Water 1

The Decision-Making Experience of Mothers

Selecting Waterbirth

Chia-Jung Wu � Ue-Lin Chung*

ABSTRACT: Waterbirth has been a way of birth for 20 to 30 years abroad, while in Taiwan, only in the past three years

have some women chosen water birth. This study aims to explore the decision-making experience of

mothers selecting waterbirth. A phenomenological approach was employed in this study. Nine mothers

who had given birth in water successfully in the midwife clinic in the past year were chosen and

one-by-one, face-to-face interviews were conducted. The research tools included a basic information

questionnaire, a semi-structured and open-ended interview guide, and an audio recorder to record the

entire interviews. The content of the interviews was faithfully transcribed and analyzed with Giorgi’s

phenomenological method and Lincoln and Guba’s qualitative credibility. Four main concepts concluded

from the experience context of the studied women were: (1) Dissatisfaction with existing obstetric

practices; (2) Demonstration of autonomy; (3) Consideration of relatives’ attitude; and (4)

Employing strategies to achieve goals. The result of this study can help nursing staff and the public to

understand the decision-making experience of mothers selecting waterbirth, and help the contemplation

of health care providers with respect to furnishing a more humanized birth environment in hospitals.

Key Words: waterbirth, decision-making process.

Introduction

Human waterbirth was first invented by the Russian

physiologist Igor Charkovsky in the 1960s. Observing

water animals delivering in the water, she found that water

could alleviate the impact of gravity on brain cells during

the birth of the fetus. She thus thought that waterbirth could

be a good childbirth method. In the 1970s, Dr. Michel

Odent in France started to introduce waterbirth to hospi-

tals, and Dr. Michael Rosenthal introduced it to the USA in

the 1980s. As of 1996, 25,000 babies had been delivered by

waterbirth in the USA, while 20,000 babies were delivered

by waterbirth in the UK in 1993 alone. The estimated num-

ber of babies delivered by waterbirth worldwide is 150,000

from 1985 to 1999 (Harper, 2000; Lin, 2000).

There has been a 20- to 30-year history of waterbirth

abroad, but waterbirth is still in the rudimentary phase in

Taiwan. There have been 30 mothers to date choosing to

deliver by waterbirth since September of 1999 in Taiwan;

all of these deliveries were carried out in the midwife

clinic. The researchers wanted to study why these women

chose waterbirth, and what their decision-making experi-

ences were. So far there has been a lack of studies on

waterbirth in Taiwan. Most studies abroad on waterbirth

are quantitative, while fewer studies are qualitative. Hence,

our study used the phenomenological research method

with interviews to collect the data. The results could offer

an understanding of the decision-making experience of

mothers selecting waterbirth, as a reference for the public

and medical staff in Taiwan.

Literature Review

Definition of waterbirth

Waterbirth is one way of delivery whereby low risk

women immerse themselves in specially designed pools or

tubs, and deliver in the posture in which they feel most

comfortable. Because they are bathing in warm water dur-

ing delivery, their muscles are relaxed, and this helps to

reduce pain (Milner, 1988).

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Journal of Nursing Research Vol. 11, No. 4, 2003

RN, MSN, Instructor, Ching Kuo Institute of Management and Health; *RN, MN, EdD, Professor & President, National Taipei College of Nursing.

Received: June 27, 2003 Revised: September 4, 2003 Accepted: September 12, 2003

Address correspondence to: Ue-Lin Chung, No. 365, Ming-Te Rd., Taipei 112, Taiwan, ROC.

Tel: 886(2)2822-7101 ext. 2000; Fax: 886(2)2822-2432; E-mail: [email protected]

Reports about waterbirth abroad

(1) Aspects of perineal injuries, labor progress, analge-

sic treatment, and satisfaction with delivery

There are inconsistent study results about the impact of

waterbirth on the degree of perineal injuries. Some studies

(Burns & Greenish, 1993; Geissbuhler & Eberhard, 2000)

showed that the probabilities of first- and second-degree

tears in the waterbirth group were higher than those in the

non-waterbirth group. However, Garland and Jones (1997)

stated that the waterbirth and non-waterbirth mothers had

the same degree of perineal tears. Conversely, the study of

Rush et al. (1996) supported the view that waterbirth is more

likely to maintain the perineum intact.

As for labor, Halek (2000) pointed out that the survey

of 602 lying-in women conducted by the Royal Society of

Medicine during 1989-1994 found waterbirth labor to be

faster than traditional labor.

