Giving Birth in Water

Vilma Ruddock
Water Birth

Giving birth in water can be relaxing and can reduce pain and anxiety. There is no evidence, however, that compared to traditional labor and delivery, there are additional benefits for mothers or babies. In addition, there are concerns about safety, because there are reports of serious injuries in newborns born underwater.

Water Immersion Labor and Birth

The term "water birth" accurately means the birth of a baby under water. However, people loosely use it to refer to any part of water labor and delivery. You decide how long to stay in the water during the process.

First Stage of Labor

Immersion hydrotherapy or immersion labor refers to the first stage of labor in water. If you choose, you can stay in the birthing pool/tub just for this stage and move to a bed for delivery of your baby and placenta.

Underwater Birth

You can continue to the second stage of labor and deliver your baby under water. After delivery, your baby is immediately brought to the surface before he breathes so he doesn't inhale water. The placenta can be delivered in or out of water.

Intermittent Immersion

Some women move in and out of the water during the first stage of labor. It is best to get out of the water to take breaks during early labor and to use the bathroom. You can labor naked or wear a comfortable bikini so you are covered when you get out of the pool. Take the bikini bottom off when your cervix is fully dilated.

Birthing Pool

For a home birth, your bath tub or Jacuzzi can serve as your birthing pool. Buy or rent a special birthing pool, if you prefer, and fill it with tap water.

Waterbirth Solutions, for example, has a selection of pools you can purchase. Many birthing pools have a seat you can rest on and handles to hold for support.

Water Temperature

The water should be kept at a constant, comfortable temperature, no higher than 95-100°F (35-38°C). If you are overheated this can lead to fetal distress and newborn complications.

Location Options

Not all doctors do water births. If your doctor doesn't provide this option you will have to find a midwife who does.

You have three options of where to have a water labor and birth:

  1. At Home: A midwife might agree to deliver your baby in your home. Don't choose to birth at home without a trained obstetrics provider. Think about the dangers of delivering at home unattended by a midwife or doctor. Ask about procedures for monitoring you and baby.
  2. Free-standing birthing center: Most birthing centers have birthing tubs or Jacuzzis. Ask your midwife or doctor and tour the center. Check if the birthing center accredited by the Commission for the Accreditation of Birth Centers (CABC).
  3. A hospital birthing room: Some hospitals in the U. S. provide the option of water birth in special birthing rooms. They have special underwater equipment to monitor your baby. Check with your hospital and ask for a tour of their facilities.

Birthing centers and hospitals are more equipped to handle emergencies. Ask your doctor or midwife which location is best for you.

The Benefits

Advocates of water labor and birth find the process appealing for several reasons.

Natural Birth

Women who prefer a "natural birth" like the idea of a water labor because it is less restrictive than a traditional labor bed. The partial flotation in a birthing pool makes it easier to move around and get more comfortable during labor.

Relaxation

Immersion in warm water is soothing and relaxing. The calming effect releases muscle tension and helps you manage the work of labor.

Reduced Pain and Anxiety

The relaxation of water immersion can help you cope better with the pain and anxiety of labor and delivery. You may have less need for pain medicines or anesthesia.

Labor Support

Often a woman's partner can go in the pool with her and give close physical and emotional support. Some midwives will allow other family members in the room. This supportive, relaxed environment helps with relaxation.

The Risks

The research on the safety of water birth for women or babies is limited and uncertain. Potential risks include:

  • If the umbilical cord is short, it can break as your baby is lifted out of the water and he/she could hemorrhage and die.
  • Your baby could inhale underwater and drown.
  • The placenta could separate and deliver before the baby is out of the water and remove his lifeline and cause blood loss.
  • If the birthing tub/pool is not clean, or becomes contaminated, you and your baby can get an infection.
  • You could slip and fall in the water.
  • If you have an emergency it might be difficult to get out of the water quickly.
  • If you labor at home or in a birthing center you won't have access to the same monitoring, intravenous fluids, medicines and anesthesia as you would in a hospital setting.

