Water Birth.


Both the Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives support labouring in water for healthy women with uncomplicated pregnancies. The evidence to support underwater birth is less clear but complications are seemingly rare. If good practice guidelines are followed in relation to infection control, management of cord rupture and strict adherence to eligibility criteria, these complications should be further reduced.

Lying in warm water gives a sense of relaxation, but whether it actually reduces pain is unproven. A perception of relaxation, pain relief, ease of movements and more holistic experience made labour in water a popular choice during the 1980s.

Perinatal mortality is not substantially higher among babies delivered in water than among those born to low risk women who delivered conventionally.9901

There are considerable perceived benefits of using immersion in water during labour, including less painful contractions and less need for pharmacological analgesia, shorter labour, less need for augmentation, with no known adverse effects for the woman herself.0501,0502

However, there may be rare but clinically significant risks for the baby born under water. These include respiratory problems (including the possibility of fresh water drowning), cord rupture with haemorrhage, and waterborne infections.

Overall, there is no difference found in the use of analgesia, although women allocated to immersion in water needed less epidural, spinal or paracervical analgesia. There was no significant difference in other important clinical outcomes, including duration of labour, operative delivery and perineal trauma. There were no increased adverse outcomes for the baby. 0401

Possible complications that may be associated with water birth include fresh water drowning, neonatal hyponatremia, neonatal waterborne infectious disease, cord rupture with neonatal hemorrhage, hypoxic ischemic encephalopathy, and death. The rates of these complications are likely to be low but are not well defined.0404

Labouring in water under midwifery care may be an option for slow progress in labour, reducing the need for obstetric intervention, and offering an alternative pain management strategy.

Most of the available evidence is restricted to healthy women with uncomplicated pregnancy at term although there is some evidence that labouring in water under midwifery care may be an option for slow progress in labour, reducing the need for obstetric intervention, and offering an alternative pain management strategy.0402

Although there is no evidence of higher perinatal mortality or admission to special care baby units (SCBUs) for birth in water, 0401, 0403

 caution is advised because of small numbers, possible under-reporting of SCBU admission and exclusion of women who were in labour in water but gave birth conventionally after complications. The maternal and fetal infection rate is comparable to traditional deliveries.0602, 0501

The selection of a low-risk collective is essential to minimize the risks with the addition of strictly maintained guidelines and continuous intrapartum observation and fetal monitoring. Water births are justifiable when certain criteria are met and risk factors are excluded.0603

All healthy women with uncomplicated pregnancies at term should have the option of water birth available to them.0601

Monitoring of the fetal heart using underwater Doppler should be standard practice.

If the woman raises herself out of the water and exposes the fetal head to air, once the presenting part is visible, she should be advised to remain out of the water to avoid the risk of premature gasping under water.

All birthing pools and other equipment (such as mirrors and thermometers) should be disposed of or thoroughly cleaned and dried after every use, in accordance with local infection control policies. Disposable sieves should be made available to ensure that the pool remains free from maternal faeces and other debris. Local information and guidelines regarding prevention of legionella build up in water supply from seldomly used pools should be obtained from local NHS trust estates and should be adhered to. Midwives should use universal precautions and follow local trust infection control guidelines.

Midwives should discuss antenatally the use of immersion in water in labour with all women in a low-risk category, as part of their overall discussions regarding options for pain relief, and information leaflets should be available.

All midwives should ensure that they are competent to care for a woman who wishes to have a water birth and have a good understanding of the basic principles of caring for a woman in labour, and should make themselves aware of local policies and guidelines.

Midwives, managers and supervisors of midwives should ensure that training in caring for a woman who wishes to have a water birth is undertaken by midwives who undertake intrapartum care, in order to increase choice for women and promote normality and ensurequality care.

Links to reference abstracts.

Women's Health

Women's Health