The Benefits and Risks of Choosing a Water Birth

Are you pregnant and working on your birth plan? Do you think a water birth sounds like a cool way to bring your baby into the world?

When it comes to giving birth, how you plan to do it is a personal decision. Because it’s an experience you’ll always remember, it’s a good idea to know all the options available to you. That’s why we put together this guide on water birth, a trend in birthing plans that’s become more popular in recent years.

If you’re considering a non-medicated vaginal birth, a water birth may have benefits for you. Here we’ll discuss the facts, pros, and cons of water birth, providing you with plenty of information that may help in this big decision. Let’s get started.


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Water Birth Infographic
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What Is Water Birthing?

Woman in tub having a water birth

Water birthing can take place in a hospital setting, at a birthing center, or even at home. At home, you may have an inflatable tub for submerging yourself in the water. At a birthing center or hospital, it could also be inflatable, or a standard tub may be available.

There are a couple of ways a water birth can proceed. Some women choose to labor and birth in the water, and others decide to labor in the water and give birth on dry land (source).

Not all hospitals allow for a water birth. So, if it’s something you feel strongly about, you may need to check in with your preferred hospital and healthcare provider.

Benefits of Water Birth

In the last few decades, water births have become more popular. According to the American College of Obstetricians and Gynecologists (ACOG), being submerged in water during the first stage of labor can be beneficial to the mother (source).

Although the ACOG recognizes the benefits of water during the first stage of labor, that is where their endorsement stops (source). They don’t have the same recommendation for the later stages of labor, although some research points to an increase in energy towards the end with a water birth.

There have been smaller studies about water births that may show they decrease the rate of needing a cesarean section (source). However, this needs further research to be more conclusive.

Other reported benefits of water birthing include:

  • The warm water can be soothing.
  • The buoyancy of the water can relieve the mother of some body weight, making her more comfortable.
  • Being submerged may make you feel less anxious, thus lowering blood pressure.
  • The warm water relaxes the perineum and reduces the need for an episiotomy.
  • Mothers often feel less inhibited while submerged in the water, thus more inclined to act and behave naturally along with the process.

Does It Hurt Less?

There is no hard evidence that a water birth reduces the pain of labor. However, many women report they feel calmer and more at ease.

Lying in the warm water may help relax your muscles or calm your breathing. It might give you the impression there is less pain. Sometimes the perception of less pain is all you need.

Are There Risks With Water Birth?

Woman delivering water birth

For mothers who want to give water birth a try, the ACOG recommends the following guidelines:

  • The mother is between 37 weeks and 41 weeks gestation.
  • The pregnancy is considered low risk.
  • The amniotic fluid is clear.
  • The baby is in a head-down position.

If the mother is in preterm labor, water birth is not recommended (source). Also, if the mother has previously had two or more cesareans, she should skip this idea. Each c-section may increase your risk of having problems with the placenta, making your delivery more complicated (source).

The following conditions also make water birth a less-recommended option:

  • An active skin infection.
  • A fever of 100.4 degrees Fahrenheit or higher.
  • Heavy vaginal bleeding.
  • A history of shoulder dystocia.
  • Being under sedation.
  • Having a herpes infection.
  • Having preeclampsia or diabetes.
  • Your baby is nine pounds or more (source).
  • You are older than 35 or younger than 17.

Also, if there is difficulty finding the fetal heartbeat, water birth may not be the best course of action.

There are a few risks to your baby that you should be aware of before choosing to proceed with this method. The risks aren’t common occurrences, but they do exist:

  • Difficulty regulating the baby’s body temperature after birth.
  • A chance the umbilical cord will be damaged or tear.
  • Asphyxia and seizures.

One of the biggest risks is Legionnaires’ disease, caused by the Legionella bacteria (source). It is an extremely rare complication, but it can happen, and it is sometimes fatal.

The aspiration of tiny water droplets containing the bacteria causes this severe disease. Symptoms typically include a fever, cough, and pneumonia.

Many doctors recommend getting out of the tub once you enter the second stage of labor for this reason. This also makes it easier to move quickly if something goes wrong and you need an emergency cesarean.

We should consider water birth for mothers with a healthy, low risk, term pregnancy. The American College of Nurse-Midwives takes a different stance (source) and states that it is essential for OB providers to respect the woman’s choice. Women who experience a water birth have higher levels of patient satisfaction. Investigators have not found increased rates of death or significant risk to mom or baby. If we’re listening to mothers and she is aware of the dangers- why are we not respecting their choice?