As for analgesia, most studies concluded that analgesia

(e.g., analgesic, epidural analgesia) is less required in

waterbirth deliveries (Burke & Kifoyle, 1995; Burns & Green-

ish, 1993; Geissbuhler & Eberhard, 2000; Rush et al., 1996).

Most studies pointed out that mothers who choose

waterbirth have greater satisfaction, and are more likely to

be willing to choose this childbirth method next time

(Burke & Kifoyle, 1995; Church, 1989; Garland & Jones

1997; Geissbuhler & Eberhard, 2000).

Additionally, Geissbuhler and Eberhard (2000) found

that mothers choosing waterbirth have less blood loss and

lower episiotomy rates than mothers choosing traditional

childbirth methods.

In general, most studies support the following conclu-

sions: mothers choosing waterbirth have faster labor, lower

need for analgesia, and lower episiotomy rates, less blood

loss, and a higher degree of satisfaction at their delivery

experience; waterbirth newborns have higher Apgar

scores. However, whether waterbirth decreases the proba-

bility of perineal tears remains inconclusive.

(2) Infection rate

Most studies show that infection rate of waterbirth is

minimal, but there are some studies reports of waterbirth-

related infection. For example, Rawal, Shah, Stirk, &

Mehtar (1994) stated that the contaminated birth tub will

cause newborn bacterial infection (e.g. Pseudomonas

aeruginse, Klebsiella pneumoniae, etc.) These bacteria

usually grow in the water pump, heating systems, pipes and

water. There is a report on a newborn baby developing

Pseudomonas sepsis after waterbirth. Hence, Rawal et al.

(1994) emphasized the importance of cleaning the birth tub

with water for waterbirth deliveries.

(3) Newborn mortality rate

Gilbert and Tookey (1999) sampled 4032 low risk

women who chose waterbirth in England and Wales in

U.K. They found that waterbirth did not have higher mor-

tality rate than that the traditional childbirth method did.

Waterbirth in Taiwan

Waterbirth has been implemented to date at a mid-

wifery clinic in Hsinchuang in Taiwan. Three years ago, a

woman who had studied in France wanted to experience the

wonderful waterbirth she had read about on the Internet. She

was then referred to a midwife with 26-year midwifery

experience. Eventually Taiwan had its first waterbirth.

According to the midwife at the clinic, waterbirth is covered

by the National Health Insurance program. Waterbirth at

home is not easy because the bathtub at home is usually too

small, so that the mother has difficulty changing her posi-

tion. Hence, most mothers choosing waterbirth deliver their

babies in the large-size bathtubs at the midwifery clinic. In

addition, the water used in the bathtub is sterilized.

The procedures of waterbirth are approximately the

same in Taiwan as in other countries. Details are described

as follows (Harper, 2000; Michelle, 2000; Tsai, 2001, Aug.):

(1) First, add filtered sterile water to the pool or bathtub.

The water temperature is kept at about 37 �C. When

the mother’s cervical opening is 5 cm wide with

strong and regular contractions, she will wash her

body and then enter the pool or bathtub with the water

level chest high and covering her abdomen.

(2) When the newborn’s head is about to come out, the

midwife will tell the mother to open her mouth. Mean-

while, the mother or midwife can support the perineum

with her hands so that the newborn’s head can come out

slowly. When the newborn’s head comes out, the mid-

wife will touch its neck and check whether the umbili-

cal cord is wrapped around the baby’s neck.

(3) If the examination confirms that the umbilical cord is

not wrapped around the baby’s neck, the midwife will

encourage the mother to draw a breath and keep exert-

ing herself, and thereby the baby can be delivered suc-

cessfully.

(4) When the newborn is completely delivered, the mid-

wife usually will not remove the baby from the water

immediately if its condition is fine.

(5) One to five minutes later, the newborn is slowly removed

from the water and held close to the mother’s chest.

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J. Nursing Research Vol. 11, No. 4, 2003 Chia-Jung Wu et al.

(6) When the newborn’s umbilical artery stops beating,

the father cuts the umbilical cord.

(7) When the umbilical cord is cut, prepare for the third

stage of labor (helping the mother to leave the bathtub

and lie on the temporary delivery table.

(8) When the mother leaves the water, wrap her body with

a blanket to keep her warm.

