Water Births Not Safe Enough to Recommend, Say Pediatric Experts

Natural birth advocates claim that using water as part of labor and delivery, in a tub or hot tub, can relieve and even shorten labor symptoms, and that it’s good for the baby. Water births became popular in the 1990s, according to a European study.

But a new report in the journal Pediatrics looks into whether these claims have any validity. The American Academy of Pediatrics (AAP) Committee on Fetus and Newborn and the American College of Obstetricians and Gynecologists (ACOG) Committee on Obstetric Practice examined the available data on water births, distinguishing between early and late stage labor.

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In the first stages of labor, immersion in water can help mothers feel more relaxed and in control of the process, and was associated with less use of epidurals and other forms of anesthesia, and a shorter labor. But water wasn’t associated with any significant drop in perineal trauma or tears, or a drop in the need for assisted vaginal deliveries or Cesarean sections. Giving birth underwater was correlated with some risks as well, such as infections in both mom and infant, problems with the infant’s ability to regulate body temperature, and umbilical cord ruptures, which can lead to hemorrhaging and shock.

Statistics on how many women in the U.S. choose to use water immersion aren’t available yet, since the practice isn’t measured as part of routine birth statistics, but home births are on the rise. The data follow recent studies on alternative birthing practices that show midwife-assisted home births can be more deadly than midwife-assisted hospital births, and led the AAP and ACOG to recommend delivering in a hospital birthing center. If women want to deliver at home, the groups encouraged them to seek midwives certified by the American Midwifery Certification Board.

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Now the committees conclude that giving birth underwater should be considered an experimental procedure, since the studies investigating its safety and benefits aren’t large and robust enough to sanction or dismiss the practice.

The experts also note that given the small number of studies on immersion, it’s hard to determine whether other factors related to the using water during labor and delivery are affecting the outcomes in both the first and second stages of labor, such as how often the mother is examined. They advise that expectant moms interested in using water-based methods should use it only for the early stages of delivery, and ensure that their birthing facility maintains strict protocols for keeping the tubs clean and have established programs for monitoring the labor as it progresses. Any deliveries occurring under water should be done in the context of a clinical trials in which mothers are fully informed of the potential risks and benefits.