The Question Remains: Is Water Birth Really Safe?

This article was contributed by fan-favorite, Elaine Dalton.

Water births might be trending right now, but they have been in strong use since the 1980s and 1990s, with historical evidence placing the use of water births back in 1803. Water births occur frequently in a homebirth setting with a midwife supervising, but more hospitals are allowing water immersion during labor with a few tentatively exploring water births.

In other countries, water births are becoming a common occurrence and are considered a viable birthing option available to many low-risk mothers.

A water birth takes place when a laboring mother gives birth in a vessel full of water to her baby—with the placenta being delivered in the water or outside the water. Water immersion occurs when a mother labors in water but does not give birth in it, and a land birth is when a mother gives birth on land—no tub required.

I personally have positive experiences with a water birth. My second baby was a homebirth with a lovely birthing tub. I got into the water right before pushing and the submersion into such instantly relieved the majority of the pain from my back labor. I was able to have the temperature at a lovely comforting degree and position myself any way I wanted. Three good pushes and out whooshed my second daughter.

Interestingly enough, the birth experience was so calm and stress-free for her that she was born asleep and we had to wake her up to take her first breath and look around at everything before she snuggled up and went back to sleep.

She’s a naturally chill kid even now at the terrible twos.

What Is A Water Birth And Why Don’t Doctors Like It?

Water immersion during labor isn’t new, but it isn’t a familiar concept for many doctors. They weren’t exactly trained for this in medical school. The mainstream medical model teaches them to make the laboring mother acclimate to the doctor’s needs instead of the other way around. She should be on her back with her feet in stirrups. Or should she?

What Your OB Might Say

Doctors go to school for a very long time and are essentially hands-on in most emergency situations. They are trained to view birth as an emergency which requires the proper equipment, procedures and standard care to prevent the situation from escalating.

While this isn’t exactly a bad thing, the vast majority of water births are for low-risk healthy mothers who don’t require all the equipment, procedures and standard care. They support a do-it-yourself situation with very clear goals of low intervention, zero pain meds and a positive experience.

Water births enable women to be comfortable, get in touch with their bodies and move around into a favorable position at the slightest whim, thereby reducing the risk for many things such as episiotomies and c-sections.

The nature of the water birth reduces the doctor to being a hands-off supervisor. He can’t really see what is going on because the mother is most likely squatting or on all fours in the tub; she doesn’t need counter-pressure to protect against tears and baby can slide right into the water so the doctor doesn’t need to immediately catch him. This type of aloofness isn’t natural to educated doctors and it worries them.

Another cause for concern from doctors is that they are very evidence-based and by their reasoning, there haven’t been enough studies done to conclude that water births are safe. However, there have indeed been numerous studies in multiple first-world countries over the years, as outlined in detail by Evidence-Based Births. Doctors also state the risk of water aspiration for the baby as a concern and the risk of infection for mothers.

While it is true that some babies do startle and inhale, those documented in the studies made a full recovery with no side-effects. In most cases, water birth is very gentle and baby won’t startle at the touch of cold air which causes him to gasp and inhale. There are infant reflexes in place to prevent this actually. As to the infection risk, it is no greater than that of a land birth—particularly if a liner is used with the birthing tub and other preventative measures are taken to reduce the risk of infection.

What Midwives Say

Midwives are all for water births and many use birthing tubs as a standard part of their practices. They handle more homebirth water births than doctors do and many are able to tell from experience when it is time to get out of the tub and head to the hospital. Compared to the number of land births that end in a hospital, water births are more successful and very few participants end up vacating the tub in favor of a bed.

Midwives are trained to view birth as a natural occurrence with the knowledge that a woman’s body knows exactly what to do. Some guidance for new mothers is required in terms of encouragement, breathing, remembering to move around and try new positions, and to help them cope with the pain of contractions.

Subsequent mothers require less guidance from experienced midwives—often placing the midwife in a supervisory role. This is a comfortable role for the midwife and she has the knowledge and experience to assist should her skills be required in a more hands-on manner.

