Water Birth

What is water birth?

Water birth is the process of giving birth in a tub of warm water. Some women choose to labor in the water and get out for delivery. Other women decide to stay in the water for delivery as well. The theory behind water birth is that the baby has been in the amniotic sac for 9 months and birthing into a similar environment is gentler for the baby and less stressful for the mother. It is the belief of midwives, birthing centers and a growing number of obstetricians, that reducing the stress during labor and delivery also reduces fetal complications. Water birth should always occur under the supervision of a midwife, physician or birthing center.

What are the potential benefits of water birth observed by midwives and birthing centers?

Benefits for Mother:

  • Water is soothing, comforting, relaxing.
  • In the later stages of labor, the water seems to increase the women’s energy.
  • The buoyancy lessens her body weight, allows free movement and new positioning.
  • Buoyancy promotes more efficient uterine contractions and better blood circulation, resulting in better oxygenation of the uterine muscles, less pain for the mother, and more oxygen for the baby.
  • Immersion in water often helps lower high blood pressure caused by anxiety.
  • Water seems to alleviate stress-related hormones, allowing the mother&'s body to produce endorphins, which are pain-inhibitors.
  • Water causes the perineum to become more elastic and relaxed, which reduces the incidents and severity of tearing and the need for an episiotomy or stitches.
  • As the laboring women relaxes physically she is able to relax mentally, concentrating her efforts inward on the birth process.
  • The water provides a sense of privacy, which releases inhibitions, anxiety, and fears.

Benefits for Baby:

  • Provides a similar environment as the amniotic sac.
  • Eases the stress of the birth, providing reassurance and security.

What are the risks to the mother and baby?

Over the last 30 years as water birth has grown in popularity, there has been very little research done to determine the risks of water birth. Some studies have been done in Europe demonstrating similar perinatal mortality rates between water births and conventional births.1 According to an article by the Royal College of Obstetrician and Gynecologists, there may be a theoretical risk of water embolism, which is when water enters the mother’s blood stream.2 Though the British Medical Journal is 95% confident in water births, they do see a possible risk for water aspiration. If the baby is experiencing stress in the birth canal or the umbilical cord becomes kinked or twisted, the baby may gasp for air, possibly inhaling water into the lungs.3 This would be rare, as babies do not inhale air until they are exposed to air. They receive oxygen through the umbilical cord until they start to breathe on their own or until the cord is cut. The final potential risk to consider is that the umbilical cord could snap as the baby is brought to the surface of the water. This is preventable by recognizing the possibility of a short umbilical cord and using caution when lifting the baby up to the mother’s chest.

What situations are not ideal for water birth?

  • If you have Herpes: Herpes transfers easily in water, so you will want to discuss this thoroughly with your caregiver.
  • If you tend to be inflexible: Every birth is different, so you will need to be flexible and realize that your desire for water birth may not become a reality.
  • If your baby is breech: Though water birth has been done with bottom or feet first presentations you will want to discuss this thoroughly with your caregiver.
  • If you have been diagnosed with one of the following: excessive bleeding, maternal infection, and multiple births.
  • If you are having multiples: Though water births have been successful with twins around the world, you will want to discuss this thoroughly with your physician or caregiver.
  • If preterm labor is predicted: If a baby is pre-term, indicating two weeks prior to scheduled due date, waterbirth is not recommended.
  • If there is severe meconium: Mild to moderate meconium is fairly normal. Since meconium floats to the surface in a tub, your caregivers will watch for it and remove it immediately, or help you out of the tub. Meconium usually washes off the face of the baby and even comes out of the nose and mouth while the baby is still under water. If the water is stained and birth is imminent, the woman can lift her pelvis out of the water to birth the infant.
  • If the baby has Shoulder Dystocia: Some find it is easier to assist a shoulder dystocia in the water. It is believed that tight shoulders happen more often because of mom or caregiver trying to push before the baby fully rotates. Better to wait a few contractions and allow baby to rotate. Because position changes in water are so much easier, a quick switch to hands and knees or even standing up with one foot on the edge of the pool helps to maneuver baby out.
  • If you have toxemia: You will want to thoroughly discuss this with your physician or caregiver.

I thought hot tubs and whirlpools could be dangerous during pregnancy?

Yes, that's true, but it's all about the temperature. If water is too hot, dehydration and overheating become risks to you and the baby. You will want to be sure to stay well hydrated and make sure the temperature of water stays at 97 degrees Fahrenheit. Birthing pools are specifically made with this precaution in mind.

How do I prepare for a water birth?

Check first with your hospital or midwife. They may already be equipped for water birth with a special tub, or know the simplest route to take in your area for setting up a water birth. If you plan to give birth at a hospital make sure their policies are water-birth friendly. More and more hospitals are welcoming parents who want to try water birth.

You may rent a birthing tub for about $350. Check online or in the phone book. Be sure to ask if fees include shipping both ways and any other extras to make your birth experience more enjoyable. Check with your insurance company to see if they will reimburse the expense of the rental.

1. Gilber RE, Tookey PA. Perinatal mortality and morbidity among babies delivered in water: national surveillance study. BMJ 1999; 319:483-7
2. LMM Duley MRCOG, Oxford. “Birth In water: RCOG Statement No. 1.” Royal College of Obstetricians and Gynecologist. January 2001.
3. “Perinatal mortality and morbidity among babies delivered in water: surveillance study and postal survey.” British Medical Journal. August 21, 1999.

Reprinted with permission from American Pregnancy Association