In my experience, water birth is marvelous. I have seen women serenely breathe or roar their babies out by listening to their body. Baby is gently passed up to mama’s chest and in many cases, doesn’t quite realize she has been born!

Headshot of Caitlin Goodwin, MSN, RN, CNM

Editor's Note:

Caitlin Goodwin, MSN, RN, CNM

If you are carrying multiples (twins, triplets, or more), you may not be a good candidate for a water birth. Multiples have a higher risk of being born prematurely. Plus, they usually require closer monitoring during labor.

Best Location for Water Birthing

Should you go to a birth center, a hospital, or stay home for this method? As we mentioned earlier, some hospitals may not allow for a water birth. It’s best to contact the ones in your area and find out whether it’s allowed.

Some may require that you give birth in a bed, but they will allow you to labor submerged.

A birth center is another option. These are free-standing facilities not associated with a hospital (source). A midwife or a certified nurse-midwife provides the medical care.

If you’ve had a low-risk pregnancy and want a more home-like facility, a birth center may be a good go-between choice for you. Many will facilitate a water birth and will have all the necessary supplies already on site.

How To Decide

The best way to understand which is right for you is to do a tour of the facilities. Ask to see the tubs, and ask about all the rules regarding what is and isn’t allowed.

If the hospital or birth center requirements don’t align with your plan, you can choose home birth. Proceeding at home will require the services of a midwife. Plus, you’ll need to rent or purchase your water birth supplies.

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Water Birth Precautions

Woman Having Natural Birth Water Birth

Before finalizing your birth plan, have an in-depth discussion with your doctor or midwife. There are a few questions you’ll need to have answered before you decide. Some considerations include whether:

  • You’ll have an experienced and licensed professional assisting with your birth, and that you’ll have a doctor on backup should you need them.
  • The tub will be clean, hygienic and well maintained.
  • There will be adequate measures taken for infection control.
  • Proper monitoring of you and your baby will take place while you are laboring.
  • There’s a plan in place for getting out of the tub if your doctor recommends it.
  • The water will be kept at a well-regulated temperature (source).
  • You will have access to plenty of fresh drinking water to prevent dehydration.

Being Asked to Exit the Water

If your midwife has cleared you to deliver while submerged, you may still be asked to get out of the water at some point.

The reasons could be:

  • You start to feel faint or drowsy.
  • There’s a problem with the baby’s heartbeat.
  • Your labor is progressing too slowly.
  • You start bleeding.
  • Your blood pressure creeps up.
  • Your body temperature goes up.
  • Meconium (fecal matter from the infant) is found in the water.

Being asked to change your birth plan may be distressing. Just keep in mind it’s for the good of you and your baby. You may be able to get back in the water if things return to a more stable condition.

What Supplies Will I Need?

If you decide to do a water birth at home, you have to be prepared. The first thing you need to consider is the tub.

You could choose to buy one, or there might be rental options in your area. Your midwife may be able to supply one and have it delivered to your house.

Once you’ve found the tub you’ll use, you need to decide where in your home to put it. You should consider the weight of the tub when filled with water. Another consideration is getting it in and out of your space.

It isn’t generally recommended that you use your bathtub for a home water birth. It is difficult to ensure it’s completely clean. Also, it may not be big enough, and space in bathrooms is usually limited.

For a birth at home, the next step will be to gather your other supplies (source). Most midwives will provide this list and places for purchase, but here’s a general idea:

  • A birth pool liner.
  • A strainer or fishnet for scooping solid materials.
  • A new garden hose that is long enough to stretch from your sink to the tub.
  • An adapter that will allow you to attach the garden hose to your sink.
  • Epsom salts and sea salt, 2 to 3 pounds each.
  • A tarp for putting under the tub to protect your floor.
  • A floating thermometer.
  • Plenty of towels.
  • Pots of boiling water to be used as a backup for keeping the water warm.

Frequently Asked Questions

Your midwife should be able to help you prepare your birthing tub. The goal is to make it as clean and hygienic as possible.

If birthing at a center or hospital, they will take care of everything for you. At home, you’ll have more responsibilities beforehand.

