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Is water birthing a safe alternative?

By Stacy Taylor

 Date: 10/14/2006


Introduction: What is Water Birthing?


Water birthing is a method of giving birth where the mother delivers her child in a bathtub or basin full of warm water. The first recorded account of an underwater birth was in 1805 in France.  The woman was reported to be exhausted after 48 hours of labor.  After being placed in a tub of water, she was revived and was able to give birth to a healthy infant.  Since that event, water birth has been promoted as a natural and safe method of pain relief and relaxation during labor. []



Who uses it?


Water birth is a leading alternative to the conventional bed delivery practiced by most U.S. hospitals.  The exact number of water births is unknown because of a lack of literature and record of the manner of births.  It is know that as of 2001, at least 143 hospitals in the United States were providing water births as a delivery option. [3]  Since 1984 Waterbirth International has been keeping their own record of water births which, as of last year, topped 2300. []


There are many reasons why women choose home birth by water.  Many women consider conception, pregnancy, and labor to be very personal and natural processes that do not need intervention from medical monitoring or analgesics.  Women can feel alienated at a hospital by the lack of personal attention or by other birthing mothers in their ward.  Many women find it distracting to be in a new place, with bright florescent lights, and a stream of unfamiliar faces.  Any of these anxieties could raise the stress level in the mother and in turn greatly increase the perception of pain. []


Birthing pools can be rented or bought for your home or used in hospitals for assisted care.  They are usually just big enough for one to two people and are usually heated.  It is the heat of the pool that contains most of the claimed effects of relaxation and calming.  These pools can either be still or jet powered like a spa.  (




The complications and illnesses that are not recommended for water birthing even by the pro-water birthing community include:




What is the public saying?


There are articles supporting water birth published in health magazines and websites such as Discovery Health [] as well as advice columns like Andrea’s Diary [].  Water birthing gets a lot of positive attention from reputable and highly educational sources.  It is not easy to deny that a tub of warm water soothes muscles and anxiety.  Many people enjoy a long bath after work or a dip in the jacuzzi.  It is the safety of this procedure that is under speculation.  Personal testimonials supporting this method are most often found on websites trying to sell birthing pools and therefore should be validated.  Websites like Gentlewater [] offer an extremely positive yet one-sided perspective on water birthing, which is followed by a ploy to sell birthing tubs.


The American Academy of Pediatrics has published articles which represent a much more critical view of water birthing.  The article Underwater Birth: Missing the Evidence or Missing the Point [] asks the public to apply more scrutiny to the medical practices that affect their family’s health. The article sites several cases of neonate complications probably related to the choice of birth.  The lack of a clear history of documented scientific support for water birthing is enough to make many people wary of this procedure.  Many others feel that a lack of evidence against the procedure speaks just as loudly as the presence of evidence in support of it.


What are scientists showing?


One of the most recent and helpful studies of water births was presented in The Journal of Meternal-Fetal and Neonatal Medicine [] titled “Review of 1600 water births. Does water birth increase the risk of neonatal infection?”  This study reviewed 1600 water births at a single institution for about 8 years.  They compared 737 primiparae (first-time mothers) deliveries in water with 407 primiparae deliveries in bed, and 142 primiparae on the delivery stool.  They evaluated the duration of labor, the amount of perineal trauma, the arterial cord blood pH, postpartum maternal hemoglobin levels, and the rates of neonatal infection.  The following results were recorded:








(n= 737)

(n= 407)

(n= 142)


First phase (min)





Expulsion (min)





Cord blood pH





Base Excess meq/l





Episiotomy rate

0.68% (5)

23.3% (95)

8.4% (12)


Grade I lacerations

23.7% (175)

22.3% (91)

23% (33)


Grade II lacerations

11.4% (84)

11% (46)

13% (18)


Grade III lacerations

0.95% (7)

0.9% (4)

2.1% (3)


Hb (g/dl, first postp. Day)






