Water Birth: Benefits, Risks & Precautions

When it comes to giving birth, how you plan to do it is a personal decision. Because it’s an experience you’ll always remember, it’s a good idea to know all the options available. That’s why we put together this guide on water birth, a birthing plan that’s become more popular in recent years.

If you’re considering a non-medicated vaginal birth, water birth may have benefits for you. Here we’ll take an unbiased look at water birth. Our medical team will explain the benefits and risks of water birth and provide you with plenty of information that may help in this big decision.

What Is Water Birthing?

Water birthing can occur in a hospital setting, at a birthing center, or even at home. At home, you may have an inflatable tub for submerging yourself in the water. A birthing center or hospital might provide an inflatable or standard tub.

There are a couple of ways a water birth can proceed. Some women choose to labor and deliver in the water, and others decide to labor in the tub and give birth out of the water.

Not all hospitals allow for a water birth. So, if it’s something you feel strongly about, you may need to check in with your birthing facility and health care provider.

Benefits of Water Birth

In the last few decades, water births have become more popular. According to the American College of Obstetricians and Gynecologists (ACOG), being submerged in water during the first stage of labor can be beneficial to the mother ⁽¹⁾.

Although the ACOG recognizes the benefits of water during the first stage of labor, that is where their endorsement stops ⁽²⁾. They don’t have the same recommendation for the later stages of labor, although some research points to an increase in energy toward the end with water birth.

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There have been smaller studies about water births that may show they decrease the rate of needing a cesarean section ⁽³⁾. However, this needs further research to be more conclusive.

These are some other reported benefits of water birthing:

• The warm water can be soothing.
• The water’s buoyancy can relieve the mother of some body weight, making her more comfortable.
• Being submerged may make you feel less anxious, thus lowering blood pressure ⁽⁴⁾.
• The warm water relaxes the perineum and reduces the need for an episiotomy ⁽⁵⁾.
• Mothers often feel less inhibited while submerged in the water, thus more inclined to act and behave naturally along with the process.

Risks of Water Birth

For mothers who want to give water birth a try, the ACOG recommends the following guidelines:

• The mother is between 37 weeks and 41 weeks gestation.
• The pregnancy is considered low risk.
• The amniotic fluid is clear.
• The baby is in a head-down position.

Water birth is not recommended if the mother is in preterm labor ⁽⁶⁾. Also, if the mother has previously had two or more cesareans, she should skip this idea. Each C-section may increase your risk of having problems with the placenta, making your delivery more complicated ⁽⁷⁾.

The following conditions also make water birth a less-recommended option ⁽⁸⁾:

• An active skin infection.
• A fever of 100.4 degrees Fahrenheit or higher.
• Heavy vaginal bleeding.
• A history of shoulder dystocia.
• Being under sedation.
• Having a herpes infection.
• Having preeclampsia or diabetes.
• Your baby is nine pounds or more ⁽⁹⁾.
• You are older than 35 or younger than 17.

Also, if there is difficulty finding the fetal heartbeat, water birth may not be the best course of action.

You should be aware of a few risks to your baby before choosing to proceed with this method. The risks aren’t common occurrences, but they do exist:

• Difficulty regulating the baby’s body temperature after birth.
• A chance the umbilical cord will be damaged or tear.
• Asphyxia and seizures.

One of the most significant risks is Legionnaires’ disease, caused by the Legionella bacteria ⁽¹⁰⁾. It is an extremely rare complication, but it can happen, and it is sometimes fatal.

The aspiration of tiny water droplets containing the bacteria causes this severe disease. Symptoms typically include a fever, cough, and pneumonia.

Many doctors recommend getting out of the tub once you enter the second stage of labor for this reason. This also makes it easier to move quickly if something goes wrong and you need an emergency cesarean.

We should consider water birth for mothers with a healthy, low-risk, full-term pregnancy. The American College of Nurse-Midwives takes a different stance and states that it is essential for OB providers to respect the woman’s choice. Women who experience a water birth have higher levels of patient satisfaction. Investigators have not found increased death rates or significant risk to mom or baby ⁽¹¹⁾.

If we listen to mothers, and they are aware of the dangers, why do we not respect their choice?

In my experience, water birth is marvelous. I have seen women serenely breathe or roar their babies out by listening to their bodies. The baby is gently passed up to the mother’s chest, and in many cases, they don’t quite realize they have been born!

