When you consider that your baby spends nine months floating in the warm and wet comfort of your womb's amniotic fluid, a water birth in a tub or pool might seem like a natural way of coming into the world. But it's important that you know exactly when it's safe to be in the water during the labor and childbirth process — and when it isn't — so that you can make the best decision for you and your little one.
Here's what you need to know about water birth so that you can decide if it's right for you, plus how to safely incorporate the practice into your own labor experience.
What is a water birth?
A water birth is when you spend at least part of your labor or delivery (or both) in a birthing pool filled with warm water. Plenty of moms and practitioners tout its potential benefits, and it's generally accepted among many midwives.
However, water birth is not widely practiced by doctors, since delivering in water can put your baby at risk for a number of rare but dangerous conditions and no scientific studies have confirmed the benefits during the second stage of active delivery, when the baby is pushed out.
The American College of Obstetricians and Gynecologists (ACOG) recommends laboring in water but delivering on land. The group strongly cautions against water immersion during baby's delivery, since it can lead to potentially serious and even fatal conditions in newborns.
What are the benefits of a water birth?
Water birth during the first stages of childbirth — while the cervix dilates and contractions pick up in frequency and intensity, before pushing baby out — may:
- Decrease labor pain or your need for anesthesia
- Decrease the duration of labor
- Give you a greater sense of control
- Conserve your energy
- Reduce perineal trauma
- Reduce the likelihood of an episiotomy (though this practice is rarer these days, no matter how or where you deliver)
Even if you decide not to stay in a birthing tub for long — whether it's because you're uncomfortable or your hospital doesn't allow it — you may find it's relaxing to begin labor in the water.
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What are the downsides and risks of a water birth?
Since babies don't breathe in utero, in theory your baby shouldn't start breathing until he comes out of the water and into the air. But ACOG still says no when it comes to actually giving birth in the water. If your baby does happen to take a breath while he's submerged, it can cause potentially serious complications, including drowning and meconium aspiration.
In addition, the Centers for Disease Control and Prevention (CDC) cautions that babies born underwater could contract Legionnaires' Disease — an extremely serious type of bacterial pneumonia — as was the case with at least two newborn infants delivered in home bathtubs in 2016. Though more research needs to be done, Legionnaires' is a very real potential complication of water birth that parents need to consider.
Because of the risks to the baby during the final stages of labor and delivery, ACOG says it's okay to labor in water but moms should push and deliver on "dry land." This shouldn't be an issue, ACOG notes, because delivering underwater hasn't been scientifically proven to provide any maternal or fetal benefits anyway.
Who should not have a water birth?
Because continuous electronic fetal monitoring isn't possible during a water birth, it's only an option if your pregnancy has been low-risk so far (otherwise your newborn might need immediate medical attention that's best offered in a hospital).
That means water birth is not recommended if you have:
- Had a previous difficult labor or delivery, including a prior C-section
- A chronic medical condition like hypertension, diabetes or herpes (which spreads more easily in water)
- A pregnancy complication like gestational diabetes or preeclampsia
- A baby in a breech position, since this usually makes a C-section your safest option
- Multiples
- Preterm labor, because going into labor more than two weeks ahead of your due date means your baby will likely need to visit the NICU for extra monitoring and care
How to plan a water birth
Generally, you can have a water birth in the following places:
- At home
- At some birthing centers
- At some hospitals
While some birthing centers have birthing pools or Jacuzzis on-site, hospitals are less likely to be equipped to handle a water birth, though some are. If it's important to you to labor in water, advocacy groups like Waterbirth International may be able to negotiate permission from your hospital for you to bring in a purchased or rented birthing pool.
Of course, if you're planning a home birth, you're free to take advantage of your bathtub during the early stages of labor — or bring in a birthing tub that's big enough for you and your partner or coach.
After getting approval from your hospital or birthing center for a water birth, find out if you need to bring your own equipment. If you're planning to give birth in your own bathtub at home, you'll want to have a thermometer on hand to measure the water temperature. (Birthing tubs come equipped with a thermometer.)
How much does a water birth cost?
The cost of a water birth can vary depending on where you have it and whether your hospital or birthing center offers it as an option. Hospitals and birthing centers that do have birthing pools may charge you a fee for using it, or they may not charge at all if they have the equipment on hand.
If you buy your own pool kit, you can usually do so for around $250 or less. And if you get a pool through your midwife, she may charge you a fee to rent it (how much will depend on the midwife).
If you do need to get your own equipment, let your insurance company know about your plans as soon as you make them, since it may cover the costs.
What happens when you go into labor during a water birth?
When you go into labor, call your practitioner, then fill up your tub and wait for them to arrive before getting in. Once you're in, have your partner adjust the water as necessary so the temperature remains between 95 and 100 degrees F and no higher than 101 (otherwise your body temperature could rise, causing the baby's heart rate to increase).
Have plenty of drinking water on hand, along with a few washcloths your coach can dampen with cold water to help cool off your face or neck. Your practitioner will monitor your baby's condition with an underwater Doppler device.
When it comes time to push, make sure you've already discussed your plan with your practitioner, as this is the most potentially dangerous part of a water birth, and pushing and delivering underwater is not advised by experts. Your partner can be in the tub or pool with you during the rest of labor to support you and then get out of the water when you're ready to push to play catch (literally) with the baby.
Keep in mind that if you ignore ACOG's recommendations and decide to deliver underwater, not only is your baby at risk for the aforementioned complications, but the umbilical cord can tear, cutting off your little one's oxygen lifeline. That puts him in further danger because when the placenta separates from the uterus (which can happen at any time after delivery), it can no longer provide your baby with sufficient oxygen.
Once baby arrives, your practitioner will place him upright on your chest, where you can finally say your first face-to-face hello!
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