If you’re pregnant and haven’t decided how or where to give birth yet, you have options. Maybe you’ve been envisioning one of those deluxe birthing suites at a hospital or birthing center where labor, delivery, and recovery happen all in one place, or you’re more about spending a private moment with your family as baby arrives quietly in your own home. Will you want an epidural or want to go without? Access to a full medical team or a midwife? Or what about giving birth … underwater?
First things first, you’ll want to pick who will deliver your baby: an obstetrician, a family practitioner, or a midwife. An ob-gyn specializes in the care of birth and delivery, while a family practitioner has completed schooling and training in various medical fields and can handle low-risk pregnancies and deliveries in a hospital. Midwives have degrees in nursing and offer deliveries with little medical intervention in homes, birthing centers, or hospitals.
Next, you’ll want to choose where to deliver. Ob-gyn and family practitioners typically deliver in hospitals, while midwives have a bit more flexibility. A birthing center has fewer restrictions in terms of decisions made around a labor, while the home is where women have been giving birth for centuries.
While home births are recommended for low-risk pregnancies only, one of the more popular — and most controversial — delivery methods you may find in either a home birth or birthing center are water births. An increasing amount of hospitals also are beginning to offer water births as a delivery option.
So, are they safe? Let’s go over the benefits, risks, outcomes and history of water births to see if one may be right for you and your baby.
The History of Water Births
Before getting into the history of the water birth debate, we should define a water birth. Water birth, simply put, is the process of giving birth in a tub of water. Many women choose this method because they subscribe to the theory that since baby has been in the amniotic fluid sac for nine months, a birth in a similar environment will be less stressful for both baby and mother.
Some women choose to labor in the water and get out for delivery, while others stay in the water for both.
Water births have been hot in the labor and delivery scene for 30 years or so, but only reviewed and written about more frequently in the last 15 years. Still, not many studies or statistics exist to tip either side as more favorable than the other.
According to an article published in the Journal of Perinatal Education in 2014, titled “Birth, Bath, and Beyond: The Science and Safety of Water Immersion During Labor and Birth,” water births have both been objected to by major pediatric organizations but also found safe by others, including midwives, obstetricians, and pediatricians.
The most recent objection in 2014 by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists on immersion in water during labor and birth argued that while it may be associated with decreased pain or labor duration during the first stage of labor, there are no known benefits to either mother or baby during the second stage of labor and a water birth could even cause serious harm. Particularly, baby might not be able to breathe underwater, can have trouble regulating his or her temperature, or water can enter the mother’s blood stream.
The American Academy of Pediatrics first warned about the dangers of water births in 2002 as being a “near drowning experience,” while the Committee on Fetus and Newborn also published a negative opinion on the method in 2005 based on that report.
However, more evidence has surfaced on the safety and efficacy of labor and birth in water.
The Benefits of Water Births
There are several benefits associated with water births, and they’re among the reasons many women are choosing this route for labor and/or delivery. They include:
- Reduced stress, anxiety and pain. Warm water also has been shown to increase a woman’s energy and focus during the later stages of labor, according to the American Pregnancy Association.
- You may be in labor for a shorter period of time. A review of 1,600 water births by a group of ob-gyns in Italy showed the duration of the first stage of labor was significantly shorter with a water birth than with a land delivery — about 88 minutes less. Babies are at the highest risk of injury if labor is long or difficult.
- The buoyancy of a water birth decreases a woman’s body weight, so she can move more freely and reposition herself as necessary. It also promotes more efficient uterine contractions and blood circulation, which results in less pain and more oxygen for the baby.
- Water causes the perineum to become more elastic and relaxed, therefore reducing the severity of tearing.
- The rate of neonatal infection isn’t any greater than it is during a traditional birth.
Additionally, the water provides an environment similar to the amniotic sac for baby, so it eases the stress of birth and increases a sense of security. Overall, that same study of 1,600 water births concluded that if the right women are selected for water birth — there are some cases where risks increase — and hygiene rules are followed, it appears to be a safe option for both mother and baby.
The Risks of Water Births
Less pain during labor? Where do we sign up?
While all those benefits sound immense, there are some risks associated with water births, though few studies have been done to fully research them. It’s possible that water aspiration can occur if the baby is stressed and gasps for air underwater. However, this would be rare, as babies don’t typically take their first breath until they are exposed to air. They continue to receive oxygen through the umbilical cord until they start to breathe on their own or the cord is cut — although the cord could snap as the baby is brought to the surface.
Other studies have argued about water embolism, where water enters a mother’s blood stream. This is a theoretical risk only when the placenta is delivered underwater. Many women will leave the water for the third stage of labor to prevent this. As more bleeding may happen in warm water and the water itself dilutes the amount of blood in the pool, it’s important to monitor blood loss with water births.
Some situations where water births are not ideal include:
- If the mother has herpes, as that transfers easily in water.
- If mother has been diagnosed with excessive bleeding or maternal infection.
- If mother has preeclampsia or toxemia.
- If baby is breech or there are multiple births. Both should be discussed with your health care provider.
- If baby is pre-term (two weeks or more prior to due date).
- If there is severe meconium (early stools from baby), though if the water is stained and birth is imminent, mother can lift her pelvis out of the water to deliver baby.
How to Have a Successful Water Birth
If you’ve read up on all the risks and benefits and have decided a water birth is the best fit for you and your family, the first step is to clear it with your doctor or midwife. Next is to prepare for birth.
Dehyrdration and overheating can be a risk to you and baby, so be sure to keep your tub at 97 degrees Fahrenheit. Birthing pools make this a lot easier to manage, so check with your health care provider to see if they are already equipped with this special tub.
You can also rent a “birth pool in a box” from various online suppliers, and they can include everything from the basic pool itself and a liner (for about $99 to start), along with a water pump, air pump, thermometer, tarp, return label with instructions, and more (about $300 for the whole kit). Some companies will set up your birthing pool for you, while your insurance company may even reimburse you for the rental.
If you plan to give birth at a hospital, make sure to check their policy on water births ahead of time. Local birth centers also may offer water birth options.
Welcoming a baby into the world is a beautiful but scary thing. Whatever birthing option you choose, we’re right here with you along the way, with more resources on how to make a birth plan, the stages of pregnancy, and your after-birth care guide.