Contraindications

You should only consider giving birth in water if you have a low risk pregnancy. The chances of a poor outcome is greater if you have these contraindications:

  • Medical conditions in you, such as diabetes, high blood pressure, heart disease, kidney disease
  • You have an infection
  • You are having twins or more
  • Your baby is in a breech position
  • Your baby is premature
  • Your baby is big and you are at risk for shoulder dystocia
  • You need continuous fetal monitoring for the safety of your baby
  • No easy access to a hospital if there is an emergency

Further Advice

Before you decide to give birth in water:

  • Make sure your doctor or midwife has experience in managing water labor and birth.
  • Ask your healthcare provider to explain all the steps in the process so you know exactly what to expect.
  • Ask about procedures to monitor you and your baby.
  • Be sure there is a plan to deal with emergencies if you choose to give birth at home or a free-standing birthing center.
  • Check your maternity coverage with your insurance company before you go into labor to find out what services and equipment they will cover.

While you are in the water:

  • If you have a home water birth, drink enough water during labor to stay hydrated.
  • Make sure the water is always comfortably warm.
  • Low lighting and soft music in the room helps you relax.
  • Don't bring any electrical items in the water.
  • Make yourself as comfortable as possible and move around when you need to.
  • Choose to float on your back or your tummy. An inflatable pillow can help support you.
  • Don't get out of the tub/birthing pool by yourself while you are in labor to prevent falls.

Note that, although at home you can get in the pool when you want to, at a hospital you may have to wait until you are 5 cm and in active labor. There is a chance that your labor might slow down if you get in too soon.

Scientific Studies

There are no reliable studies showing that water labor and birth lead to benefits for mother or baby except for relief of pain and anxiety during labor.

Pain Management

Women who labor in water appear to experience less pain than women in a traditional labor bed.

The journal, Research in Nursing Health, February 2001, published a study on pain relief. In addition, Cochrane Database of Systematic Reviews, April 2009 reported a review of 11 studies on water labor and births.

These studies found a significant reduction in pain for women who labored in water compared with those who didn't. There was also less need for anesthesia, such as an epidural.

Maternal and Newborn Outcomes

There are no well-designed studies that clearly show better outcomes for mothers or babies from a water labor and birth.

The Cochrane database 2009 review cited above and an earlier study of 274 women published in the journal Birth, June 2001 found no difference for maternal and newborn outcomes for the following:

  • Duration of labor
  • Need for induction or augmentation of labor
  • Assisted (forceps or vacuum) vaginal delivery
  • Cesarean section rate
  • Perineal tears
  • Postpartum recovery of mother
  • Maternal infection
  • Newborn Apgar scores
  • Fetal distress during labor; but more babies who were born under water had to be resuscitated than those who were not
  • Newborn admission to the neonatal intensive care unit (NICU)

Another review article published in the Journal of Obstetric, Gynecologic, and Neonatal Nursing in September 2013, concluded that there was "minimal benefit of underwater birth to the mother and no benefit to the infant."

Safety

There are not enough studies to prove the safety of water labor and birth, particularly to babies. While the limited studies and reviews revealed minimal risks, there have been reports of newborn injuries.

The American Journal of Obstetrics and Gynecology, May 2004, published a review of 16 articles on complications of water birth. They found the following severe, though uncommon, newborn outcomes after underwater birth:

  • Neonatal pneumonia from infection
  • Neonatal drowning and near drowning
  • Low blood sodium
  • Rupture of the umbilical cord causing newborn blood loss, low oxygen, brain injury, and death

Professional Society Opinions

The American College of Nurse Midwives (ACNM) endorses and actively promotes water labor and birth as safe and beneficial for women and babies. On the other hand, the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) do not completely endorse it because of the lack of sufficient data.

ACOG and AAP issued a joint Committee Opinion in the journal, Obstetrics and Gynecology, in April 2004 on immersion labor and birth. They endorsed water immersion for the first stage of labor as beneficial for pain relief. However, because of the lack of reliable data, they considered underwater birth to be "experimental" because of concerns for newborn safety.

In the UK, the Royal College of Obstetricians and Gynaecologists (RCOG) and the Royal College of Midwives (RCM) issued a issued a joint statement in 2006 endorsing water immersion labor and birth for healthy women with uncomplicated pregnancies.

Safety First

Giving birth in water can be more relaxing and less painful than an out-of-water labor and delivery. While these benefits are important, the safety of you and your baby come first. Talk to your healthcare provider about the risks and your contraindications.

If you chose a water labor and birth make sure that precautions and procedures are in place and are carefully followed. This will ensure that you have a safe labor and that giving birth in water doesn't cause injuries to your baby.

Giving Birth in Water