(9) Check if there are perineal tears after the placenta is

delivered. Suture the wounds if there are tears.

(10) After the waterbirth is complete, the mother should

perform breast-feeding as soon as possible. Pay close

attention to the postpartum uterine contractions.

(11) Sterilize the bathtub and other facilities and keep them dry.

Methods

Study DesignWe used a qualitative research method. The study is

aimed at examining the subjective experience of the deci-

sion-making process of mothers choosing waterbirth. We

employed phenomenological interviews to collect the

experiences of the participants.

ParticipantsAll participants came from the single midwifery clinic

where waterbirth is performed. The participants were eligible

to enter our study if they met the following criteria: citizens of

Taiwan, speaking Mandarin or Taiwanese, having had a suc-

cessful waterbirth experience within the past year, and being

willing to participate in our study. Nine participants were

interviewed from December 2001 to April 2002. In fact, no

new data were derived from the seventh participant. But to

confirm that no new data would be obtained from new partici-

pants, two more participants were interviewed.

Data CollectionIn order to keep the data collection consistent, the

investigator was also the interviewer. The interviews were

semi-structured. The interview started with questions like

“Would you please tell us what your expectation for deliv-

ery is? Why did you choose waterbirth? How did you make

that decision? ….” The interviewer never tried to influence

the responses of the interviewee. The interview lasted from

60 to 90 minutes. The locations of the interviews were

mostly homes (eight participants) or quiet coffee shops.

Data AnalysisThe analytical procedure was phenomenological in

nature and was comprised of five steps, inspired by Giorgi

(1997): reading of interviews, division into meaning units,

transformation, synthesis and general structure. These are

also central concepts of the mothers’ decision-making pro-

cess and experience.

RigorWe used the four indicators of trustworthiness pro-

posed by Lincol and Guba (1985): credibility, transferabil-

ity, dependability, and confirmability.

With regard to credibility, we have started to contact

waterbirth mothers at least 10 months before the study was

conducted. As we researchers involved ourselves deeply in

the study, we could more easily understand and observe the

characteristics of phenomena. During the interviews, the

participant’s emotions and body language were thoroughly

documented.

In the process of data analysis, the investigator and a

graduate student with the same training background sepa-

rately analyzed the data in terms of “meaning units”, and

then compared their results. When the results were different,

the two analysts sought a consensus through discussion.

Transferability relies on thick description. Each inter-

view of these nine participants took 1 to 1.5 hours, so we

had thick description for analysis. The concepts derived

from the analysis can give guidance for clinical practice.

With regard to dependability, our study documented

the interview scenarios using audio recording and

non-language information. The data were analyzed and

consistency was assured. With regard to confirmability, the

audio tapes, documents, interview records, post-interview

logs, and data analysis results were all encoded, classified

and well preserved. Thus future confirmation or tracing is

possible.

Results

Nine mothers, aged 28-41, were interviewed in our

study. They included four primiparas and five multiparas.

In terms of educational status, one had a high school

diploma, five had college degrees, and three had postgrad-

uate degrees. Five were housewives, three were teachers,

and one was in the service industry. Eight resided in Taipei

and one in Taichung. All of the mothers chose to breast-

feed, and their newborns were healthy. Four key concepts

extracted from the Giorgi phenomenological data analysis

of this study were feeling dissatisfied with existing obstet-

ric practices, demonstrating autonomy, considering rela-

tives’ attitudes, and employing strategies to achieve

goals.

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Decision-Making Experience of Waterbirth Mothers J. Nursing Research Vol. 11, No. 4, 2003

Dissatisfaction With Existing Obstetric Practices

Dissatisfaction with the current medical care system

The participants thought that lying-in women are usu-

ally encouraged to have a cesarean section (CS). They

regarded intravenous (IV) medication and fasting as prepa-

ratory procedures for CS, and were afraid of CS. As partici-

pant 1 put it, “CS is hinted at for mothers in many hospitals

in Taiwan, unless the doctors are decent. … Why is it neces-

sary to have IV medication, fasting, and intravenous uter-

ine contractor? One will become weak after receiving such

treatment, which thereby leads to CS.”

The other participant described her impression of visiting

a hospital as, “The delivery room in the obstetric hospital is ter-

rifying. Everything is white and there is a lot of cold metal

material. The delivery room looks like an operating room.

…basically, I suppose that one only goes to the hospital

because of sickness. However, doctors usually choose to do CS

or use forceps to facilitate the labor, which is fast and brutal.

