Semi-structured interviews, collation of service documents and public-facing information, and observations of the unit environment Deductive thematic analysis and systematic coding | A |
21 | Milosevic, S., et al., 2019a UK | To identify factors influencing the use of birth pools | Mixed methods cohort study Phase 2 and 3 Qualitative component Descriptive | Opportunistic Eligibility—unclear | 21 midwives, 8 obstetricians, 6 paed/neonatologist (85 women) | Online discussion groups and semi-structured interviews Thematic analysis | B |
22 | Muñoz-Sellés, E., et al., 2013 Spain 28 hospitals in Catalonia, Spain accredited as public normal birth centres | To describe the professional profile of midwives who provide care for natural childbirth in Catalan hospitals accredited as centres for normal birth, to assess midwives’ levels of training in CAT and their use of these therapies and to identify specific resources for CAT in labour wards | Quantitative Descriptive cross-sectional survey | Purposive Eligibility- Qualified midwives who had worked for at least 6 months in one of the hospitals in Catalan | 237 midwives | Questionnaire based on Sara and Hastings-Tolsma (2009) Descriptive statistics—frequencies for categorical variables, means, standard deviations, medians, minimums, maximums Chi-square and student t-test for comparisons Pearson’s correlation p < 0.05 significant | B/C |
23 | Newnham, E. C., McKellar, L. V., and Pincombe, J. I., 2015a Australia Metro tertiary hospital labour ward | To examine personal, social, institutional and cultural influence on women in their decision to use epidural in labour and a comparison of policy and information pamphlets for using epidural or water in labour | Qualitative Critical medical anthropology (CMA) Ethnography | Purposive Eligibility—Maternity staff and women who consented to be observed Documentation included client information handouts, hospital policies, state department policy | Maternity staff present at the time of observations (unclear numbers) (16 women/ 6 women consented to presence of researcher at birth) Documentary review | Participant observation and informal interviews with staff Detailed noted of observations, conversations and interactions CMA framework Document analysis | A |
24 | Newnham, E., McKellar, L., and Pincombe, J., 2017a Australia Metro tertiary hospital labour ward | To investigate personal, social, institutional and cultural influences on women making decisions about using epidural analgesia in labour which we juxtapose with similar processes relating to use of water for labour and/or birth | Qualitative Ethnography Critical medical anthropology (CMA) | Purposive Eligibility—Maternity staff and women who consented to be observed | Maternity staff (unclear numbers) (16 women) | Participatory observation Sequential interviews Field notes CMA framework | A |
25 | Nicholls, S., et al., 2016 Australia Four public maternity services in a metropolitan area | To capture midwives’ perceptions of becoming and being confident in conducting waterbirth | Qualitative Grounded theory | Purposive sampling Eligibility—Qualified midwives working at the four public hospitals in WA | 26 midwives | One-to-one interviews Focus groups Thematic analysis | A/B |
26 | Orrantia, E. and C. Petrick, 2020 Canada Northern Ontario state wide | To understand the beliefs and perspectives of women in northern Ontario and their obstetrical providers with respect to water birthing as access to this service is limited in this region | Quantitative Survey | Opportunistic Eligibility- Women of childbearing age and maternity professionals from four locations in northern Ontario | 33 midwives 56 registered nurses 34 family physicians 11 obstetricians (400 women) | Two surveys – patient and health care professionals Proportions and 95% confidence intervals (CIs) were calculated for each of the response options Chi-square tests, t tests, p < 0.05 | C/D |
27 | Pagano, E., et al., 2010 Italy One hospital | To assess the cost-effectiveness of water compared with normal delivery | Quantitative Economic evaluation from retrospective cohort study | Matched cohort study Eligibility—All nulliparous women who had birthed within the time parameters | (110 women who had a waterbirth, 110 who had a land birth during the same period.) | Retrospective case note review Analysis comparing groups Economic evaluation | A/B |
28 | Plint, E., and Davis, D., 2016 Australia Tertiary level hospital with AMU | To describe and compare the attitudes and practices of midwives and obstetric doctors in a tertiary setting regarding water immersion for labour and birth and to identify strategies for improving bath usage in the facility | Mixed methods Survey | Purposive Eligibility—All employed midwives and obstetricians who provided labour care in the facility in the prior 12 months | 13 obstetricians, 62 midwives (49 birth suite midwives, 13 continuity midwives) | Online and hard copy questionnaire adapted from Russell (2014) Mean and median scores were determined for each professional group, Mann–Whitney U using Fisher’s exact test or continuity correction Open-ended text analysed descriptively | A/B |
