Water births aren’t safe. Here’s why.

You’d think, being land-based mammals, we’d all be able to agree on the basic fact that humans breathe air, and that newborn human babies ought to be born into the air.  You know, so they can breathe. That’s how human babies have always been born, and that’s how all other primates are born, and that’s how all other land mammals are born. (Hats off to our cetacean cousins for their sticking to their evolutionary guns on the water birth. Unlike humans, Flipper doesn’t do well in air.)

And yet, there’s always someone willing to wonder, “Could there be a better way?” Immersion in water during labor or birth is touted by some as beneficial to both mother and baby. What does the evidence show? I’m willing to suspend common sense, here—show me it’s safe, then, sure, let’s join the dolphins.

Except it isn’t safe. And the purported benefits? No so much.

In a joint statement from the American Academy of Pediatrics and the American Congress of Obstetricians and Gynecologists, physicians have reviewed what we know and don’t know about water birth. What we do know, really, is very little — studies are of limited quality and small scope, and use varying methods and varying definitions of “water birth.”

Many of the “studies” are not in scientifically reviewed journals, and are more like collections of cherry-picked stories than actual objective evidence. Most of these “studies” show zero objective benefit during labor, though some pooled studies combining case series show a reduced use of anesthesia and a reduced time of labor during immersion in water. However, no matter how the data are combined, there’s no difference in perineal trauma, tears, c-section rates, or a need for assisted delivery. And there are no individual trials or pooled collections that show any benefit to the newborn infant at all.

What there are, though, are several case reports and case series of babies suffering harm from water birth. Because the numbers of women undergoing labor or birth in a water bath aren’t known, we can’t estimate the rates of these complications. But the complications are real and can be devastating: umbilical cord tears leading to hemorrhage and shock,  hypothermia, drowning, seizures, brain damage, and death. Are these kinds of risks an acceptable trade-off for the meager, unproven benefits of water birth?

The ACOG and AAP point out that immersion in water during what’s called the first stage of labor — the early part, when there are regular contractions but the cervix isn’t fully dilated — may be appealing to some women, and may offer some potential benefit in terms of pain control. Even though there’s no evidence of benefit to the baby, as long as immersion doesn’t otherwise interfere with good care it’s not unreasonable. Rigorous protocols ought to be in place, though, to protect mom and baby — including maintenance and cleaning of the tubs, infection control and monitoring, and careful observation for signs that it’s time to move out of the tub. Before someone gets hurt.

However, immersion during the second stage of labor, when the cervix is dilated and Junior is making his way into the world we share — that’s of zero benefit, and can lead to great harm. Humans are not water creatures, and it’s not likely that our babies really ought to be born underwater.

Roy Benaroch is a pediatrician who blogs at The Pediatric Insider. He is also the author of Solving Health and Behavioral Problems from Birth through Preschool: A Parent’s Guide and A Guide to Getting the Best Health Care for Your Child.

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  • JR DNR

    When I have menstrual cramps, a hot bath helps.
    When I have pain from gut problems (celiac) a hot bath helps.

    In both cases, a hot bath is absolutely the most awesome amazing incredible thing for abdominal pain ever. For me anyways.

    While I imagine it vary from women to women… I can totally imagine a hot bath would help with cramps in the early stage of labor and want that option.

    • http://www.pediatricinsider.com/ Roy Benaroch MD

      Agreed. Which is what I said. Immersion during early labor can be comforting, and is probably harmless.

      It’s the birthing part– the baby being born underwater– that’s asking for trouble.

      • http://www.dpsinfo.com LaurieMann

        A warm bath early in labor has been common in many places (particularly in England). But it’s like anything else – if a woman is more comfortable giving birth in water, and if the baby is removed and examined quickly, I can’t really see that it would do much harm unless there was a post-delivery complication.

      • JR DNR

        No, you said:

        “may be appealing to some women, and may offer some potential benefit in terms of pain control. Even though there’s no evidence of benefit to the baby”

        “may” “potential” – sounds like someone doubting it could possibly do anything of the sort. I like the benefit of the baby counter… epidurals don’t benefit the baby. So why argue pain control doesn’t benefit the baby?

  • JR DNR

    Warning against water births without clear evidence is ok.
    Warning against the use of… what was the latest scare? Oh yes, wireless internet in your home. Yes, warning against the use of wireless internet in your home without clear evidence is purely reckless.