They do not offer a means of relaxation” (Participant No. 5).

One participant felt that she was being treated as an

object on the production line. She though there was no

respect, support, warmth, or autonomy in hospitals. The

design of the delivery table and the environmental temper-

ature did not meet the needs of mothers.

As participant No. 6 put it, “I felt like a case or object

being packed. Mothers and babies are not treated as inde-

pendent individuals. The delivery room is not a warm

place, and humanity is not considered. A lying-in woman is

manipulated and controlled in the hospital! … The delivery

table is not ergonomically designed. The room temperature

is lower than 20 �C. Under such circumstances, the deliv-

ery may be more torturous in the wintertime.”

Negative previous delivery experience

The participants feared the non-humanistic medical

procedures that they had encountered during their previous

deliveries. They found it hard to bear the negligence of

medical staff, feelings of being threatened, painful experi-

ence of CS, and postpartum complications. As participant

No. 2 said, “My first delivery was carried out at a clinic.

The nurses were not competent in handling my problems,

and the doctor arrived when the baby’s head had come out.

That was so terrible! I was in darkness and terror. The pla-

centa was not delivered naturally, so I received a uterine

contractor injection. I was so terrified!”

Another participant (No. 9) also mentioned a similar

experience of the doctor being late for her delivery. She

was told to hold it when her baby was about to come out.

Such pain was worse than her labor pains. She thought the

hospital did not do a good job at all.

Experience that falls short of expectations

The participants wished to be accompanied by family

members during their deliveries. They wanted to perform

breast-feeding right after the baby was born. They also

wished to try VBAC (Vaginal Birth After Cesarean) and

not to need episiotomy. However, these demands cannot be

met in the current medical care system. As participant No.

1 put it, “When I attended the Mothers’ Course, I asked if

the hospital encouraged the father-to-be to accompany the

delivery. The Chief Executive of that hospital said the

delivery might be disturbed by the father-to-be…. I don’t

think that the hospital takes our concerns seriously and the

hospital does not implement up-to-date care procedures. I

was so disappointed.”

Demonstration of AutonomyDue to dissatisfaction with the current medical care

system, the participants insisted on their autonomy in their

deliveries, and hence they tried to understand and scruti-

nize childbirth methods outside the system.

Autonomy in delivery

The participants conceived that they should be able to

decide their own childbirth methods. They thought deliver-

ies in hospitals would be dominated by doctors, and doc-

tors would perform CS whenever possible. As participant

No. 5 said, “My husband supposes that every mother

should be able to have a normal spontaneous delivery.

When one goes to the hospital, the doctor cannot wait too

long, so they will perform CS after a certain point of time …

(pause). My labor pains were so hard to bear then, that I

might have changed my mind at any time. But I told myself

and my husband, when I was shivering in pain, that I had to

insist [on waterbirth], otherwise all my efforts would have

been in vain…. Why I insisted was because doctors domi-

nate everything at hospitals.”

Understanding and scrutinizing alternative childbirth

methods

The search for alternative childbirth methods was

driven by dissatisfaction with the current environment.

These mothers assessed the current mainstream childbirth

methods and informed themselves about the environment

and waterbirth provided at midwifery clinics. Participant

No. 6 said, “I carefully examined the information about both

deliveries at hospitals and childbirth methods outside hospi-

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tals. I decided to choose waterbirth in the last month of my

pregnancy. I received antenatal examinations at both hospi-

tals and midwifery clinics. So, it was not the way other peo-

ple said—that I did it simply as an idea!” Participant No. 1

said “ I told my family not to worry. I had assessed

waterbirth for a long time, and I had great confidence in it.

All the information was saved and documented.”

Trusting the midwife

Although the participants thought midwifery has

become gradually obsolete, and facilities at midwifery

clinics are less advanced than those at hospitals, they still

appreciated the enthusiasm and rich midwifery experience.

As the participant No. 7 said, “Ms. Tsai [the waterbirth

midwife] was so eager to help me, and I took her advice. …

It is said that childbirth is dangerous, so I have to rely on a

skillful, experienced, and attentive doctor. … I know mid-

wifery has become less and less popular, but I still have

confidence in the techniques of Ms. Tsai.”

