Water Birth: Pros, Cons, and What You Need to Know

During a water birth, a pregnant person can experience labor and delivery in a tub of warm water. A water birth can be at home, in a birthing centers, or in a hospital that accommodates a water birth. Some hospitals may not allow the actual birth to occur in water, but may allow a pregnant person to labor in the water, then move to a bed for delivery.

Pregnant people who desire a "natural childbirth"—an outdated term because all births are natural but is commonly used to refer to birth without medication or epidurals—sometimes choose water birth because it can provide "a gentle, natural experience," says Ami Burns, a Chicago-based childbirth educator and writer and owner of Birth Talk. "They find being submerged in a tub provides more comfort during contractions than being 'on land.'"

But that doesn't mean water births are 100% pain-free either. In fact, "labor pains are just as present in the water birth pools as they are anywhere else, but the environment is more relaxing and soothing therefore offering a more pleasurable experience," says David Ghozland, M.D., an OB-GYN practicing in Santa Monica, California.

Water births also come with a host of risks and potential complications, some of which can be serious. These range from infection to meconium aspiration to drowning. To clear common misconceptions, here's everything parents-to-be need to know about giving birth in water.

Who Can Have a Water Birth?

Aside from any rules surrounding the place you plan to give birth, there are other conditions a pregnant person will most likely need to meet to qualify for a water birth. For instance, an uncomplicated pregnancy (low blood pressure, over 37 weeks gestation, baby with a head down, etc.) is required for a water birth. "High-risk conditions or complications in labor often necessitate continuous fetal monitoring or immediate intervention, which is better accomplished outside of the water," explains Edwin Huang, M.D., an OB-GYN practicing in Cambridge, Massachusetts, and an assistant professor at Harvard Medical School.

There are certain circumstances in which someone should not choose water birth. Marra Francis, M.D., a gynecologist practicing in San Antonio, specifies that people with "Group B Strep positive cultures, gestational diabetes, preeclampsia, macrosomia, intrauterine growth restriction, prematurity, and an unproven pelvis" should opt out of water birth.

Of course, always talk to your health care provider to understand the full risks and reality of your choices. Water birth is a very personal decision, one that requires much thought and research—because there's more to water birth than the tub.

Water Birth Pros and Cons: Is It Safe?

In 2016, the American College of Obstetricians and Gynecologists (ACOG) advised against water births, given a lack of available data on the topic. The organization said that while immersion during the first stage of labor may have benefits, "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. Therefore, until such data are available, it is the recommendation of the American College of Obstetricians and Gynecologists that birth occur on land, not in water," according to a November 2016 Committee Opinion by ACOG.

However, professional organizations like the Royal College of Obstetricians and Gynaecologists and the American College of Nurse–Midwives support water births in certain situations.

"Researchers indicate that women who experience uncomplicated pregnancies and labors with limited risk factors and evidence-based management have comparable maternal and neonatal outcomes whether or not they give birth in water," the American College of Nurse–Midwives said in a 2014 position statement. "Women should be given the opportunity to remain immersed during labor and birth if they wish to do so within the context of a shared decision-making process with their health care providers. This process includes ongoing maternal and fetal assessment as labor progresses."

What's more, a December 2019 study from the University of Michigan compared 397 water births with 2025 land births. It found that the birthing practices were equally safe, "and that women in the water group sustain fewer first and second-degree tears," according to the statement. Land births and water births also had comparable postpartum hemorrhage rates and neonatal intensive care admissions.

And the largest study to date, done in 2021 and published in the British Journal of Obstetrics and Gynecology, concluded that not only are water births safe, but they are actually associated with better outcomes than land births, including decreased rates of postpartum hemorrhage and hospitalization after delivery, and no increase in neonatal death.

The Benefits of Water Birth

Some of the purported benefits of water birth include decreased pain and complications during delivery, thanks to relaxing of the muscles and tissue.

For instance, some claim that unmedicated water births lessen the pain of labor and delivery, thanks to the buoyancy of the water. "For women who are skeptical about water births, I always ask if they have ever taken a hot bath to relieve terrible menstrual cramps. That is usually the aha moment for most of them," says Amber Ford Cottrell, a doula who practices in New York City.

Barbara Harper, R.N., founder of Waterbirth International, a nonprofit organization that helps make giving birth in water an available option for parents-to-be, and Michelle Collins, C.N.M., an assistant professor of nursing at the Vanderbilt University School of Nursing who specializes in nurse-midwifery, explain why water may lessen labor pain.

When laboring individuals get into the deep water of a birth pool, not just a shallow bathtub, there is a chemical and hormonal response that adjusts the level of the hormone oxytocin, which pumps from the brain and helps regulate the intensity of the contractions. So, as the body becomes buoyant in the deep water and more oxytocin is released, more pain-inhibiting endorphins flood the brain, putting the laboring person more quickly into an altered state of consciousness and allowing their body to do the work that it needs to do. What's more, Harper and Collins say, water causes the perineum to become more relaxed, which can reduce the severity of vaginal tearing.

