Water birth

Water birth is childbirth that occurs in water. Proponents believe water birth results in a more relaxed, less painful experience that promotes a midwife-led model of care.[1] Critics argue that the safety of water birth has not been scientifically proven and that a wide range of adverse neonatal outcomes have been documented,[2] including increased mother or child infections and the possibility of infant drowning. A 2018 Cochrane Review of water immersion in the first stages of labor found evidence of fewer epidurals and few adverse effects but insufficient information regarding giving birth in water.[3] Parent, child, and birthing organizations have produced statements both supporting and criticizing water birthing.


A moderate to weak level of evidence indicates that water immersion during the first stage of childbirth reduces the pain of labor.[3] A 2018 Cochrane Review found that immersion during the first stage of childbirth reduces the use of epidurals, however there is no clear evidence on the benefits of water immersion for the second stage of labor or full water birth.[3] There is no evidence of increased adverse effects for immersion during the first or second stages of labor.[3] There is not strong evidence that a water birth reduces tearing or perineal trauma.[3]

Water birth may offer perineal support for a birthing mother, and some theorize that this may decrease the risk of tearing and reduce the use of episiotomy.[4]

A 2014 review reported that it has been found that water immersion during the first stage of labor can reduce the length of the first stage, reduce labor pain, and the use of epidural/spinal analgesia. It is also associated with a lower rate of cesarean delivery and stress urinary incontinence symptoms 42 days after delivery. The review reported that immersion during labor did not appear to increase the rate of infections for the mother or the baby, and APGAR scores for the baby were similar to that of conventional births. [5]

Risks and concerns

The British Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives issued a joint statement supporting water birth for healthy women with uncomplicated pregnancies but does not recommend it in cases of complications.[6]

In a 2005 commentary, the Committee on Fetus and Newborn of the American Academy of Pediatrics (AAP) released an analysis of the scientific literature regarding underwater births. The Committee noted several positive studies for underwater birth but went on to criticize them for lacking proper scientific controls, a significant number of infant deaths and diseases, and the general lack of information to support the use of water births. The paper concluded:[7]

The safety and efficacy of underwater birth for the newborn has not been established. There is no convincing evidence of benefit to the neonate but some concern for serious harm. Therefore, underwater birth should be considered an experimental procedure that should not be performed except within the context of an appropriately designed RCT after informed parental consent.

The AAP received numerous letters in response to the statement, many claiming passionately that water birth had strong benefits and minimal risks for both parents and children and criticizing the AAP for failing to publish positive studies about the practice. In response, an author of the statement noted that the claims made were unsubstantiated and based purely on anecdotal evidence, with no randomized controlled trials (RCTs) that would allow an evidence-based assessment of the safety and benefits of water births. The author concluded by urging for proponents to support such a trial so that the question could be answered. The editor of the journal Pediatrics, where the commentary was published, noted that no such trials had ever been submitted to the journal, which had a policy against publishing articles that are not based on scientific evidence. The reply concluded that "I have not received any science-based commentaries from the groups that you cite in your letter. We cannot publish every letter, based on opinions only, that we receive."[8]

Birth pool

A birth pool is a specially designed vessel containing water for women to immerse themselves in for pain relief during labour. Birth pools work on the same principle as a bathtub, but are distinct from them[9] due to buoyancy and freedom of movement, factors deemed to be important in labour.[10] A birth pool can either be permanently installed or portable. Getting into a pool of water for labour is often called water birth because some women choose to remain in the water for birth as well.

Health policy in England stipulates women should be given the opportunity to labour in water through the publication of Intrapartum care guidelines issued in 2007 by the National Institute for Health and Care Excellence (NICE). The Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives have jointly supported labour and birthing in water, and encourage hospitals to ensure birth pools are available to all women.[11]

Immersing in water in a birth pool is one of the methods available to manage pain during labour, in addition to TENS machine, Gas and air, Pethidine injection, deep breathing, massage and epidural.[12]


Before birth pools became readily available there are many stories of women labouring and birthing in re-purposed tub-like products including animal watering troughs.[13]

Ordinary bathtubs found in American and British homes are not adequate to provide enough room for women to comfortably move and try different positions in labour, such as squatting or kneeling, and are not deep enough to create buoyancy. In order to create the feeling of weightlessness through buoyancy the water needs to almost cover the women's breasts while she is sitting and should cover her belly while she is squatting, leaning over the side of the pool or kneeling upright in the pool sitting back on her heels.