You’ll want to clean the tub thoroughly with a mixture of 10 parts water to one part bleach (source). The mixture should be allowed to sit for 5 minutes, and then you need to rinse thoroughly to remove all traces of bleach. Before you start filling the pool, place the tarp underneath to protect your flooring.

During the first stage of labor, the water in the birthing tub should be kept somewhere between 97 degrees and 100 degrees Fahrenheit (source). While hotter water than that may sound soothing, it could pose an overheating risk to both you and your baby.

In the second stage of labor, the water should hover around 100 degrees Fahrenheit.

Once you feel the pangs of labor, the first thing you should do is call your healthcare provider. The early signs may include contractions every five minutes and your water breaking.

Your midwife may ask you to begin filling the tub, but don’t enter it until he or she arrives.

Remember

Wherever you are, once your midwife or doctor arrives, he or she will help you submerge.

The baby’s heartbeat will be monitored with a Doppler device made for underwater use (source).

Throughout the laboring process, you may see materials floating in the water. They could include mucus, bloody show, and maybe even feces.

Bloody show is a mucus discharge that may be tinged brown or pink with blood. Don’t worry, it’s a normal occurrence. But if you are squeamish, you might want to reconsider your commitment to water birth.

Your midwife may help clear debris from the water with the fishnet. If not, your partner may be able to take on this duty.

After your baby is born, your midwife will likely be caring for you and your newborn. Once you are both recovering contentedly, the midwife usually begins emptying the tub with a pump.

Discard the liner, clean the tub again with the bleach mixture, and allow to dry. It will then likely be ready for returning if it is a rental, or for placing in storage if it is your own.

You should wear whatever you want. Feeling as comfortable as possible is crucial, so whatever makes you feel best is what you should wear.

Since the tub is basically like being in a small pool, some women choose to wear a bikini top. Others wear shirts or sports bras. You may even choose to be completely naked.

The midwife will likely prefer that you stay naked on your bottom half. It makes it easier for him or her to monitor your labor. However, if you feel uncomfortable, you could wear a loose skirt.

The practice of delayed cord clamping (DCC) has become increasingly popular. DCC means waiting to clamp the umbilical cord until the blood has stopped flowing from the placenta to the baby. Waiting is thought to increase your baby’s iron levels and boost the immune system (source).

You’re able to practice DCC during a water birth unless either you or the baby are in distress after delivery. If the baby is not breathing normally, the midwife may go ahead and cut the cord. Safety will always take priority over DCC.

In some cases, the placenta may come quickly in the tub. I have also kept the cord attached to the placenta, placed it in a bowl, and floated it in the tub per the family’s birth plan. It’s important to discuss your wishes for the birth of the placenta before your baby’s birthday.

Headshot of Caitlin Goodwin, MSN, RN, CNM

Editor's Note:

Caitlin Goodwin, MSN, RN, CNM

In most cases, the midwife will ask you to exit the tub before delivering the placenta. There are two reasons why it’s better to deliver the placenta outside the water.

  • Gravity can help you deliver the placenta: Squatting while in the tub may not be a good idea. Some mothers feel faint immediately after delivery.
  • Exiting the tub before entering the third stage of labor makes it easier for the midwife to care for you: If you do become faint while delivering the placenta, the midwife will have a hard time getting you out of the tub.
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The Cost of a Water Birth

A water birth that takes place in a hospital is usually no more expensive than a typical vaginal birth.

If you’re planning on having a home birth, you’ll have to buy or rent a birthing pool. The price for these varies from place to place. The best option is to see what your midwife recommends.

The cost for a midwife will likely be the same, whether you are doing a traditional at-home birth or a water birth. Typically, the fees for midwives can range from about $2,000 to $6,000.

For those choosing to birth in a birthing center, the cost of the tub will be added to the center’s cost list.

Your health insurance may cover a lot of the costs of a water birth. You should speak to an agent to find out what your plan covers.


The Choice Is Yours

Successful water birth with newborn baby

Your birth plan is yours. No one can tell you what will feel right for you. All we can do is provide comprehensive information to allow you to make the best choice.

If you’re expecting an uncomplicated delivery, a water birth may be a good option for you. Investigate all your birthing options — a hospital, birthing center, or at-home birth. Then, you can decide on the appropriate path.

Has this information on water birth helped you? If it did, tell us about it in the comments below. Also, if you know other moms contemplating water births, please share this article!

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