  • guest

    Anecdotal, I know, but I have a beautiful niece who had a water birth and was delivered by an obstetrician. My niece opened her eyes in the warm water and looked around. It was a pretty amazing experience. Maybe they ought to study it more.

    • http://www.pediatricinsider.com/ Roy Benaroch MD

      I’m glad your family had a good experience. Would it have been less wonderful if she had opened her eyes into the air? I always think that’s a magical moment, and I’ve never really thought it could be improved by the baby being submerged.

      Agree, more study needed. I would like to see a solid, prospective study, with informed consent for families, collecting exact numbers– how many babies born this way, how many complications (comparing traditional to water births.) Absent that kind of information, we only have case reports and sketchy collections to inform our decisions. And those case reports are grim, if you’re concerned about the well being of babies.

      • guest

        No opening her eyes in the water had nothing to do with the magic of it. The magic of it came with having a good experience that was best for my sister and her family.
        Her obstetrician has been in practice for years and is well regarded. The decision was between my sister and her obstetrician. It’s nobody else’s business, really.

  • JR DNR

    Sorry – I was being sarcastic :)

  • http://www.pediatricinsider.com/ Roy Benaroch MD

    I’ll just quote my own post:

    “What there are, though, are several case reports and case series of babies suffering harm from water birth. Because the numbers of women undergoing labor or birth in a water bath aren’t known, we can’t estimate the rates of these complications. But the complications are real and can be devastating: umbilical cord tears leading to hemorrhage and shock, hypothermia, drowning, seizures, brain damage, and death. Are these kinds of risks an acceptable trade-off for the meager, unproven benefits of water birth?”

    The references to those reports are in the policy statements I linked to.

    So we’re got real, documented, devastating consequences from water birth. For very little benefit (none, actually, for the baby.) Is this not a compelling reason for pediatricians to recommend against water birth?

    • JR DNR

      There are case reports of women dying from c-sections, babies dying during vaginal births…

  • Allie

    The medical community has a long way to go in terms of developing trust, particularly around life-changing events like birth. You can offer what you consider reasoned arguments, but when the alternative you are suggesting is being treated by people who think http://www.gomerblog.com/2014/05/birth-plan/ is funny, women are going to rationally choose what seems to be more woman-centered care. Many women are scared of medical birth practices, like unnecessary c-sections (ironically the women most scared of it, i.e. higher s-e status, are less likely to get unnecessary ones). So, we should really work on our own faults before castigating women trying to find alternatives.

  • JR DNR

    Hot water DOES offer pain control to some women.

    • RenegadeRN

      I hear you, but kinda cringe when I read the words Hot Water and pregnancy. Warm water bath- ok..hot water- not ok.

      I too love a hot bath when my back or, guts hurt, but never in late pregnancy.

      • JR DNR

        Oh no, does that mean getting a thermometer out when taking a bath?

        • RenegadeRN

          Ha ha! Only if someone can’t distinguish between warm and hot with your hand. ;-)

  • RenegadeRN

    Just an aside…that ” screaming” has a valid protective use in helping the alveolar sacs in the in lung to fully inflate and facilitates the transition from fetus to neonate. Also helps to facilitate many vital physiological events preventing medical issues… Ie. PDA, liver shunts etc.

  • RenegadeRN

    I can too, but felt I should share my personal shift in thinking… I am an ex neonatal ICU nurse, and so thankful I had my child many years prior to even becoming a nurse.

    I worked for many years in a large urban level 3-4 NICU, and we were called down to deliveries more times than I can count for unexpected issues. Life threatening issues such as gastroschisis, unexpected cranial malformations , you name it. Point I’m making is that until you have work end the environment, there is no way to fully understand the potential problems.

    I was a child of the 60′s and 70′s and can remember saying when I was pregnant, that it shouldn’t be “medicalized” and I wasn’t having any part of routine IVs or episiotomy..and I didn’t! But I recognize now how darn lucky I was. Nothing is as wonderful as a good birth- and nothing as awful as a tragedy.

    • RenegadeRN

      Sorry, it wouldn’t let me edit… I meant to correct a typo and correct a thought.
      …worked in the environment …but then I remembered you are a midwife, so of course you know what I am talking about! No disrespect meant, btw.

  • William Viner

    Thanks Gorgeous. I will.