{{Short description|Childbirth that occurs in water}} {{Use dmy dates|date=April 2022}} thumb|A mother participating in a water birth. thumb|Water birth '''Water birth''' is childbirth that occurs in water, usually a birthing pool. It may include the use of water for relaxation and pain relief during the first stage of labour, birth into water in the second stage of labour, and the delivery of the placenta in the third stage of labour.
==Benefits==
Water birth was associated with more positive childbirth and with more relaxed, less painful experience.<ref name=":1">{{Cite journal |last=Lathrop |first=Anthony |last2=Bonsack |first2=Carrie F. |last3=Haas |first3=David M. |date=2018 |title=Women's experiences with water birth: A matched groups prospective study |url=https://onlinelibrary.wiley.com/doi/10.1111/birt.12362 |journal=Birth |language=en |volume=45 |issue=4 |pages=416–423 |doi=10.1111/birt.12362 |issn=0730-7659|url-access=subscription }}</ref><ref name="Cochrane2009">{{Cite journal|last1=Cluett|first1=E. R.|last2=Burns|first2=E.|year=2009|editor1-last=Cluett|editor1-first=Elizabeth R|title=Immersion in water in labour and birth|journal=The Cochrane Database of Systematic Reviews|issue=2|article-number=CD000111|doi=10.1002/14651858.CD000111.pub3|pmc=3982045|pmid=19370552}}</ref> A 2018 Cochrane Review of water immersion in the first stages of labour found evidence of fewer epidurals and few adverse effects but insufficient information regarding giving birth in water.<ref name=":0">{{Cite journal|last1=Cluett|first1=Elizabeth R.|last2=Burns|first2=Ethel|last3=Cuthbert|first3=Anna|date=2018-05-16|title=Immersion in water during labour and birth|journal=The Cochrane Database of Systematic Reviews|volume=5|issue=6 |article-number=CD000111|doi=10.1002/14651858.CD000111.pub4|issn=1469-493X|pmid=29768662|pmc=6494420}}</ref> A moderate to weak level of evidence indicates that water immersion during the first stage of childbirth reduces the pain of labour.<ref name=":0" /> Several studies, including a 2018 Cochrane Review found that immersion at this stage reduces the use of epidural analgesia.<ref name=":2">{{Cite journal |last=Vanderlaan |first=Jennifer |last2=Hall |first2=Priscilla J. |last3=Lewitt |first3=MaryJane |date=2018 |title=Neonatal outcomes with water birth: A systematic review and meta-analysis |url=https://linkinghub.elsevier.com/retrieve/pii/S0266613817301249 |journal=Midwifery |language=en |volume=59 |pages=27–38 |doi=10.1016/j.midw.2017.12.023|url-access=subscription }}</ref><ref name=":1" /> However, there is no clear evidence on the benefits of immersion for the second stage of labour, namely delivery (sometimes called full water birth).<ref name=":0" /><ref name=":2" /> There is no evidence of increased adverse effects for immersion during the first or second stages of labour.<ref name=":0" />
Water birth may offer perineal support for the mother, and some theorize that this may decrease the risk of tearing and reduce the use of episiotomy.<ref>{{cite book | last = Garland | first = D | title = Waterbirth: An Attitude to Care | publisher = Elsevier | year = 2000 | isbn = 0-7506-5202-0 }}</ref> Water birth was also associated with higher rates of breastfeeding initiation in the delivery room.<ref name=":1" /> Evidence for this is not strong.<ref name=":0" />
A 2014 review reported that water immersion during the first stage of labour can reduce the length of that stage, labour pain, and the use of epidural or spinal anaesthesia. It is also associated with a lower rate of cesarean delivery and stress urinary incontinence symptoms 42 days after delivery. The review reported that immersion during labour did not appear to increase the rate of infections for the mother or the baby, and Apgar scores for the newborn infant were similar to those of conventional births.<ref name="BMC Pregnancy & Childbirth">{{cite journal|title=A comparison of maternal and neonatal outcomes between water immersion during labour and conventional labour and delivery|author1=Yinglin Liu|author2=Yukun Liu|journal=Research Article|publisher=BioMed Central|author3=Xiuzhi Huang|author4=Chuying Du|author5=Jing Peng|author6=Peixian Huang|author7=Jianping Zhang|year=2014 |volume=14 |issue=1 |page=160 |doi=10.1186/1471-2393-14-160 |pmid=24886438 |pmc=4019783 |doi-access=free }}</ref>
==Criticisms==
Waterbirth may lead to a higher rate of cord avulsion, or the snapping of the umbilical cord.<ref>{{cite journal | url=https://onlinelibrary.wiley.com/doi/10.1111/jmwh.12157 | doi=10.1111/jmwh.12157 | title=Umbilical Cord Avulsion in Waterbirth | date=2014 | last1=Schafer | first1=Robyn | journal=Journal of Midwifery & Women's Health | volume=59 | issue=1 | pages=91–94 | pmid=24588881 | url-access=subscription }}</ref> Statements on water birth by peak gynaecological and midwifery bodies in the UK, Australia and New Zealand all stipulate that exclusion criteria apply for high risk births.<ref name="auto1">{{Cite web | title=Archived copy | url=https://ranzcog.edu.au/wp-content/uploads/2022/05/Water-immersion-during-labour-and-birth.pdf | archive-url=https://web.archive.org/web/20220703174109/https://ranzcog.edu.au/wp-content/uploads/2022/05/Water-immersion-during-labour-and-birth.pdf | archive-date=2022-07-03}}</ref><ref name="auto">{{Cite web | url=https://www.midwife.org.nz/wp-content/uploads/2019/05/The-Use-of-Water-for-Labour-and-Birth.pdf | title=Consensus Statement: The Use of Water for Labour and Birth | website=www.midwife.org.nz}}</ref><ref name="auto2">{{Cite web | title=POSITION STATEMENT - Use of Water Immersion for Labour and/or Birth | url=https://midwives.org.au/common/Uploaded%20files/ACM%20Position%20Statement%20Water%20Immersion%20Sept%202023.pdf | archive-url=https://web.archive.org/web/20231103011512/https://www.midwives.org.au/common/Uploaded%20files/ACM%20Position%20Statement%20Water%20Immersion%20Sept%202023.pdf | archive-date=2023-11-03}}</ref>
There is limited evidence for some of the purported benefits of waterbirth.