Water Birth Risks and Complications

If you plan on utilizing a water birth at your birth center or at a hospital, you should always discuss your plans with your healthcare team. If you plan on giving birth at home, additional considerations should be taken. "Anyone thinking about delivering at home needs to think through the worst-case scenario for the ultimate safety of their baby and themselves," says Sharon Mikol, M.D., an OB-GYN practicing in Cleveland. Even though steps are taken to avoid serious outcomes, and advocates state that home water birth is safe, Patrick Weix, M.D., Ph.D., an OB-GYN practicing in Irving, Texas, and contributor to the medical website healthtap.com, reveals "no adequate randomized controlled studies have been done on water births to demonstrate this."

Water births themselves are not significantly more dangerous than birth out of water, but when they take place at home—and most of them do—there is an increased risk. That's because there's usually no immediate emergency medical help with home water births. Here are some important water birth risks to know.

Infection

Water birth means sitting, pushing, and delivering in a tub—which often includes feces in the tub. A baby born in that environment could possibly swallow the contaminated water, increasing their risk of infection. Depending on whom you ask, the likelihood of an infection differs because data is limited. However, "there is no way to make the water contaminant free,"says Dr. Francis. That's because the tub becomes contaminated with vaginal and rectal flora the minute a mom sits in the tub, even if the water is sterile.

A baby that swallows tub water is at risk for infection. Babies are genetically and physiologically programmed to take their first breaths of air, not water, within seconds of their head being delivered. They do have a "dive reflex" that instinctively closes their airway and prevents them from breathing in water, but a few scenarios may still cause them to inhale water:

• They are startled during birth
• The head is brought to the surface before the rest of the body; this overrides the dive reflex
• Their oxygen supply from the placenta is affected in some way

It is important to know, however, that even as infectious bacteria is expelled outward during birth, nothing is moving up and inward. Therefore, the risk of infection occurs only if the baby breathes too soon (midwives and OBs are trained to minimize that risk) or if the equipment (tubs, filters, pumps) is not sterilized properly.

Depending on how long your own water has been broken and how long you are using water during labor, there is also a risk of infection through the water into the uterus. For instance, most hospital guidelines stipulate than once someone's water has broken, the risk of infection rises significantly and the ACOG recommends delivery within 24 hours. Giving birth in the water at home increases the risk that you may not know fully when your water has broken and you may introduce bacteria to your baby through the water.

Meconium aspiration

This medical term means a baby has had its first bowel movement before birth and inhales the contaminated amniotic fluid, which causes respiratory problems. Doctors and midwives are able to tell if this has happened when the water breaks because meconium is typically green, sticky, chunky, and thick. Extra precautions have to be taken when the first bowel movement occurs prior to delivery and it may be difficult to clear the baby's airway with a water birth.

Pneumonia

Although significant studies have yet to show the exact percentage of pneumonia cases in water birth, it is one of the risks.

Pneumonia usually develops within the first 24 to 48 hours after birth, and it is caused by meconium aspiration, fecal contamination, and bacteria from tub water. "There are also case reports of babies dying of pneumonia post-water birth that was a direct result of ingesting water with fecal contamination. As most water births are done at home or in a freestanding birth center, there is little 'research' done as a collective group," Dr. Francis says.

Drowning

Where there is water, there is a risk of drowning. A 2004 study lists drowning and near-drowning, as well asphyxiation as all risks of possible water birth complications. Owing to complications, the baby could possibly stay underwater too long and their lungs could fill up with water. In a medical environment with a water birth, your delivery team would help prevent this by placing the baby with their head above water so they can get enough oxygen to breathe as soon as the baby is born.

Umbilical cord tears

Dr. Weix reveals that "short umbilical cords can tether the fetus underwater or tear, leading to fetal blood loss. Maternal tears can be difficult to assess [underwater], and patients may bleed excessively." The good news is that a cord short enough to cause such an incident is rare.

During a water birth, a baby is usually brought quickly to the surface, head first. This swift movement will enable them to start breathing as soon as possible, but there's a risk that the umbilical cord may snap. "A snapped umbilical cord can be life-threatening, as the fetus can bleed freely until it is stopped. It is usually easily managed by clamping the cord. It leads more often to neonatal anemia than anything else," Dr. Weix explains.

Where to Have a Water Birth

Although some hospitals allow unmedicated water births, the majority occur at home or at stand-alone birthing centers (these are typically independent facilities, though a growing number are affiliated with and often housed inside of traditional hospitals). Water birth centers are equipped with IVs, oxygen, medication, and infant resuscitation equipment, so if need be, emergency care can be started if a transport to the hospital is needed.

Even though birthing centers are not as common as hospitals, a quick search for "water birth centers near me" will give some results. The American Association of Birth Centers can also help you find a birth center in close proximity to you.

Choosing a Water Birth Tub

The key to achieving buoyancy, and ideally pain relief, is in the choice of water birth tub. Most birthing tubs are inflatable and similar to a kiddie pool. Their pliable sides are softer than those of a regular bathtub, so they allow people to labor in different positions. Unlike a kiddie pool, however, the tubs are wide and deep enough to fully submerge a pregnant belly and, if desired, a partner as well.

Birthing tubs can be rented or purchased on the Internet or through a midwife, and they average around $250 with liners and filters. If you don't want to rent or buy a birthing tub, you may use your own home bathtub; just make sure your belly can be fully submerged in water and your midwife has easy access to you to assist with labor.

Water Birth Cost

Delivering at a birthing center is usually less expensive than a hospital because people typically stay for a shorter time and use fewer interventions. The majority of insurance companies cover births in a birthing center, but only some providers cover home births. Check with your insurance provider to understand your birth coverage.