The Benefits Of Water Birth For Mom

The biggest benefit of water birth is the pain relief. The ability to adjust the water temperature to a comfortable level (usually around 97 degrees Fahrenheit) does wonders for the pain of labor. With a water birth, mothers aren’t hooked up to monitors that impede movement, and they aren’t restricted to a handful of positions on the bed. They can move around in the tub and get into whatever position feels the most comfortable to them.

Most birth tubs have thick bottoms with a built-in stool and sturdy handles. Many laboring mothers feel more confident in the water with a higher degree of privacy—in spite of the fact that they are mostly or completely naked. There aren’t bright lights shining on her; there aren’t several nurses and a doctor poking around calculating the length of her labor. It is usually just her, her partner, a midwife in the corner, and her baby on his or her way.

The risk of an episiotomy is lower with a water birth—with Evidence Based Birth citing one study that said the risk decreased up to 33%. Correspondingly, the risk of a third- or fourth-degree tear is also lower, with one study in the UK in 2012, reporting that out of over 5,100 water births, only about 2% had a third-degree tear and there were zero fourth-degree tears reported. There is an 11% increase in first- and second-degree tears with a water birth.

This is most likely due to the fact that these mothers were allowed to tear naturally instead of receiving an episiotomy which would have been administered in a standard land birth—resulting in a third- or fourth-degree incision requiring stitches. Other tears to the vaginal walls and labia can occur with a water birth but to such a lesser degree of frequency that these injuries are not usually documented.

Aside from pain relief and an intact perineum, the other benefits of a water birth for mom include a shorter labor with the cervix dilating faster, and the risk of hemorrhaging is lower. Evidence Based Birth reported the results of one study in which 72% of women said they would pick a water birth again while only 9% would opt for a land birth option in the future.

This is likely due to the fact that a water birth leads to a better overall experience with lower pain levels and fewer complications than other birth options available. The reduction of stress levels provides laboring mothers with the mental and emotional clarity needed to focus on their bodies and the births of their babies with lower anxiety levels.

Water Birth Is Good For Babies, Too

The birth process can be stressful for baby as he picks up on his mother’s cues from her hormone changes, heart rate and anxiety levels. It can be scary to go from a safe enclosed space, squeezed out through a tight tunnel and then brought up in the cold air and bright light.

At least with a water birth, he is receiving calmer cues from his mother and enters the outside world in a warm and wet environment similar to the one he just exited—making the transition for baby much smoother and calmer. After birth, baby is immediately given to the mother and there is usually a delayed cord cutting, giving baby all the extra benefits of the cord blood.

The Practical Side Of Things

This little section is mainly for the birth attendant since he will be the one running around setting up and taking down everything while mom is busy with contractions. Firstly, a birthing tub will need to be acquired through buying, renting or borrowing. Most will need to be inflated with air till firm and then an old blanket or quilt with a tarp should go on the floor underneath the tub to give it a softer base.

A clean, non-toxic garden hose with the correct fittings is required to attach to the nearest sink faucet to fill the tub with hot water. After the birth, the placenta and anything else will need to be fished out of the pool before the hose can be reattached to drain the water. If the tub was borrowed, a quick wipe down and the removal of the liner should be performed.

If the tub was purchased, sanitize thoroughly (assuming a liner wasn’t used). Then completely dry out and deflate the tub before folding it into a weird square, shoving it into its box or travel bag and putting it away or returning it.

Who Should Not Have A Water Birth

There are some restrictions on who can safely undergo a water birth. Individuals with herpes, a diagnosis of excessive bleeding or maternal infection, twins or breech baby (both can be safely birthed with a water birth but this will need to be discussed with your doctor or midwife first), preterm labor, severe meconium, toxemia or preeclampsia. Remember, no water birth is complete without all of the necessary supplies to further support mom and baby.

Sources: Evidence Based Birth, NPR, American Pregnancy, NCBI, Science and Sensibility, Cochrane Library Waterbirth Study