Although the first documented case of water birth happened over 200 years ago in France, water births – in which women intentionally deliver underwater – are still pretty rare in hospitals in the United States. In fact, according to the Journal of Midwifery & Women’s Health, as of 2009 only 229 hospitals across the country actually offer this option.
Why, you may wonder? Not enough evidence regarding its safety. In the spring of 2014, The American College of Obstetricians and Gynecologists and the American Academy of Pediatrics issued a joint statement advising against water births because of this lack of data. The statement recommended that water births should only be performed in a research setting making it difficult for smaller hospitals to offer this option.
Considering a water birth? We spoke to Joanne Motiño Bailey, CMN, Ph.D., the director of Nurse-Midwifery at the University of Michigan Von Voigtlander Women’s Hospital – where water births make up 10-15 percent of vaginal deliveries.
What is water birth?
There are two types of water birthing options to consider, says Bailey. First, there is laboring in water, in which women immerse themselves in warm water during labor. In this birthing option, women give birth on land. At the Von Voigtlander Women’s Hospital birthing center, where eight rooms are equipped with birthing tubs, Bailey says “well over half of the woman we care for here will use warm water immersion for some part of their labor.”
The second – and the more controversial sister of the two – is a water birth, which is defined as the act of intentionally delivering your baby beneath the water.
Natural pain relief
In 2009, the Cochrane Review published its results on a 12 trial (3,243 women) study on water immersion during labor and birth. The results of the study noted that water immersion during labor “reduced epidural/spinal analgesia requirements, without adversely affecting labor duration, operative delivery rates, or neonatal wellbeing.”
To combat the pain of contractions, Bailey says women immerse in the warm water to aid in relaxation. “When we think about pain labor,” says Bailey, “there is the bare bone sensation of the uterus contracting but then there is a whole bunch of other things overlaid on top of that.” Things like surrounding muscle tension and the anxiety of the experience.
It is suggested that immersing in the warm water helps these muscles – and the mother – relax. Also, Bailey adds, “it’s the buoyancy, the feeling of lightness,” which she says helps to ease mobility allowing the mother to more freely change to a more comfortable position. The possible benefits don’t end there either. Decreased stress levels, less use of medications, greater sense of control and high patient satisfaction with the birth experience are among the other potential perks offered by laboring in water.
For Dr. Mark Werner at the Karmanos Center for Natural Birth at Beaumont Hospital in Royal Oak, there is also “the satisfaction of doing something in a natural way without any anesthesia.” And he adds, “possibly a faster delivery because the mother is more relaxed.” While the Karmanos Center for Natural Birth does not offer water births, mothers do have the option of using large hydrotherapy tubs during labor.
Any benefits to baby?
While some may argue that a water birth provides a gentler entrance for the baby, Bailey states, “there are no documented benefits to baby.”
“At the University of Michigan, we track our data and have actually looked at the last 15 years of water births and compared them to similar women having land births,” Bailey says. “And when we compared those two groups, there was essentially no difference in the mother’s health or baby’s health.”
It’s not for everyone
Candidates for water births and water labor need to be generally low risk with minimal medical issues. Some of the characteristics considered for eligibility at the Von Voigtlander Women’s Hospital birthing center include singleton pregnancy, gestational age of 37 weeks or more, maternal and fetal status within normal limits, no signs of infections, have a BMI of less than 40, and no signs of a potentially challenging birth (i.e. history of large babies or shoulder dystocia).
“The biggest thing is that if we ask you to get out of the tub, you need to get out of the tub,” says Bailey. Adding, “you can’t have any pain medications… you can’t be in the tub with an epidural or receiving pain medications that would change your alertness,” says Bailey.
The controversial concerns
“There are some very unique and very rare complications that have been documented in the literature and women choosing water births should be informed,” says Bailey. “The two concerns are the baby breathing in water that had an infection and then got a very serious life threatening infection. And then the potential of the baby to breathe in water, and essentially risk drowning.”
“The argument is that a healthy baby doesn’t take its first breath until the baby hits air,” adds Bailey.
According to a statement in the Journal of Midwifery & Women’s Health, “provided that the neonate [infant] is promptly brought to the surface, it is thought that the diving reflex, which mechanically blocks the airway of submerged infants (although not older children or adults), will prevent the newborn from aspirating the water.”
“We have had none of those documented cases of drowning or near drowning experiences,” says Bailey. “None of that has happened for us.”
For Werner, “if a baby swallows water, it could theoretically drown and because of that we recommend laboring in the bed. We labor for as long as possible in the water, but when the mother is ready to deliver, we deliver in the bed.”
Some of the other potential concerns that Bailey indicated included a higher risk of infection for baby and mother, possible thermoregulatory changes in the fetus, and cord avulsion requiring a transfusion.
If you’re considering a water birth, make sure to speak with your medical provider regarding all risks associated with such a delivery.
This post was originally published in 2016 and is updated regularly.