We connected to two certified nurse midwives to answer all your questions about water births, including benefits, risks, and how to have a successful and safe delivery in the water.
How Water Births Work
Most of us think of water births as happening only during a home birth, but these days, you can have a water birth in various settings, including birthing centers and even some hospitals, explains Stephanie Crowell, a certified nurse midwife at Ascension St Vincent Hospital in Carmel, Indiana. Wherever you deliver, you should pick a midwife or doctor who is specifically experienced in all the ins and outs of giving birth in the water, Crowell recommends. In a general sense, the process of giving birth in the water is the same as other types of birth, says Jennifer Vanderlaan, PhD, MPH, CNM, FNP, a certified nurse midwife and family nurse practitioner. Your birth attendant will follow the same care standards during your labor, such as listening to your baby’s heart tones and monitoring the progress of your birth, says Dr. Vanderlaan. There may be differences in equipment, though, as your doctor or midwife will need to ensure that the equipment is safe to use in the water, she explains. Water birth usually is defined as when you actually birth your baby in the water. But some parents use water immersion during labor only, and then give birth in more traditional locations, such as in bed, says Crowell. “Many birthing people use hydrotherapy during labor to help them cope, but get out of the tub before the baby is born,” Crowell explains. “This is different from a water birth, which actually takes place in the water.” When birthing folks deliver in the water, they often choose to get into the tub during active labor or the transition phase of labor, when the pain is most intense, Crowell explains. “They stay in the tub until after the baby is born and then are assisted out either before or after the placenta is delivered,” she describes.
What Are the Benefits of a Water Birth?
There are many benefits to giving birth in water. Dr. Vanderlaan is a co-author of a 2022 systematic review and meta-analysis on water birth published in BMJ Open. She and her team combed through 36 studies about water birth spanning and found, overall, water births are safe and that have numerous benefits for birthing people and their babies. Dr. Vanderlaan says that the most commonly cited benefit of water birth is pain relief. But her study found other positives as well, including less labor induction and fewer episiotomies. “Our most recent meta-analysis found reduced odds of augmentation in labor, reduced odds of a maternal infection, and reduced odds of a postpartum hemorrhage,” she said. “We also found an increased odds of an intact perineum, which appears to be due to reduced use of episiotomy." Finally, Dr. Vanderlaan and her team found increased satisfaction among people who had water births. There isn’t a lot of research regarding the benefits of water birth for infants. But according to a 2014 statement from the American Association of Birth Centers (AABC), data collected between 2007-2010 found that water birth resulted in fewer newborn hospital transfers following birth as compared to non-water births. Additionally, rates of adverse newborn outcomes—such as low APGAR score, respiratory distress, infection, and NICU transfers—were 1% lower in water birth babies than in babies born “on land.”
What Are the Risks of a Water Birth?
Unfortunately, there aren’t many studies about the risks associated with water births, says Crowell, and the research available is based on case studies, which only look at isolated incidents of poor results following a water birth. “We need more conclusive studies and evidence to help parents make a better-informed decision,” she explains. For example, there are a few case studies of babies experiencing infections following water births. In 2014, the CDC shared the case of a baby who died from legionellosis following a water birth. The CDC’s assessment was that better sanitizing practices of birthing pools can prevent tragic incidents such as this one. Crowell agrees that the risk of babies getting infections from water births is greatly reduced by proper sanitation practices. “There have also been questions about the risks of infection to the mother and newborn after birth,” she says. “There are things you can do to reduce this risk by using clean supplies and water and having the ability to disinfect materials after use.” According to Dr. Vanderlaan’s research, infants do have an increased risk of infection during water births. Additionally, there is an increased risk of cord avulsion, she says, which is when the umbilical cord disconnects from the placenta. But parents and providers are not powerless here. “Both of these risks are managed by following standard protocols and ensuring proper training of the birth attendants,” Dr. Vanderlaan says.
How Do I Know if a Water Birth Is Right for Me?
Water birth is a good option for you if you are looking for a natural method of pain relief, and the idea of using water to help with contractions and pushing sounds appealing to you. “The main draw of a water birth is that it provides pain relief plus a reduction in stress and anxiety during labor,” says Dr. Vanderlaan. Water birth is not a good option for someone who thinks they might want to have an epidural during childbirth, because you can’t immerse yourself in water if you have an epidural. “Epidurals reduce your mobility and you need to be able to get in and out of the tub without assistance to have a water birth,” Dr. Vanderlaan adds. Another thing to keep in mind is that water births are only for people who are having a low-risk pregnancy. Some factors that may exclude a person from having a water birth include complications like poorly controlled gestational diabetes, preeclampsia, gestational hypertension, being pregnant with multiples, preterm labor, or fetal abnormalities, says Crowell.
Preparing for a Water Birth
The first step in preparing for a water birth is to find both a provider who performs water births and a facility for delivery. “Water births can happen in hospitals, birth centers, or homes,” Dr. Vanderlaan says. You can start by searching for water birth services on the internet. “If you are not finding the information you need, widen your search to look for birth centers and midwives who can connect you to the right services in your community,” she advises. Crowell emphasizes the need to seek doctors or midwives with specific water birth experiences. “A water birth should only be done by a trained professional who is familiar with the possible risks, and who has the appropriate equipment and sterilizing/sanitizing procedures in place,” she says. And what do those cleaning and sanitizing protocols look like? “Many home birth midwives have portable tubs with strong liners to help keep their tubs clean,” Crowell says. Hospitals that perform water births will usually have written guidelines for how water birth tubs should be sanitized after each use, Crowell explains. If you are having a water birth at home or at a freestanding birth facility, you may need to purchase certain equipment, says Dr. Vanderlaan. “What a family may need to purchase will depend on the midwife and birth location—there is no standard list,” she says. For most hospitals and birthing centers that do water births, you will not have to purchase anything in advance.
A Word From Verywell
Choosing how and where to give birth is a deeply personal decision—and one that may change given how your pregnancy or labor progresses. There are no right or wrong answers here: every birthing person should feel empowered to choose a birthing experience that’s right for them. If you have any further questions, definitely reach out to a midwife or doctor who has experience with water birth.
