Planning a Water Birth: Key Considerations for Mom and Baby

A water birth can lead to a beautiful birth experience, but is it safe? As with any birth decision, it is critical to be fully informed about the risks and benefits and to consult your healthcare provider for the best decision for you. Read on to learn about water birth, safety considerations, and how to make the best decision for your delivery.

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Water birth

As the name suggests, water birth involves giving birth surrounded by water. While there are historical accounts of water birth, and laboring in water is established in Western cultures, pushing and giving birth in water still raises questions.

Benefits of water birth

Water birth offers many potential benefits compared to traditional birth.

We spoke with Dr. Tiffany L. Stensvad, Certified Nurse Midwife and Doctor of Nursing Practice to find out more, “Water during labor and delivery is a great potential pain management option. Everyone experiences pain differently, but research shows it makes a difference,” says Dr Stensvad.

Some benefits of water birth vs. traditional birth include:

  • Less pain. If you have ever climbed into a warm tub to ease menstrual cramps, you know how relaxing it can be. Soothing warmth can reduce the perception of painful contractions.
  • Easier movement. Because of water’s buoyancy, it is easier for a laboring mother to move than in traditional birth. This can help with pain control and the baby’s position.
  • Faster labor progress. Reports describe mothers delivering their babies within an hour or two of climbing into warm water, potentially due to relaxation and better positioning.
  • Feelings of well-being. Mothers report a birth experience with less anxiety and more feelings of empowerment in water.
  • Less perineal tearing. Water can help your perineum stretch gently and may reduce tearing.
  • Bonding. After a water birth, skin-to-skin contact happens naturally, helping you and your baby bond.
  • Fewer medical interventions. Water birth leads to less epidural anesthesia, synthetic oxytocin, vacuum or forceps instrument use, and fewer C-sections.

Risks with water birth

Birth is a complex process, and problems can arise due to many factors. In general, studies do not find higher rates of most complications with water birth vs. traditional birth in a bed.

“Water birth has been used for many years. If protocols and guidelines are followed for low-risk women and babies and you have trained providers, the risks are low,” says Dr. Stensvad.

However, even though water birth does not have a higher rate of many complications in studies, there are individual reports of babies with health problems that could have been due to being born in water.

Possible complications include:

  • Umbilical cord tearing. Your baby can get tangled in the umbilical cord when they are born into an open pool of water. One study found a higher rate of umbilical cord tears in water births, potentially because the baby was pulled out of the water too quickly without checking for a tangled cord.
  • Infection. There have been several reports of serious infections after water birth, usually if equipment was not properly sanitized or if water supplies were contaminated. “Infection is a risk if sanitation guidelines are not followed, but if they are followed, there is no increased infection risk,” says Dr. Stensvad.
  • Temperature regulation. Your baby can become cold after birth if the water temperature is not monitored appropriately. If the water is too hot during labor, it can increase the mother’s internal temperature and cause the baby’s heart rate to increase.
  • Drowning risk. It is unlikely that your baby will try to breathe before their face is out of the water. However, there have been rare cases where babies have inhaled water during a water birth.
  • Microbiome changes. One study found changes in the bacteria in babies' mouths and ears after being born in water. Water birth may interfere with a healthy microbiome.
  • Perineal tearing. Some studies show more perineal tears with water birth. However, rates of episiotomy — a cut placed in your perineum to avoid tearing — are much lower.

As with any birth, the risk is not the same for everyone. Your health and risks with your pregnancy have an impact, too.

Safety measures for water birth

Your healthcare provider can minimize risks through safety procedures.

Dr. Stensvad says, “To keep your baby safe, the water temperature must be monitored. Their face should be lifted from the water after birth for the first breath and never re-submerged. If safety guidelines are followed there are no further research-based risks.”

Make a plan with your healthcare provider for:

  • Temperature control. Keep the water at a comfortable temperature between 92ºF and 101ºF (33.3–38.3ºC).
  • Fetal monitoring. Your healthcare provider should monitor your baby’s status frequently and intervene if there are signs of distress.
  • Vital signs. Your healthcare provider should monitor your vital signs and may have you leave the water if you have low blood pressure, a fever, or a fast heart rate. All of these can affect your baby.
  • Infection prevention. It's recommended to fill the pool with fresh water, regularly replacing it for sanitation purposes. The tub should be disinfected thoroughly. A hot tub may not be safe since internal tubing and pipes cannot be disinfected adequately.
  • Considering different sources of infection. Ask if your birthing place has its water cultured regularly to check for bacterial contamination. To avoid bacterial growth, do not preheat your water, such as in a tub or a heating system.

You should also avoid water birth if you have had a recent diarrheal illness or infection, which could contaminate the water. Ask your healthcare provider if you are group beta strep (GBS) positive. Water birth may not increase the risk of giving this bacteria to your baby, but the evidence is not clear.

Mom's safety for the water births

With water birth, infection is a risk for the mother, too. The measures you take to protect your baby will protect you. Your healthcare provider should monitor you for signs of infection and intervene promptly if you develop a fever, low blood pressure, or fast heart rate.

People who give birth in water are much less likely to have medical interventions such as an episiotomy, but more likely to have a perineal tear. To minimize your risk of a tear, your healthcare provider can stretch your perineum gently and help your baby's head emerge slowly.

What do experts recommend?

Studies show the benefits of water birth; however, some case studies report babies who had complications that could have been due to water births. There is limited research, and studies have not been large enough to show its effect on the rates of rare complications.

🩺 American College of Gynecologists suggests: that only women at term — between 37 weeks and 41 weeks, six days with uncomplicated pregnancies — labor in the water.

Experts do not recommend birth in water until there is more research to support its safety. Other professional organizations have not released statements about water birth.

Have an open discussion with your healthcare provider about the best path for you and your baby. Your baby’s safety should always come first. If you decide to proceed with a water birth, make sure your attendants have proper training and a safety plan based on evidence so that you and your baby can have the best birth experience.


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