29 | Russell, K., 2011a UK One hospital labour ward | Using action research to identifying inequalities in the availability of water birth on one hospital labour ward | Mixed methods Qualitative component of action research study Critical theory and critical discourse analysis | Purposive Eligibility—Midwives who regularly worked on labour ward at the study site | 16 midwives | Face-to-face interviews Focus groups Structural and interactional analysis | A/B |
30 | Russell, K., et al., 2014a UK One obstetric-led hospital | Using action research and follow up questionnaire to explore improving the availability of hydrotherapy and waterbirth in one UK labour ward | Mixed methods Quantitative component of action research study | Purposive Eligibility—Labour ward coordinators and midwives working at the study site | 105 midwives (9 labour ward coordinators involved in workshop and 96 midwives completed questionnaires) | Problem solving workshop Survey based on Davies and Hodnett (2002) Tests for normality on the distribution of scores for Total Personal Knowledge, Total Waterbirth Self-efficacy and Total Social Support (Kolmogorov–Smirnov > 0.05, Histograms and Q–Q plots). One-way ANOVA with post-hoc Tukey tests | A/B |
31 | Seibold, C., et al., 2010 Australia Major metropolitan maternity hospital | To explore and describe midwives’ perceptions of birth space and clinical risk management and their impact on practice both before and after a move to a new facility | Qualitative Exploratory descriptive study with modified participatory approach and observation | Purposive Eligibility—midwives working at the study site | 18 midwives including graduate, caseload and hospital midwives | Focus groups with three groups Field notes from birth space both before and after moving to new site Modified participatory and observation Framework analysis | B |
32 | Stark, M. A. and M. G. Miller, 2009a US Country wide | To determine nurses’ perceived barriers to the use of hydrotherapy in labour | Quantitative Comparative descriptive survey design | Convenience and purposive Eligibility—Nurses attending a national convention and members of perinatal listserves who had provided care to a laboring woman in the last 12 months | 401 intrapartum nurses | Online and paper-based survey (?revised from pilot below, not clear) Variance. Bonferroni’s post hoc analyses were performed .05 was determined a priori | A/B |
33 | Stark, M. A., and Miller, M. G., 2010a US Country wide | To develop and test an instrument of nurses’ perceptions of the barriers to the use of hydrotherapy in labour | Quantitative Griepp’s (1992) Model of Ethical Decision Making in the Management of Clients’ Pain Scale/questionnaire development | Convenience and purposive Eligibility- Nurses attending a national convention and members of perinatal listserves who had provided care to a laboring woman in the last 12 months | 65 intrapartum nurses | Phase I—Online survey (?pilot not clear) For each item, range, mean, standard deviation and distribution were examined Correlations were determined Construct validity against Labour Support Scale | A/B |
34 | Sushma, Y., et al., 2019 India One general hospital | To assess the level of knowledge of waterbirth among staff nurses | Quantitative Descriptive design Questionnaire | Convenience sampling technique Eligibility- Nurses at study site | 100 nurses | Questionnaire Frequencies, percentages, mean, standard deviation, Chi square tests | D |
35 | Ulfsdottir, H., Saltvedt, S., and Georgsson, S., 2020 Sweden Country wide | To explore the experiences, knowledge and attitudes regarding waterbirth among midwives, obstetricians/ gynecologists and neonatologists | Mixed methods Cross-sectional survey | Purposive Eligibility—All maternity staff working within Swedish maternity wards | 1467 midwives 105 obstetricians/gynaecologists 37 neonatologists | Mixed methods survey Descriptive statistics and quantitative content analyses Univariate comparisons between the professions were performed using Chi square, Fisher’s exact test and Mann Whitney U-test as appropriate. P-values < 0.05 were considered statistically significant Content analysis for qualitative data | B |
36 US Country wide | Way, S. E., 2015 (THESIS) | To specifically examine perceived barriers to attending waterbirth as reported by CNM midwives | Quantitative The social amplification of risk framework Survey | Convenience sampling Eligibility—ACNM members | 1,565 / 7,374 Nurse-Midwives | Online survey Descriptive statistics, frequency distributions, and nonparametric measures of correlation | C |
37 UK Across all birthplace settings | Woodward, J. L., 2012 (THESIS) | To investigate the feasibility of a waterbirth RCT to assess the effects of a waterbirth on the neonate, to explore women’s thoughts about participation and whether randomisation affects women’s satisfaction with their childbirth experience and to assess midwives’ attitudes to waterbirths | Mixed methods Qualitative component (from wider feasibility study) | Opportunistic sample Eligibility—Practicing midwives at the time of the study | 5 midwives (4 NHS, 1 Independent Midwife and worked bank shifts in local unit.) | Semi-structured interviews Thematic network analysis | C |