Water birth

Water birth is childbirth that occurs in water, usually a birthing pool. It may include the use of water for relaxation and pain relief during the first stage of labour, birth into water in the second stage of labour, and the delivery of the placenta in the third stage of labour.

Approximately 10% of births in the UK take place in water, and approximately 20% of births include the use of water for pain relief.^[1] A cohort study carried out in the UK of 73,229 women concluded that there was no association with adverse fetal or maternal outcomes.^[2]

Health policy in England stipulates women should be given the opportunity to labour in water through the publication of Intrapartum care guidelines issued in 2007 by the National Institute for Health and Care Excellence (NICE). The Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives have jointly supported labour and birthing in water, and encourage hospitals to ensure birth pools are available to all women.^[3]

Birthing pools are available in many public hospitals in the UK.^{[4][5][6][7][8]}

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists supports the use of water immersion during labour within safety and clinical guidelines, noting that there is evidence of benefits to the mother and no evidence of adverse effects to the mother or baby.^[9] The New Zealand College of Midwives supports water immersion during labour when there are no factors that would prevent it, noting that there is no evidence for adverse fetal or maternal outcomes, but that further evidence is required for the delivery of the placenta.^[10] The Australian College of Midwives also supports immersion in water during labour and/or birth.^[11]

Birthing pools are available at many public and private hospitals in Australia^[12] and New Zealand.^[13][14][15]

Water birth is not commonly available in hospitals in the United States, and American clinical opinion is generally skeptical of the practice. The American College of Obstetricians and Gynecologists does not recommend birthing in water, although its 2016 Committee Opinion on the matter states that immersion in water during the first stage of labour may be offered to women with uncomplicated pregnancies.^[16]

In a 2005 commentary, the Committee on Fetus and Newborn of the American Academy of Pediatrics (AAP) released an analysis of the scientific literature regarding underwater births. The Committee noted several positive studies for underwater birth but went on to criticize them for lacking proper scientific controls, a significant number of infant deaths and diseases, and the general lack of information to support the use of water births.^[17]

Proponents believe childbirth in water results in a more relaxed, less painful experience.^[18] A 2018 Cochrane Review of water immersion in the first stages of labour found evidence of fewer epidurals and few adverse effects but insufficient information regarding giving birth in water.^[19] A moderate to weak level of evidence indicates that water immersion during the first stage of childbirth reduces the pain of labour.^[19] A 2018 Cochrane Review found that immersion at this stage reduces the use of epidural analgesia; however, there is no clear evidence on the benefits of immersion for the second stage of labour, namely delivery (sometimes called full water birth).^[19] There is no evidence of increased adverse effects for immersion during the first or second stages of labour.^[19]

Water birth may offer perineal support for the mother, and some theorize that this may decrease the risk of tearing and reduce the use of episiotomy.^[20] Evidence for this is not strong.^[19]

A 2014 review reported that water immersion during the first stage of labour can reduce the length of that stage, labour pain, and the use of epidural or spinal anaesthesia. It is also associated with a lower rate of cesarean delivery and stress urinary incontinence symptoms 42 days after delivery. The review reported that immersion during labour did not appear to increase the rate of infections for the mother or the baby, and Apgar scores for the newborn infant were similar to those of conventional births.^[21]

Waterbirth may lead to a higher rate of cord avulsion, or the snapping of the umbilical cord.^[22] Statements on water birth by peak gynaecological and midwifery bodies in the UK, Australia and New Zealand all stipulate that exclusion criteria apply for high risk births.^[23][24][25]

There is limited evidence for some of the purported benefits of waterbirth.

A birth pool is a specially designed vessel for waterbirth.^[26] They are generally larger than bathtubs to enable buoyancy and freedom of movement during labour.^[27] A birth pool can either be permanently installed or portable.

Before birth pools became readily available there were many stories of women labouring and birthing in re-purposed tub-like products including animal watering troughs.^[28]

The original circular birth pool used by Michel Odent, the originator of the concept of birthing pools, at Pithiviers hospital in France in the early 1980s was 2 metres (6 ft 7 in) in diameter and 60 centimetres (24 in) deep, large enough to accommodate two people and make it difficult for interference during the birthing process.^[29] Modern birth pools are somewhat smaller, with a diameter between 110–150 cm (43–59 in) and at least 50 cm (20 in), preferably 56 cm (22 in), of water.^[30]