The original circular birth pool Dr Michel Odent used at Pithiviers hospital (France) in the early 1980s was two meters in diameter and .6 meters deep, large enough to accommodate two people and make it difficult for interference during the birthing process.[14] Modern birth pools are somewhat smaller with a diameter between 110-150 centimeters and at least twenty, preferably twenty-two, inches of water.[15]

Factors to consider when choosing a birth pool are:

  • Size – is it appropriate for you and the place you will give birth
  • Fill time and process – how long will it take and what type of hose/spout is required
  • Safety – how will you safely get in and out

Types available in the UK

Birth pools are generally categorised between two broad types: permanently installed or portable. Many hospitals in the United Kingdom now have a birth pool plumbed in, and portable birth pools can be purchased or hired for use at home or in hospital.

  • Permanently Installed Birth Pools: The National Health Service (NHS) purchases birth pools for hospital birth centres, delivery suites and community midwife teams throughout the country.
  • Portable Birth Pools: More often used for home births, portable birth pools can also be used within hospitals when a permanently installed birth pool is not available.


  1. Cluett, E. R.; Burns, E. (2009). Cluett, Elizabeth R (ed.). "Immersion in water in labour and birth". The Cochrane Library (2): CD000111. doi:10.1002/14651858.CD000111.pub3. PMC 3982045. PMID 19370552.
  2. Schroeter, K. (2004). "Water Births: A Naked Emperor". Pediatrics. 114 (3): 855–858. doi:10.1542/peds.2004-0145. PMID 15342864.
  3. Cluett, Elizabeth R.; Burns, Ethel; Cuthbert, Anna (2018-05-16). "Immersion in water during labour and birth". The Cochrane Database of Systematic Reviews. 5: CD000111. doi:10.1002/14651858.CD000111.pub4. ISSN 1469-493X. PMC 6494420. PMID 29768662.
  4. Garland, D (2000). Waterbirth: An Attitude to Care. Elsevier. ISBN 0750652020.
  5. Yinglin Liu; Yukun Liu; Xiuzhi Huang; Chuying Du; Jing Peng; Peixian Huang; Jianping Zhang. "A comparison of maternal and neonatal outcomes between water immersion during labor and conventional labor and delivery". Research article. BioMed Central. Retrieved 20 January 2015.
  6. "Immersion in water during labour and birth" (PDF). Royal College of Midwives/Royal College of Obstetricians and Gynaecologists. 2006. Archived from the original (pdf) on 2009-04-13. Retrieved 2012-08-29.
  7. Committee On Fetus Newborn; Blackmon, D. G.; Adamkin, L. R.; Bell, D. H.; Denson, E. F.; Engle, S. E.; Martin, W. A.; Stark, G. I.; Barrington, A. R.; Raju, K. J.; Riley, T. N.; Tomashek, L.; Wallman, K. M.; Couto, C.; Couto, J. (2005). "Underwater Births". Pediatrics. 115 (5): 1413–1414. doi:10.1542/peds.2004-1738. PMID 15867054.
  8. Hess, S. (2005). "Strong Opinions Versus Science in Water-Birth Controversy". Pediatrics. 116 (2): 522–523, author 523 523. doi:10.1542/peds.2005-1334. PMID 16061620.
  9. Harper, R.N., Barbara (2005). Gentle Birth Choices. Inner Traditions. pp. 175. ISBN 1-59477-067-0.
  10. "Tips on encouraging a straightforward birth during labour". National Childbirth Trust.
  11. "Joint Statement on Birth In Water" (PDF). Royal College of Midwives RCM. Joint Statement by RCM and RCOG. 1994.
  12. Leap, Nicky; Dodwell, Miranda; Newburn, Mary (January 2010). "Working with pain in labour". New Digest. National Childbirth Trust NCT. 49.
  13. Bertram, Lakshmi (2000). Choosing Waterbirth. USA: Hampton Roads Publishing Company, Inc. pp. 31. ISBN 1-57174-152-6.
  14. Harper, Barbara (2005). Gentle Birth Choices. USA: Inner Traditions. pp. 175–176. ISBN 1-59477-067-0.
  15. Lichy, Dr. Roger; Herzberg, Eileen (1993). The Waterbirth Handbook. UK: Gateway Books. pp. 63, 132. ISBN 0-946551-70-7.
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