Can I Have a Water Birth in a Hospital?
Water births let women experience labor and delivery while submerged in warm water. The buoyancy of the water lessens labor pains, which makes this method especially popular during a "natural delivery" without medication or an epidural.
Water births typically happen at home or a stand-alone birthing center, explains Marra Francis, M.D., a gynecologist practicing in San Antonio, and the former chair of the OB-GYN department at Memorial Hermann Hospital. But, given the popularity of water births, hospitals are starting to accommodate the method (although this remains rare overall). Here's what you need to know about having a water birth in a hospital.
Why Some Hospitals Prohibit Water Births
The main reason most hospitals don't offer water births is that there is "increased risk without proven benefit," says Patrick Weix, M.D., Ph.D., an OB-GYN practicing in Irving, Texas, and contributor to the medical website healthtap.com. All in all, it's not always easy to assess what's happening underwater, he says.
Possible risks to the fetus include:
- Infection. Water birth tubs may be contaminated with feces during delivery, and an infection can occur if the baby swallows it.
- Meconium aspiration, which might happen if Baby has their first bowel movement before birth and inhales contaminated amniotic fluid. In these cases, the midwife or OB-GYN needs to clear the baby's airways right after delivery, which may be difficult with a water birth.
- Pneumonia resulting from bacteria, meconium aspiration, or fecal contamination.
- Drowning, which may happen in the case of labor complications.
- The umbilical cords can tether the fetus underwater or tear, leading to fetal blood loss.
- Vaginal tears can be difficult to assess, and patients may bleed excessively.
The American Academy of Pediatrics has expressed concerns over the safety of water births, owing to insufficient numbers of studies on the subject. Similarly, according to a November 2016 Committee Opinion by the American College of Obstetricians and Gynecologists (ACOG), "there are insufficient data on which to draw conclusions regarding the relative benefits and risks of immersion in water during the second stage of labor and delivery." This conclusion led the ACOG to recommend "that birth occur on land, not in water."
It's important to note, though, that other professional organizations—such as the Royal College of Obstetricians and Gynaecologists and the American College of Nurse–Midwives—support the option of water births for healthy moms without pregnancy complications. Similarly, a study from the University of Michigan in December 2019, which compared 2,025 land births and 397 water births, concluded that both methods are equally safe. It also found that women with water births had fewer first- and second-degree tears, as well as comparable neonatal intensive care admissions and postpartum hemorrhage rates.
Changing Guidelines: Allowing Natural Water Births in Hospitals
Despite the limited data on water births, studies show that the lack of medical services available in a home delivery is more harmful to the baby than the actual water birthing method. A 2010 study of neonatal mortality rates published in the American Journal of Obstetrics & Gynecology concluded that "less medical intervention during planned home birth is associated with a tripling of the neonatal mortality rate." It makes sense, then, that having a water birth in a hospital is safer than having one at home.
This information—combined with the data supporting water birth as a significant alleviator of labor pain—has swayed some hospitals into accommodating water birth. This practice is still very limited, though, as obstetricians and hospitals sift through data and demand. Many doctors, midwives, and doulas agree that the rates of water birth are rising, and the fact that some hospitals are offering water birth brings the option to more mothers and helps make the choice much safer.
The hospitals that do offer water birth "have an adjoining birthing center staffed by midwives [and] are offering that option on hospital grounds," Dr. Francis says. The water birth centers are fully stocked with birthing tubs, IVs, oxygen, medication, and infant resuscitation equipment. These items should, hopefully, help out in emergency situations—at least until the mother and/or baby are transported to the actual hospital.