Editor's Note:

Caitlin Goodwin, MSN, RN, CNM

Water Birth Precautions

Before finalizing your birth plan, have an in-depth discussion with your medical practitioner. There are a few questions you’ll need to have answered before you decide.

These are some considerations to take:

• Will you have an experienced and licensed professional assisting with your birth, and will a doctor be on backup should you need them?
• The tub must be clean, hygienic, and well maintained.
• There must be adequate measures taken for infection control.
• Proper monitoring of you and your baby needs to take place while you are laboring.
• Is there a plan for getting out of the tub if your doctor recommends it?
• Can you keep the water at a well-regulated temperature ⁽¹²⁾?
• Will you have access to plenty of fresh drinking water to prevent dehydration?

Being Asked to Exit the Water

If your midwife has cleared you to deliver while submerged, you may still be asked to get out of the water at some point.

These are some of the reasons you may be asked to leave the birthing tub:

• You start to feel faint or drowsy.
• There’s a problem with the baby’s heartbeat.
• Your labor is progressing too slowly.
• You start bleeding.
• Your blood pressure creeps up.
• Your body temperature goes up.
• Meconium (fecal matter from the infant) is found in the water.

Being asked to change your birth plan may be distressing. Keep in mind it’s for the good of you and your baby. You may be able to get back in the water if things return to a more stable condition.

What Supplies Will I Need?

If you decide to do a water birth at home, you have to be prepared. The first thing you need to consider is the tub.

You could choose to buy one, or there might be rental options in your area. Your midwife may be able to supply one and have it delivered to your house.

Once you’ve found the tub you’ll use, you need to decide where to put it in your home. You should consider the weight of the tub when filled with water. Another consideration is how to get it in and out of your space.

It isn’t generally recommended that you use your bathtub for a home water birth. It is difficult to ensure it’s completely clean. Also, it may not be big enough, and bathroom space is usually limited.

For a home birth, the next step will be to gather your other supplies ⁽¹³⁾. Most midwives will provide this list and places for purchase, but here’s a general idea:

• A birth pool liner.
• A strainer or fishnet for scooping solid materials.
• A new garden hose that is long enough to stretch from your sink to the tub.
• An adapter that will allow you to attach the garden hose to your sink.
• Epsom salts and sea salt, 2 to 3 pounds of each.
• A tarp for putting under the tub to protect your floor.
• A floating thermometer.
• Plenty of towels.
• Pots of boiling water to use as a backup for keeping the water warm.

The Cost of a Water Birth

A water birth that takes place in a hospital is usually no more expensive than a typical vaginal birth.

If you’re planning on having a home birth, you’ll have to buy or rent a birthing pool. The price for these varies from place to place. The best option is to see what your midwife recommends.

The cost for a midwife will likely be the same, whether you are doing a traditional at-home birth or a water birth. Typically, the fees for midwives can range from about $2,000 to $6,000.

For those choosing to birth in a birthing center, the cost of the tub will be added to the center’s cost list.

Your health insurance may cover a lot of the expenses of a water birth. Speak to an agent to find out what your plan covers.

Water Birth FAQs

Why Can’t You Have an Epidural With a Water Birth?

An epidural is not typically used with a water birth because the effects of the epidural can limit a woman’s mobility, making it unsafe to be in the water. Water births require the ability to move freely and maintain balance in the tub.

Does Water Birth Have Increased Risk of Infection?

Water birth does not inherently have an increased risk of infection if the water is clean and the tub is properly maintained. However, it’s crucial to follow guidelines for hygiene and water temperature to minimize any risk.

How Long Can a Baby Stay Under Water During Water Birth?

During a water birth, a baby can stay underwater for a short time as they transition from the womb to the outside world.

Babies don’t normally inhale until they are exposed to air, but it’s important for the midwife or attending healthcare provider to ensure the baby is brought to the surface promptly and safely.

Do You Go to the Hospital After Water Birth?

Whether you go to the hospital after a water birth depends on where the birth takes place and the mother and baby’s health condition post-delivery.

If the water birth occurs at home or a birthing center and there are no complications, hospital transfer may not be necessary. However, if there are any concerns, a hospital visit is advised.

The Choice Is Yours

Your birth plan is yours. No one can tell you what will feel right for you. All we can do is provide comprehensive information to allow you to make the best choice.

If you’re expecting an uncomplicated delivery, a water birth may be a good option for you. Investigate all your birthing options — a hospital, birthing center, or at-home birth. Then you can choose an appropriate path.