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In my area of clinical practice, the most pressing clinical question that is usually asked by many patients is that: what are the benefits of water birth the newborn babies and women with uncomplicated pregnancies as compared to bed birth? Using PICOT format, the clinical question is clarified below.

P (Patient population) – neonates and women with uncomplicated pregnancies

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I (Intervention) – Water birth

C (Comparison) – Bed births

O (Outcome) – benefits

T (Tome)-during labour and birth

Opportunity for Improving Health Outcomes

Water birth is the use of warm water immersion during labor, delivery or both. According to Harper (2014), the theory behind water birth is that since the baby has already been in the amniotic fluid sac for 9 months, delivery in a similar environment is gentler for the baby and less stressful for the mother. Compared to bed delivery, water birth delivery is more relaxing for the mother and reduces the urge to seek for other medications to relieve pain (Garland, 2017). Although it is a practice that has been in existence for long, hydrotherapy has not been embraced in most healthcare facilities. Harper (2014) argue that currently, less than 10% of maternity care facilities in the United States of America offer water birth as an option for labour and delivery. This may be as a result of lack of knowledge on the benefits or myths surrounding warm birth. Most women in labor want something to ease the pain and enhance their natural delivery and warm birth has proved to be effective. Water acts a relaxer and can have the same effect during labor and child delivery. When the relaxation is increased in women who are in labor, their chances for tense breathing and taking short and shallow breathes lessens (Nutter, Meyer, Shaw‐Battista, & Marowitz, 2014). Short and shallow breathes intensifies contractions thereby increasing pain. According to Taylor, Kleine, Bewley, Loucaides and Sutcliffe (2016), the less stress imposed on the body during labor, the lesser the pain.  This is because when the body relaxes, it releases oxytocin hormone which is a stimulant of the labor contractions hence making them stronger and regular. In a relaxed state, the body also releases more endorphins which serve as pain-inhibitors thereby enabling the mother to cope up with the contractions (Chapman, & Charles, 2018). Moreover, water birth results into perineum thereby enhancing the elasticity of the cervix of the mother. This reduces the chances for episiotomy and stitches as well as severe incidences of tearing during delivery (Beal, Shaw-Battista, & Huwe, 2015). Water also makes the body buoyant thereby enabling the mother to easily move and be in comfortable positions. Buoyancy also enhances more efficient contractions in the uterus and improves the circulation of blood hence better oxygenation in the in the muscles of the uterus (Finigan, & Chadderton, 2015). Oxygenation lessens pain for the mother while ensuring more oxygen supply to the baby. American College of Obstetricians and Gynecologists (ACOG) (2016) argues that the first stage of labor can result into shorter labor periods and reduction in the use of epidurals in women with uncomplicated pregnancies if immersion of water is used. As compared to bed births, warm births reduce the labor period by 32 minutes. The first stage is the onset of labor contractions until dilation. Although ACOG (2016) argues that there is no sufficient data to support the second stage of labor which is delivery, Cluett, Burns, and Cuthbert (2018) found that there are no risks associated with warm birth delivery. Research has also demonstrated that immersion in water can help lower high blood pressure which is usually caused by anxiety. Since water provides a greater sense of privacy, women in labour are able to relax mentally and hence reducing inhibitions, fears and anxiety as compared to the use of bed births.

Article That Best Supports Nursing Interventions for the Topic

The article that best supports the nursing intervention for my topic is Cluett, E. R., Burns, E., & Cuthbert, A. (2018). Immersion in water during labour and birth. Cochrane Database of Systematic Reviews, (5). This is because the article is guided by a research problem, question and hypothesis.  The problem has guided the procedure and ensured that the research methodologies, study design, research analysis and sampling strategies are clearly identified and are in line with answering the research question. To ensure that the results and findings when compared to the objectives provide valid bases for conclusion and recommendation, the research problem must guide the research. The article also supports the nursing intervention for my topic because it rests on certain critical assumptions. These assumptions highlight the key findings in the analysis as well as the implications when the findings are applied in nursing practice. The assumptions also identify how a gap in the previous literatures has been filled by the research and elaborate on the impact and significance of the findings. Moreover, the assumption offers a new insight and creative approaches for framing the research problem based on the results of the study. The fact that this article clearly articulates its goals makes it the best in supporting the nursing intervention for my topic. The clear articulation of goals has ensured impartiality and provided focus and direction. This article also gives answers to a research question which is already defined by gathering and giving summary to all the empirical evidence that fits the eligibility criteria that has already been pre-specified. This makes the generated conclusions to be very transparent through the avoidance of misinterpretation of the knowledge base. Since the protocol used to make conclusions ensures that each piece of evidence is evaluated and its quality and relevance are made clear, this article has minimized bias. This article also supports the nursing intervention for my topic because the results have been synthesized. Synthesis of findings aim at making clear the link between the details of the previous literatures and the conclusions of the reviewers. By using a structured narrative, summarizing the tables and statistical analyses, this article presents formulated conclusions and recommendations which support my nursing intervention topic.