Fulfilling individual dignity of life at the price of tak-

ing risks and pressure

The participants thought that delivery is an adventure,

so they were under great stress and suffered consequences

in order to achieve their dignity of life. As participant No. 4

said, “Delivery is like an adventure…. I decided not to have

any operation! I trust Ms. Tsai [the midwife], and will

never undergo CS again. Anyway, I am willing to face all

the stress and misunderstandings of my family and friends,

and accept the consequences.”

Participant No. 6 said, “The pressure came not only

from my husband’s parents but also my friends. They had

no reason to object to my plan since they certainly had less

knowledge about waterbirth than I did. I appreciated their

concern, but I was so tired of such stress! … I could not

guarantee that waterbirth would work, and I didn’t want to

spend efforts explaining anything. All I wanted to do was

achieve my goal. So, I kept a low profile during the whole

process, … I was willing to put up with any stress in order

to achieve my dignity of my life.”

Consideration of Relatives’ AttitudeThe participants consulted their relatives for their

opinions and support, but they encountered various degrees

of support and objection.

Support

Family support, particularly from the husband, is very

important for enhancing the confidence of mothers. Partic-

ipant No. 2 said, “Many people in the breast-feeding club

had their deliveries at the midwifery clinics, and they were

all very satisfied. My parents also agreed with me, because

my mother gave birth to her three children at the midwifery

clinic….”

Worries

Some relatives had worries about waterbirth although

they did not object to it. For example, the family members of

participant No. 3 were concerned about the operation scar

from a previous CS; participant No. 4 was worried about

safety at the midwifery clinic. Participant No. 4 said, “My

sisters could not believe I decided to deliver at the midwifery

clinic, let alone choosing waterbirth. My husband, who has

studied traditional Chinese medicine, was worried, too. I

have a friend who passed away on the delivery table, and I

feel very sad every time I think of this. Luckily my delivery

was successful, and everyone was so relieved.”

Objection

Most relatives of the participants did not trust the

competency of midwives, and believed that deliveries at

hospitals were much safer. Participant No. 1 said, “My par-

ents tried to persuade me to deliver at a hospital after they

learned I planned to choose waterbirth. My mother-in-law,

who works in a hospital, had no trust in the midwife at all.”

Participant No. 5 said, “My father and cousin, who have

studied medicine, suggested I should give up the idea of

waterbirth at the midwifery clinic. Other relatives who

have midwifery licenses also suggested that I should

deliver in hospital.”

Employing Strategies to Achieve GoalsWhen relatives held different opinions on waterbirth,

the participants might choose some strategies to either

reach a consensus among their relatives, or conceal their

decisions from their relatives.

Attempts at persuasion to reach a consensus

The participants used all opportunities to let their hus-

bands read documents about waterbirth, and further explained

the benefits of waterbirth to their family members. Participant

No. 3 said, “I passed some reports about waterbirth to him,

and asked him to accompany me when I had my antenatal

exams at the midwifery clinic, where he could watch videos

and read relevant information. Hence he became less worried

after he had more knowledge about waterbirth.” Participant

No. 8 said, “My family could not accept waterbirth and I had

to tell them some concepts to help them understand this. They

265


asked if the water was clean, if the facilities were good

enough. They were worried about the scenario if CS was

needed. I had to assure them that hospitals were very close

just in case of an emergency. I also reminded my par-

ents-in-law of the fact that my mother-in-law delivered at

home, not at a hospital. We saw news on TV about women

delivering in cars, etc. We were born with the ability to deliver

naturally, not necessarily by CS.”

Mock situations and concealing their decisions inten-

tionally

The participants might conceal their decisions from

their relatives, and only tell their family members about

their deliveries after they delivered their babies. Participant

No. 1 said, “I had had episodic labor pain every 5 to 10

minutes until midnight. I let my husband know right away

while I concealed it from other family members. My mother

saw me walk awkwardly, but I still said I was fine. After my

delivery was successfully done, I called my family and told

them that I just gave birth to my baby. I knew my parents

could never accept the idea of waterbirth at the midwifery

clinic.” Participant No. 4 said, “I did not mention my deci-

sion to have a waterbirth to my parents or my husband’s

parents. They just knew when my baby would be due, and

that I probably would deliver at the clinic … I did not want

them to know that I had had a waterbirth.”

Participant No. 6 had prepared some solutions to sev-

eral scenarios beforehand: “If my labor pains occurred at

my parent’s house, they might stop me from going to the

midwifery clinic… I used to live with my parents in Taipei,

so I moved to Taoyuan after my estimated date of delivery.

