Is water birth safe, and is it better than natural birth?

Mother giving birth in the water

I am afraid that there is no quick answer to that question. Waterbirth is not for everybody. There are some perceived benefits, and there are some potential risks that you need to know. I will expand on that below and explain why some organizations consider water birth to be controversial while others support it. 

While our life is becoming more exposed to pollution and the use of technology and drugs in medicine, many women are seeking a more natural and calm experience when it pertains to their pregnancy and delivery of the baby. For some, laboring in water and giving birth to the baby underwater is a solution.

Undergoing labor in water has been recognized for a long time as an excellent way to decrease the use of epidural pain control, shortening the labor process, and providing women the opportunity to be in control. Giving birth underwater (water birth) is less studied. There are some case reports of dangerous adverse outcomes – particularly in babies, but there are also many women who delivered babies in the water safely. 

Waterbirth still is not very common and readily available for women in the USA. Barbara Harper, in her article from 2014, estimated that no more than  10% of US hospitals were providing hydrotherapy both for labor and birth. 

Potential benefits and risks of water birth

There have been case reports of drowning, suffocation, aspiration, ruptured umbilical cord, and even deaths in babies that were delivered underwater. However, in my opinion, more extensive studies reporting on carefully preselected women for waterbirth did not provide much credibility to the concerns derived from these case reports. 

Harper, in her article, reports on data from birth centers (AABC) between 2007 and 2010. There were a total of 15574 births, with 3998 of them being water births. 

The rates of baby transfer to a hospital for further care were lower for the water births; 1.5% vs. 2.8%. The rates of poor neonatal outcomes such as low Apgar scores, respiratory problems, infections, and NICU admissions were also lower for the water birth group as well (Apgar score explained in my article).

Another comprehensive analysis was published by Cochrane Collaborative in 2018. 

They compiled data from 15 different trials and a total of 3663 women. Their conclusions were: “In healthy women at low risk of complications there is moderate to low-quality evidence that water immersion during the first stage of labor probably has little effect on mode of birth or perineal trauma, but may reduce the use of regional analgesia. The evidence for immersion during the second stage of labor is limited and does not show clear differences in maternal or neonatal outcomes. There is no evidence of increased adverse effects to the fetus/neonate or woman from laboring or giving birth in water.”

The most recent outcomes-based study on water births in the USA

Joanne Bailey reported outcomes from two US centers in an article published in the “Birth” journal

The study looked at 397 water births and compared them to 2025 land births. The analysis was done in retrospective observational fashion. The results showed that there were no differences in outcomes between both groups for the Apgar scores or neonatal intensive care admissions. (Apgar score explained in my article). 

Rates of postpartum hemorrhage were similar for both groups. However, women in the water birth group seemed to have the benefit of having less frequent first- and second-degree perineal lacerations. 

What professional organizations say about water birth?

In 2014 the American Academy of Pediatrics (AAP) in collaboration with the American College of Obstetricians and Gynecologists (ACOG) issued a very controversial statement regarding water births. They said that water birth should only take place as part of a research protocol with full written consent. It created a lot of backlash from the parents, midwives, and some doctors, as it seemed that their opinions were one-sided and somewhat biased. If interested, you can read more about it here. 

Both organizations retracted to a certain degree and modified their harsh views in 2016, but still kept their recommendation that birth should occur on land (not in the water). 

The American College of Nurses and Midwives has its position on this subject as well. It is titled “Hydrotherapy in Labor and Birth.” Midwives think that pregnant women should be made aware of all the evidence regarding water labor and water birth. If expectant mothers meet the criteria for this type of delivery, they should be allowed to have it. 

In Europe, water births seem to be quite popular, particularly in the UK. The Royal College of Obstetricians and Gynecologists and the Royal College of Midwives support laboring in water for appropriate candidates. They emphasize that evidence to support underwater birth is not rich, but reported complications of water births are quite rare. Therefore, if providers adhere to best practices in infection control, management of umbilical cord rupture, and inclusion criteria are followed,  complications of water births can be minimized. 

It seems that as it used to be always the case, doctors tend to be very cautious and conservative whenever they are faced with a new approach to birth, and the lives of the woman and her baby are at stake. On the one hand, there are some case reports of adverse outcomes in newborn babies, but on the other hand, thousands of women have been reported to deliver babies underwater safely. 

What are the criteria to be eligible for water birth?

  • Single pregnancy with vertex presentation (Head down).
  • Full Term – Gestational age above 37 weeks
  • Low-risk pregnancy
  • Reassuring maternal and fetus status during labor
  • Client agrees to exit tub if advised to do so

Frequently cited contraindications to water birth:

  • Meconium stained amniotic fluid (baby passed stool in utero before birth)
  • Mother having infections such as HIV, Herpes, Hepatitis B
  • Mother having insulin-dependent diabetes
  • Suspected large baby (macrosomia)
  • Mother’s body mass index more than 40
  • History of shoulder dystocia in a previous pregnancy (=difficulty in delivering rest of the baby’s body after the head already came out) 
  • Baby needs scalp electrode monitoring
  • Mather diagnosed with chorioamnionitis
  • Mother needs epidural narcotics for pain control
  • Excessive bleeding in mother
  • Evidence of fetal compromise by any technique
  • Mother suffering from preeclampsia (significant hypertension with additional features)

What happens during a water birth?

Waterbirth means that you are staying in a tub or a pool immersed in water not only during the first stage of labor, but the expulsion of the baby takes place in the water as well. Baby is delivered into the water without having the ability to inhale air first. Since the baby’s lungs are already filled with fluid before birth, natural reflexes of the baby after birth do not allow him or her start breathing until we elevate the baby above the water surface. Many parents and providers believe that this process is gentler and less stressful for the baby. 

In the rare case that a woman raises herself out of the water and exposes the presenting part of the baby’s head before the whole body is delivered, it is usually recommended that she remains out of the water to prevent the baby from taking a breath and aspirating water into its lungs. 

Where or how can I get a water birth?

In order to have a water birth, you need to act early during your pregnancy. Not all hospitals and birth centers provide water labor and water birth. First of all, you need to ask your obstetrician if you are the right candidate for water labor and water birth (see criteria above). Then, you should find out if hospitals near you provide such a service. Finally, in most cases, you will have to involve midwife’s assistance, who will supervise your water labor and birth. If you have difficulty in finding a center that provides water birth, google for midwives in your area or locate a birth center at this URL:

If you would like to learn about the wellbeing of your future baby and want to know how he will be cared for after his birth in the hospital, read my article on this topic here.


This article is only for general information purposes. It should not be viewed as any medical advice. There is a chance that information here may be inaccurate. It would be best if you always discussed all health-related matters with your doctor before making any decisions that may affect your health or health of your family members.


Dr.Wisniewski is a board-certified pediatrician and neonatologist with over 20 years of clinical experience in the USA. He authored the book: "Babies Born Early - A guide for Parents of Babies Born Before 32 Weeks" Dr.Wisniewski loves educating parents on various health conditions affecting their newborn babies and children.

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