Feature ArticlesSystematic Review of Case Reports of Poor Neonatal Outcomes With Water Immersion During Labor and BirthVanderlaan, Jennifer PhD, MPH, CNM; Hall, Priscilla PhD, CNMAuthor Information University of Nevada, Las Vegas, (Dr Vanderlaan); and Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia (Dr Hall). Corresponding Author: Priscilla Hall, PhD, CNM, Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Rd NE, Atlanta, GA 30322 ([email protected]). Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jpnnjournal.com). Disclosure: The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Each author has indicated that he or she has met the journal's requirements for Authorship. Submitted for publication: June 4, 2020; accepted for publication: July 21, 2020. The Journal of Perinatal & Neonatal Nursing: October/December 2020 - Volume 34 - Issue 4 - p 311-323 doi: 10.1097/JPN.0000000000000515 Buy SDC Metrics Abstract Water immersion is a valuable comfort measure in labor, that can be used during the first or second stage of labor. Case reports of adverse outcomes create suspicion about water birth safety, which restricts the availability of water birth in the United States. The objective of this study was to synthesize the information from case reports of adverse water birth events to identify practices associated with these outcomes, and to identify patterns of negative outcomes. The research team conducted a systematic search for cases reports of poor neonatal outcomes with water immersion. Eligible manuscripts reported any adverse neonatal outcome with immersion during labor or birth; or excluded if no adverse outcome was reported or the birth reported was unattended. A qualitative narrative synthesis was conducted to identify patterns in the reports. There were 47 cases of adverse outcomes from 35 articles included in the analysis. There was a pattern of cases of Pseudomonas and Legionella, but other infections were uncommon. There were cases of unexplained neonatal hyponatremia following water birth that need further investigation to determine the mechanism that contributes to this complication. The synthesis was limited by reporting information of interest to pediatricians with little information about water birth immersion practices. These data did not support concerns of water aspiration or cord rupture, but did identify other potential risks. Water immersion guidelines need to address infection risk, optimal management of compromised water-born infants, and the potential association between immersion practice and hyponatremia. © 2020 Wolters Kluwer Health, Inc. All rights reserved.