My husband and I pretended to go out once in a while when

we stayed in Taoyuan, so that I could go to the midwifery

clinic on a day my mother did not expect at all.”

Discussion

We will discuss the four primary concepts one by one:

1. Dissatisfaction with existing obstetric practices; 2. Dem-

onstration of autonomy; 3. Consideration of relatives’ atti-

tude; and 4. Employing strategies to achieve goals.

Dissatisfaction With Existing Obstetric PracticesThe participants rejected mainstream medical care

and sought alternative childbirth methods mainly

because of their dissatisfaction with the current medical

environment for deliveries, and negative experience of

previous deliveries. When doctors fall short of mothers’

expectations (e.g., doctors cannot accept VBAC), moth-

ers will start to consider alternative childbirth methods.

The midwife Sha-Ning Tsai (2002) surveyed 22 mothers

choosing waterbirth between January 1999 and Decem-

ber 2001, and found that many of these mothers chose

waterbirth because they did not want to undergo CS

again.

The interviews with the nine participants showed that

each of them complained about the over-medicalization of

deliveries at hospitals nowadays. As Malterud (1993) men-

tioned, there are two sources of suppression from the medi-

cal care system for women: medicalization and negligence

of women’s grievances and feelings. These two sources of

suppression also exist in Taiwan.

Demonstration of AutonomyWhen the participants became dissatisfied with the

current medical care system, they understood that they

should decide their own childbirth methods. Wagner

(2001) stated that women at hospitals could not have

complete autonomy. They had to sign a self-discharge

paper if they failed to negotiate with the hospital regard-

ing their requests. The hospital would refuse to deliver

the child. The same phenomenon happened to mothers in

our study.

Additionally, Hall and Holloway (1998) found that

mothers choosing waterbirth had autonomy in waterbirth.

They could move their own bodies and change postures as

they wanted, in order to release their anxiety and control

their labor pains. Also, these mothers could be accompa-

nied by their family members, and thereby share their joy

and pains with their family members. These requests, simi-

lar to the requests of our participants, could not be met at

hospitals.

In the decision-making process, the professional atti-

tude of the midwife was very important. The participants

appreciated the knowledge and skills of midwives, as well

as the enthusiasm and rich midwifery experience of the

midwife. Hall and Hollway (1998) reported that mothers

were grateful that they were treated as equals and offered

chances of negotiation. Therefore, the professional atti-

tudes of the midwife played an important role in the deci-

sion-making process of mothers selecting waterbirth.

Consideration of Relatives’ AttitudeIn our family-centered society, the participants still

took into account the opinions of their relatives. In the deci-

sion-making process, the husbands usually supported their

wives, while the husband’s parents usually objected to

waterbirth. Li and Lee (1998) examined the decision mak-

266


ing experiences on amniocentesis of pregnant women with

positive results on maternal serum screening for Down’s

syndrome, and found that husband was the most important

supporter, while the husband’s parents were usually objec-

tors. Our study shows similar results.

Employing Strategies to Achieve GoalsThe participants chose some strategies when facing

the disagreement of their relatives. Li and Lee (1998)

pointed out that women who had positive test results for

Down’s syndrome chose not to tell their husbands’ parents

about their decisions to receive amniocentesis since their

husbands’ parents objected to amniocentesis. These preg-

nant women tended to use indirect methods in order to

understand what opinions their husbands’ parents held.

Sometimes the women just chose to conceal their decisions

to undergo amniocentesis from their husbands’ parents.

Our study had similar findings.

Applications to NursingOur study found that mothers chose waterbirth

because they were dissatisfied with the current medicalized

environment of deliveries. Women will have less fear of

delivery if they are provided with a delivery environment

with more humanity, where fewer medical procedures are

introduced. In addition, hospitals should consider setting

up waterbirth units as an alternative mode of delivery.

Research Limitations and SuggestionsThe participants all came from a single midwifery

clinic. These mothers were relatively homogeneous, which

could be a limitation. We suggest that future research may

use qualitative research methods to further study water-

birth experience, when waterbirth is implemented in multi-

ple institutions. Also, when the sample size is large, we

may use quantitative research methods to examine and

compare the degrees of satisfaction with delivery experi-

ence, labor length, and infection rate, etc., of waterbirth

and traditional deliveries. We will then be able to assess

waterbirth more thoroughly.

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