A waterbirth is where part of your labor and birth of your baby occurs while you are in a bath or birth pool filled with warm water. Some women and birthing people choose water immersion for labor, and then get out for the birth itself, while others choose a full waterbirth, remaining in the pool and birthing their baby underwater.
In Australia in 2021, half of all women and birthing people had a vaginal birth without intervention (in 2011 this figure was 56%). Research shows that over the past fifteen years, rates of birth interventions and caesareans have increased every year. This is a concern because birth interventions and caesareans increase a woman or birthing person’s risk of difficult physical recovery, compromised emotional health and wellbeing, and capacity to bond with their baby and parent effectively.
In this context, there is increasing awareness around finding ways to best support physiological labour and birth that are non invasive, and waterbirth is one such option. One study from 2019 recorded 740 Australian women and birthing people’s experiences of waterbirth and found that it was considered overwhelmingly positive. For those who had previous births without water, or who used water immersion during labour but not for the birth itself, their subsequent waterbirth was rated a more positive experience. The main themes that emerged from this study included a sense of safety for the birther, having an alert baby, water as soothing, having freedom of movement, being more comfortable and experiencing less pain, and the birth being more satisfying. Over 90% of the respondents said they would recommend waterbirth to others.
For various reasons waterbirth is controversial – this may be due to fears around infection from the water, potential for increase in perineal injuries, difficulty estimating blood loss, or potential risk of respiratory issues in the baby. In existing research, negative outcomes of waterbirth are few, with some studies showing that waterbirth may even hold protective factors for the newborn. However, not enough research has been undertaken, and because it is difficult to ascertain if there are more adverse effects - such as admissions to neonatal special care after birth, or perineal injury - directly due to waterbirth, doubt about its safety continue. Research shows that obstetricians and paediatricians are less likely to support waterbirth.
Exactly what happens when a baby is born in water?
If you choose to birth your baby in water, it is important to keep your lower body under the water for the entirety of the second stage (the baby’s head and body being born). There is no risk of your baby breathing before they are brought up out of the water, due to several protective features including the Dive reflex, where the larynx is covered in taste buds which interprets what substances are present, facilitating an appropriate response. This reflex is a preparation for breastfeeding, where the infant can discern different substances and adjust their swallowing and breathing accordingly.
It is important not to bring the baby up out of the water too quickly, or too slowly. Once the baby is brought up out of the water they will take their first breath. With the contrast of the cold air after the warmth of the water, a chain of chemical reactions takes place which result in the baby breathing. Depending where you are birthing, you may be asked and assisted out of the birth pool before the placenta comes.
Where can I have a waterbirth?
Women and birthing people who birth at home can buy or hire birthing pools. Wollongong Hospital has three birthing bathtubs, while Shoalhaven Hospital has four. Waterbirth is available at these hospitals for ‘low risk’ women and people. Low risk generally means the pregnancy has been healthy, the mother or birthing person is in a ‘healthy’ weight ranger, the baby is at least 37 weeks’ gestation, is head down, there is only one baby, and the labour is progressing normally.
Hospital policy may influence availability of waterbirth – baths may be for water immersion during only and not to birth in. Their use may also be limited by availability of accredited staff to facilitate waterbirth, and potentially needing lifting equipment to assist birthing women and people out of the bath. There will probably be other hospital conditions that must be agreed to in order to use water during labour and birth, such as agreeing to get out of the water in certain situations (such as increased heart rate in the baby). Hospital policies around waterbirth are seen to be restrictive and are one of the biggest barriers to accessing them, and in many cases do not reflect the current evidence base which mostly supports waterbirth.
If you are interested in waterbirth and are birthing in hospital, then it is important to ask questions and get information during antenatal appointments. Relevant questions include the availability of waterbirth, rates of waterbirth at that hospital, how many staff are accredited to support waterbirth, and what conditions and eligibility requirements are in place. You may also like to contact a doula or independent midwife to ask questions and gain information. Or use some of the links provided on this website. Here is a link to an in-depth article on the benefits of waterbirth and the larger context of its availability in various countries.
Overall, waterbirth is a safe and supportive birth method for both mother and baby. It can reduce the need for other interventions or pharmaceutical pain relief and is overwhelmingly described as a positive birth experience by those who have had waterbirths.
References
Australian Government: Department of Health and Aged Care. (2022). Waterbirth. Pregnancy, Birth and Baby. https://www.pregnancybirthbaby.org.au/water-birth
Australian Institute of Health and Welfare. (2023). Australia’s Mothers and Babies. https://www.aihw.gov.au/reports/mothers-babies/australias-mothers-babies/contents
Bovbjerg, M.L., Cheyney, M., & Everson, C. (2016). Maternal and newborn outcomes following waterbirth: The Midwives Alliance of North America Statistics Project, 2004 to 2009 cohort. Journal of Midwifery & Women’s Health, 61(1), 11-20. https://doi.org/10.1111/jmwh.12394
Cluett, E.R., Burns, E., & Cuthbert, A. (2018). Immersion in water during labour and birth. Cochrane Database of Systematic Reviews 2018, Issue 5. https://doi.org/10.1002/14651858.CD000111.pub4
Cooper, M., & Warland, J. (2019). What are the benefits? Are they concerned? Women’s experiences of water immersion for labor and birth. Midwifery, 79. https://doi.org/10.1016/j.midw.2019.102541
Reid, D. (2023). Water Birth in Australia: What you need to know. Bellybelly. https://www.bellybelly.com.au/birth/water-birth-in-australia/
Wickham, S. (2023). The benefits of water for birth. Dr Sara Wickham: Author, Speaker, Researcher. https://www.sarawickham.com/research-updates/more-benefits-of-water-for-birth/