Exploring the Evidence for Water Birth
Published: 19 June 2018
Published: 19 June 2018
Water births, or water immersion in labour, first became popular back in the 1970s, when it was noticed that women relaxing in water gave birth more easily.
Initial fears about the baby drowning were unfounded and it’s been growing in popularity ever since. McIntosh (2011) suggests that the demand for water birth is now so great, it should be regarded as a core midwifery competence.
Despite a huge rise in consumer demand for water birth in recent years, it’s not suitable for everyone and the following pre-requisites are generally accepted as standard.
(South Australian Public Health Services 2017)
When evaluating the research, it’s important to make a clear distinction between water immersion and water birth.
Warm water immersion is now generally accepted as a safe and effective way of relieving the intensity of pain associated with labour, elevating the release of endorphins, increasing the mother’s feelings of control and facilitating relaxation (Australian College of Midwives 2013).
Research into the benefits of remaining in water to give birth is also encouraging and includes a higher rate of normal vaginal birth, a higher rate of intact perineum, less use of episiotomy, and greater satisfaction with the birth overall.
(Dekker 2018)
It’s widely accepted that the greatest risk of water birth is for the baby, with particular concerns about the increased risk of infection.
Whilst most current research seems to dispel these concerns there continues to be calls for continued vigilance, audit and further research (Royal College of Midwives 2012).
Concerns about the potential risks for both mother and baby include:
(Dekker 2018)
Water birth isn’t suitable for all mothers, however, and there are many contraindications that must be excluded before immersion and birthing in water can be considered a safe option.
(South Australian Public Health Services 2017)
Many studies show that some of the benefits of water birth can also be gained with water immersion alone, followed by birthing outside the pool.
Most researchers agree that water birth appears to be associated with a significantly shorter first stage of labour, lower episiotomy rate and reduced analgesic requirements when compared with other delivery positions. As Thoeni et al. (2009) say, if women are selected appropriately and hygiene rules are followed, water birth appears to be safe for both the mother and neonate.
The Royal College of Midwives (2012) provides an excellent review of the current research evidence on potential risks and advantages of water birth. They point out, however, that the use of water during labour and birth continues to be an area with limited high-quality evidence and many researchers have called for further studies.
Important areas for further research include management into the third stage of labour and further analysis of the psychological benefits and effects on maternal satisfaction. Overall, the use of water is believed to encourage a woman-centred approach to care, support the normalising of birth and should be an important consideration in terms of maternal choice.
Cluett et al. (2018) echo the need for further research suggesting that the data available so far is of variable quality. In particular, they call for further research to be carried out in settings outside hospital labour wards.
More studies are also needed about women’s personal experience of water birth along with those of midwives and other carers. Poder and Larivière (2014) comment on the level of evidence of many studies goes from moderate to low. They suggest that whilst it’s possible to recommend immersion in water during the labour phase, no recommendation can be made as regard to the birth itself.
Whilst the benefits of water birth remain under debate among professionals, those in favour suggest it may increase maternal relaxation, reduce analgesia requirements and promote a model of obstetric care more focused on the needs of mothers.
Miller and Magill‐Cuerden (2006) suggest that if we truly wish to make birth healthier and more satisfying for mothers, to enhance job satisfaction for midwives and restore normality in birth, then every woman without major complications should be offered the opportunity to labour and give birth in water. In some contrast to these views, however, major critics continue to cite a risk of inhalation of water for the newborn and a risk of infection for both mother and baby.
As consumer demand for water birth continues to rise, most mothers and midwives would probably agree with Dekker (2018), who says that if a pregnant woman has a strong desire for water birth, and there are experienced staff who are comfortable in attending then there is no evidence to deny women this option of pain relief.
Anne is a freelance lecturer and medical writer at Mind Body Ink. She is a former midwife and nurse teacher with over 25 years’ experience working in the fields of healthcare, stress management and medical hypnosis. Her background includes working as a hospital midwife, Critical Care nurse, lecturer in Neonatal Intensive Care, and as a Clinical Nurse Specialist for a company making life support equipment. Anne has also studied many forms of complementary medicine and has extensive experience in the field of clinical hypnosis. She has a special interest in integrating complementary medicine into conventional healthcare settings and is currently an Associate Tutor, lecturing in Health Coaching and Medical Hypnosis at Exeter University in the UK. As a former Midwife, Anne has a natural passion for writing about fertility, pregnancy, birthing and baby care. Her recent publications include The Health Factor, Coach Yourself To Better Health and Positive Thinking For Kids. You can read more about her work at www.MindBodyInk.com. See Educator Profile