P-value shows a significant difference if it is <0.05

n.s. = the difference is statistically not significant




The duration of the first stage of labor was significantly shorter with a water birth than with a land delivery.  The episiotomy rate in all water births was lower when compared to a bed or birthings stool delivery.  The rate of perineal tears appeared to be the same, as was the duration of the second stage, the blood pH, and the postpartum maternal hemoglobin levels.  None of the women using water birth method required any analgesics.  The rate of neonatal infection was also not increased in water birth. []



Another study about the risks of underwater birth painted a dimmer picture.  Pinnette’s review paper, The risks of Underwater Birth, performed an extensive review of literature found on the PubMed search engine, especially the literature that dealt with complications. []

16 out of the 74 relevant articles found on PubMed detailed possible complications associated with water births.  Although many websites claim that a water birth is a much more natural and calming way for a child to enter the world, this study failed to demonstrate any benefit to the neonate.  Although there were several pieces of evidence to suggest that their was a benefit in terms of pain management of the mothers during birth, there was not sufficient evidence to support the claim that water reduces duration of labor, use of analgesia or risk of perineal tears.  What they did find was case after case examples of the possible harmful effects of this procedure.  The most common complications included wet lung, aspiration, near drowning, cord avulsion, fetal hyperthermia, and hypoxic encephalopathy. 


They also found that there may be very specific benefits to giving birth on land.  The squeezing out of the child that occurs with a greater pressure in the air births, has been attributed to greatly helping to clear lung fluid.  Children delivered by water or cesarean often have delayed lung fluid clearance. [13] The study was concluded by stating, “There is a lack of evidence to suggest a benefit of underwater birth and mounting evidence to suggest occasional poor outcomes that might be attributable to the procedure. The reports of hyponatremic seizures, drowning, waterborne infections, the potential of delivering an unexpectedly compromised fetus in a difficult to resuscitate environment, potential for fetal hemorrhage from snapped umbilical cords, risk of delayed delivery in cases of fetal asphyxia, risk of shoulder dystocia, and injury to health care workers moving patients in and out of the tub are complications that may be possibly attributed to underwater births.” []


Several other study abstracts


 “Experience of pain and analgesia with water and land births”




 “Waterbirths compared with landbirths: an observational study of nine years.”



 “Clinical condition of newborns from water birth at the Perinatology Clinic, Institute Of Gynecology and Obstetrics of the Medical University in Lodz, in the years 1996-2001”



 “Effects of water birth on maternal and neonatal outcomes.”








Water birthing is without a doubt rising in popularity to one of the most popular worldwide alternatives to traditional practices.  Although there are records of water births dating back to the early 19th century, there is still a surprising lack of conclusive data on the safety of the procedure.  One of the main reasons for this lack of information is the inherent danger of childbirth.  Scientists have to ask themselves, Is it truly ethical to perform controlled trials of waterbirthing versus bed births?   Nevertheless there is still informative scientific information available that supports water birthing’s ability to relax the nerves, calm and sooth the mother, possibly shorten labor time and reduce episiotomies.  The evidence also shows that whether the mother chooses land or water, there is not a significant difference in the rate hemorrhage, lacerations, or neonatal mortality.  There are, however, a number of mysterious complications that have been known to arise from water births, but overall, there is currently not enough information for most hospitals and medical authorities to endorse water birthing as being as safe as traditional hospital deliveries.  For every horror story of an at home birth there is another glowing testimonial of the natural wonders of birthing in water.  Is water birthing safe? It is up to each individual mother to make that decision, because as for now, medical science is simply not ready to give a conclusive answer. 





Works Cited






  1. Harper B. Waterbirth. Midwifery Today Conference, Eugene, OR. March 22–26, 2001.




















  1. A.W. Boon, A.D. Milner and I.E. Hopkin, Lung volume and lung mechanics in babies born vaginally. J Pediatr 98 (1981), pp. 812–815






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