Everything You Need to Know About Waterbirth

Waterbirth is the act of giving birth in a pool or bath of water, but the true definition is the birth of a newborn entirely underwater. This definition differs from what most hospitals allow, which is laboring in the water. (It is common in hospitals for a birthing person to be asked to exit the water before birthing the baby.) Only 10 percent of all maternity care facilities in the United States offer water immersion for labor and childbirth. 

Most often, waterbirths take place at freestanding birth centers and home births. 

There are benefits to utilizing hydrotherapy in labor and during the birth, as well as some risks that we will discuss. Like many topics on pregnancy, childbirth, and postpartum, there is not much research on waterbirth, but here is what we know.

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A study by the Cochrane Collaboration found that water immersion during the first stage of labor was associated with a reduction of epidural/spinal analgesia and a shorter first stage of labor. They also found it associated with increased mobility, lower episiotomy rates, decreased likelihood of third and fourth-degree tears and reported increased satisfaction. In addition, other benefits have been found linked to waterbirth, such as:

  • normal vaginal birth, also known as physiological labor and delivery. Studies found that those assigned to waterbirth groups were more likely to have a normal physiological birth. In these groups, the rates of forceps and vacuum delivery went down as well as the rates of cesarean sections!
  • reduced use of epidurals and pain relief. There is a reason that laboring and birthing in the water are known as "nature's epidural" in community birth. Many studies show that birthing individuals who labor and birth in the water report less pain and anxiety and do not require pain relief such as epidural or spinal analgesia.
  • intact perineum, or lesser degree tears. These studies are a mixed bag. Many studies show that birthing parents who labor and birth in the tub are more likely to have intact or less traumatic tears. Lesser tears are first- or second-degree, rather than third- or fourth-degree ones. On the other hand, other studies show an increase in the odds of tearing from giving birth in the water. When looking at both studies together, we can see that those who give birth in the water are less likely to have severe tears, but may be more likely to have minor ones.
  • less postpartum blood loss. Most studies found that people who experienced a waterbirth were less likely to have postpartum hemorrhages than those who birthed on land.
  • increased satisfaction. Researchers found that people who had waterbirths reported a better overall experience of giving birth than those on land. For example, 72.3 percent of people who had waterbirths said they would choose that method again, compared to 8.7 percent of those who had land births.
The long list of benefits makes waterbirth an attractive option for those seeking fewer interventions and a more hands-off experience. But what are the risks, and why do hospitals continue to have policies that do not support waterbirth?

When looking at risk factors, the most considerable risk that people worry about is neonatal mortality. However, when researching waterbirth, they found no increase in neonatal mortality after waterbirth, compared to land birth. Alongside this finding, APGAR scores were compared to newborns born on land. APGAR scoring is a way to quickly check a newborn baby's health. The APGAR score is given at one and five minutes and ranges from 0-10. APGAR scores higher than seven are considered normal. Similarly to the statistics for neonatal mortality rates, no evidence supports lower APGAR scores for waterbirths vs. land births.

The research also indicates that there are no differences in newborn breathing difficulties. 

There are also fewer reported transfers to the hospital, fewer NICU stays for the baby, and no difference in shoulder dystocia, newborn infections, the need for newborn resuscitation, newborn hypothermia, and the newborn microbiome. 

So, what risks did the researchers find? There was a possible increase in umbilical cord snaps and higher rates of water aspiration. Umbilical cord snaps occur when the umbilical cord is pulled too taut too quickly, separating the newborn from the placenta that is usually still inside the parent. Umbilical tearing can be avoided by keeping an eye on the length of the umbilical cord and slowly bringing the baby out of the water and to the birthing person's chest, rather than doing so abruptly. For example, if the umbilical cord is too short for the baby to be brought to the birthing person’s chest and the water is too high for the newborn to be brought to the birthing person’s belly, then a transition out of the birthing pool would be necessary to avoid the umbilical cord snapping.

The other risk is that of water aspiration. Water aspiration in a waterbirth is the main reason most hospitals do not allow water immersion during childbirth. However, new research has emerged that states the different mechanisms to prevent a baby from inhaling and aspirating. The leading causes for water aspiration are infants not being born fully immersed in the water, or being brought out of the water and accidentally resubmerging their faces. Both reasons can be avoided by watchful care providers and through taking safety precautions. A simple safety precaution is to fill the pool to the correct levels, so that submersion of the abdomen and below is easily facilitated.

Despite the lack of strong research regarding the risks of waterbirth, it appears that it can be a good and safe option for birthing individuals who desire hydrotherapy and immersion when bringing their baby earthside. However, like any intervention in childbirth, individuals should weigh their risks and benefits to ensure that waterbirth is a good fit for them. Good luck!

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