What to Know When Considering a Water Birth
The idea of a water birth being a tranquil extension of pregnancy is supported by thousands of YouTube home videos, many of which show laboring moms kneeling or squatting in small blow-up tubs, seeming to effortlessly push their babies out, underwater, into the world.
Of course, while a water birth can be a wonderful way to deliver, just like any birth, it requires lots of mental, physical and logistical preparation, and there are certain risks to be aware of. So how does water birth work, what are the benefits and are you a good candidate for this plan? Here’s what you need to know if you’re thinking of trying for water birth.
A water birth is when you spend part of your labor or delivery in a tub of warm water. Many women find being submerged relaxing during labor, and some report being able to better manage their pain. While many hospitals in the US offer tubs in their labor and delivery rooms for patients to use right up until giving birth, water birth or delivery itself—where baby is born underwater and then brought to the surface—isn’t widely practiced by OBs in hospital settings.
“OBs and nurses are under a time crunch and it’s not efficient when someone is in a tub,” says Rebecca Dekker, PhD, RN, founder of Evidence Based Birth. “If you need to do an exam, the patient has to get out and dry off; it’s much easier if the patient is in the bed and you don’t have to keep filling the tub and keep the water warm enough.”
Both the American College of Obstetricians and Gynecologists (ACOG)) and the American Academy of Pediatrics (AAP) recommend laboring in water but stepping out of the tub to deliver “on land,” citing a lack of research that substantiates the benefits of delivering baby underwater. This is what’s behind many hospital and OB practice policies—but plenty of women opt to try for a water birth at independent birthing centers. Others want a home water birth, where they submerge themselves in inflatable tubs and are guided by midwives who’ve been trained in water birth pros and cons.
Flexibility is key; while you can certainly try for a water birth, it’s important to know that it’s not always guaranteed. “When it comes to water birth, I like to be realistic,” says Mary Langlois, CPM, co-owner of Blossom Birth and Wellness Center in Phoenix, Arizona. “It’s important for new mothers to understand that baby is an active participant and sometimes they don’t want to be born in water.” To that end, your midwife will keep close tabs on your progress and your little one’s well-being; they’ll likely monitor baby’s heart rate using waterproof probes on their dopplers, says Langlois. Even if all is going well as you start laboring in water, sudden changes or complications could preclude you from delivering baby underwater, like if baby’s heart rate drops or if there’s excessive meconium.
The main benefit of laboring in warm water comes in the form of pain management, says Dekker. “You’re less likely to use pain medication, less likely to have anxiety and you’ll have better positioning of the baby in your pelvis,” she elaborates. A Cochrane review that examined eight randomized trials looking specifically at water immersion during the first stage of labor—before pushing begins—showed evidence that laboring in water reduces the use of epidurals and spinals for pain relief. It also noted that laboring in water shortened the first stage of labor by roughly 30 minutes.
There aren’t many studies that look at babies being born in water, but some key benefits of water birth noted by Evidence Based Birth include:
- Lower pain scores
- Less use of pain medication
- Shorter labors
- A higher rate of successful vaginal birth
- Lower rate of episiotomy
“Some of this makes sense,” says Dekker. “If you’re in the water, it’s harder for the provider to reach down … there’s a barrier between you and unnecessary interventions.”
When it comes to water birth risks, pediatricians are most concerned about baby possibly inhaling water, hypothermia if the water temperature is too low and infection from waterborne illnesses, according to The Journal of Perinatal Education. There’s also potential for the umbilical cord to snap if baby is brought to the surface of the water too swiftly, notes the American Pregnancy Association.
Water birth risks to Mom include slipping or falling when getting out of the tub or discomfort due to water temperature or her positioning in the pool, notes Langlois. As with non-water births, there’s always a risk of excessive bleeding after the placenta has been delivered, but it can be harder to gauge blood loss in water. “If the water turns completely red, it’s a good idea to get the mother out,” says Langlois. She adds that your midwife should be trained on how to understand and quantify blood in water.
