Grant: Operating Grant: Data Analysis Using Existing CDN Databases and Cohorts

Midwives seek to promote healthy beginnings for childbearing clients at low risk of complications, offering waterbirth (WB) as one care option. Clients highly value WB and, while research suggests outcomes similar to birth on land, some evidence suggests a higher rate of neonatal infection (NNI). Each type of NNI impacts infant mortality and morbidity differently, and the causal mechanisms of NNI transmission in WB are poorly understood. In Ontario, the current prevalence and outcomes of WB are unknown. We aim to examine the prevalence and outcomes of WB among low-risk midwifery clients in Ontario, focusing on neonatal infection. We will conduct a secondary analysis of existing data from BORN, Ontario's database of routinely collected birth data, in collaboration with Knowledge Users (KUs) including public, professional, policy and research stakeholders. Data from all eligible BORN-registered midwifery clients and infants from 2015-2021 will be analyzed, using key exposure variables (e.g. water/land birth, health history, demographics, health services provided) and outcome variables (e.g. infection, resuscitation, breastfeeding and postpartum morbidity). Water and land birth cases will be matched using directed acyclic graphs developed with our KUs, and propensity scoring will determine key exposures influencing outcomes, including neonatal sex. We will interpret findings with our KUs to mobilize research knowledge to their public, professional and policy networks. The findings from this study will support evidence-informed policy and practice related to waterbirth as an important part of high quality, safe maternal-infant health service provision in Ontario's hospital and community settings. Our findings could aid in decision-making: by clients preparing for their labour and birth experience; by policymakers planning and evaluating intrapartum services; and by health care practitioners seeking current relevant evidence related to the population they serve.