Updated guidelines for water birth

Water birth is the process of giving birth in a tub of warm water.  A few weeks ago the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) released a joint committee opinion regarding laboring and delivering in water. In it they state that “Undergoing the early stages of labor in a birthing pool may offer some advantages to pregnant women. However, underwater delivery has no proven benefit to women or babies and may even pose a risk of serious health problems for the newborn.”

It is important to understand that the committee does make a distinction between laboring in water and delivering in water.  They acknowledge that there may be some benefits to being in the water during the early stages of labor. For women who have uncomplicated pregnancies, laboring in water may result in decreased pain, reduced use of anesthesia, and shorter labors. However there is no evidence that immersion in water during the first stage of labor otherwise improves perinatal outcomes. And being immersed in water during the first stage of labor should not prevent appropriate maternal and fetal monitoring.

However, the committee did express concerns about a woman actually delivering her baby in water. They found that “the safety and efficacy of immersion in water during the second stage of labor [delivery] have not been established, and immersion in water during the second stage of labor has not been associated with maternal or fetal benefit.”

After reviewing studies on water births they found a risk of severe complications in the newborn, including
•    maternal and neonatal infections, particularly with ruptured membranes;
•    difficulties in newborn temperature regulation;
•    umbilical cord rupture while the newborn infant is lifted or maneuvered through and from the underwater pool at delivery, which leads to serious hemorrhage and shock; and
•    respiratory distress that results from tub-water aspiration (drowning or near drowning).

While these complications of water birth may be rare, they are very serious. Until more thorough studies are done and the benefits of delivering in water to both mother and baby have been proven, both ACOG and AAP suggest that deliveries in water should be done in a research setting with mothers being fully informed about the potential risks and benefits.

Tags: labor and delivery, water birth