Most birth centers and midwives will offer water births only to women with low-risk, healthy pregnancies who are at term, says Dekker. According to the American Pregnancy Association, there are some factors that may rule out a water birth; these include:
- Multiples pregnancy
- Breech baby
- Preterm labor
- Excessive bleeding
- An infection, including herpes
“You also shouldn’t give birth in the water if you’re receiving pain medication through an IV or Pitocin for an induction,” says Dekker. To that end, if you’ve got your heart set on an early epidural and a water birth, you’re going to have to choose one or the other.
Water births are almost always medication-free, so Langlois advises her moms to familiarize themselves with some key labor pain-management techniques, such as breathing exercises. Beyond the mental and physical prep, If you’re choosing to have a home water birth, you’ll also want to cross-check supplies with your midwife. For starters, you’ll likely need:
- A birthing tub. You can rent or purchase a blow-up birthing tub.
- Water Thermometer. You’ll want to make sure the water temperature is in the target range.
- Plastic sheeting or towels to place around the tub. You may also want more towels for yourself and anyone else who may join you in the tub during labor.
- An alternative place to give birth. You’ll want a bed, cot or another predetermined place close to the tub in case you’re instructed to get out of the water to give birth.
- A chair. Langlois recommends having some type of rolling chair near the edge of the tub in case you need help moving from the tub to somewhere else.
- Something comfortable to wear. If you opt to cover your breasts, you’ll want something easily removable to allow for breastfeeding and skin-to-skin contact—probably not a sports bra, which can be hard to pull off quickly.
For home water births, Langlois also recommends doing a practice run with your tub before you go into labor, sometime between 35 and 36 weeks. “In a home birth setting, one of the biggest obstacles is [a partner] trying to fill up the tub when [Mom] is in active labor and there’s no hot water ready,” says Langlois. While you’re in the birthing pool, you’ll need to maintain a water temperature of between 99 and 100.7 degrees—a little warmer than your core body temp. Any less and baby could be at risk for becoming dangerously cold; too much heat could cause a higher fetal heart rate or lead to dehydration for you, notes The Journal of Perinatal Education.
Water birth cost can vary, so you’ll want to do your due diligence to plan ahead. Unless your midwife includes the birthing pool in the cost of their services, you’ll probably need to rent or buy one if you’re trying for a home water birth. Typically, the cost to rent and buy is roughly the same—starting around $275 for a few weeks’ rental or around $250 to $500 to buy one outright. Your midwife will likely be able to guide you on options.
There’s usually no separate fee for laboring in a tub in a hospital, and your insurance will probably cover most of it (though you’ll have to check your policy). The fees for a midwife for a home water birth or birth center water birth are usually included in whatever they charge for a normal birth. Overall cost range varies from practice to practice. At Blossom Birth Center, Langlois says there’s a single fee of around $5,500 that covers all prenatal care, labor, birth and postpartum care for Mom and baby, including on-site water births.
Giving birth in water can be a beautiful thing. But it’s not for everyone. Discuss the water birth pros and cons with your midwife to determine if it’s a feasible option for you. You’ll also need to decide whether you want to pursue this plan in a hospital setting, birth center or at home. Preparation is key—but so is keeping an open mind and remembering that things can change on a dime during labor and delivery. The most important thing is that you and baby are happy and healthy.
About the experts:
Rebecca Dekker, PhD, RN, is a registered nurse and the founder and CEO of Evidence Based Birth. She received her degrees from the University of Kentucky.
Mary Langlois, CrMSM, FCP, is a licensed midwife and the co-owner of Blossom Birth Center in Phoenix, Arizona.
Please note: The Bump and the materials and information it contains are not intended to, and do not constitute, medical or other health advice or diagnosis and should not be used as such. You should always consult with a qualified physician or health professional about your specific circumstances.
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