==Birth pool== [[File:A birth pool in a birth suite at the Royal Women's Hospital, Melbourne.jpg|thumb|A birth pool at the Royal Women's Hospital, Australia]] A birth pool is a specially designed vessel for waterbirth.<ref>{{cite book|last1=Harper, R.N.|first1=Barbara|title=Gentle Birth Choices|date=2005|publisher=Inner Traditions|isbn=1-59477-067-0|pages=[https://archive.org/details/gentlebirthchoic00barb/page/175 175]|url=https://archive.org/details/gentlebirthchoic00barb/page/175}}</ref> They are generally larger than bathtubs to enable buoyancy and freedom of movement during labour.<ref>{{cite web|title=Tips on encouraging a straightforward birth during labour|url=http://www.nct.org.uk/birth/encouraging-straightforward-birth-what-do-labour|publisher=National Childbirth Trust|access-date=27 August 2017|archive-date=28 August 2017|archive-url=https://web.archive.org/web/20170828020837/https://www.nct.org.uk/birth/encouraging-straightforward-birth-what-do-labour}}</ref> A birth pool can either be permanently installed or portable.
=== Characteristics === Before birth pools became readily available there were many stories of women labouring and birthing in re-purposed tub-like products including animal watering troughs.<ref>{{Cite book|title = Choosing Waterbirth|last = Bertram|first = Lakshmi|publisher = Hampton Roads Publishing Company, Inc|year = 2000|isbn = 1-57174-152-6|location = USA|pages = [https://archive.org/details/choosingwaterbir00bert/page/31 31]|url = https://archive.org/details/choosingwaterbir00bert/page/31}}</ref>
The original circular birth pool used by Michel Odent, the originator of the concept of birthing pools, at Pithiviers hospital in France in the early 1980s was {{convert|2|m}} in diameter and {{convert|60|cm}} deep, large enough to comfortably accommodate two people.<ref>{{Cite book|title = Gentle Birth Choices|last = Harper|first = Barbara|publisher = Inner Traditions|year = 2005|isbn = 1-59477-067-0|location = USA|pages = [https://archive.org/details/gentlebirthchoic00barb/page/175 175–176]|url = https://archive.org/details/gentlebirthchoic00barb/page/175}}</ref> Modern birth pools are somewhat smaller, with a diameter between {{cvt|110–150|cm}} and at least {{cvt|50|cm}}, preferably {{cvt|56|cm}}, of water.<ref>{{Cite book|title = The Waterbirth Handbook|last1 = Lichy|first1 = Dr. Roger|publisher = Gateway Books|year = 1993|isbn = 0-946551-70-7|location = UK|pages = 63, 132|last2 = Herzberg|first2 = Eileen}}</ref>
== Around the world ==
=== United Kingdom === The first official water birth in the UK was recorded on the 12th October 1984 in Hendon, London.
Approximately 10% of births in the UK take place in water, and approximately 20% of births include the use of water for pain relief.<ref>{{cite web |date=2 September 2024 |title=Safety of water births: New research |url=https://www.britishjournalofmidwifery.com/content/editorial/safety-of-water-births-new-research/#:~:text=Approximately%2010%25%20of%20women%20in,in%20water%20for%20pain%20relief}}</ref> A cohort study carried out in the UK of 73,229 women concluded that there was no association with adverse fetal or maternal outcomes.<ref>{{Cite web |last= |first= |title=Are waterbirths safe? |url=https://www.cardiff.ac.uk/news/view/2819206-are-waterbirths-safe |access-date=2024-11-13 |website=Cardiff University |language=en}}</ref>
Health policy in England stipulates women should be given the opportunity to labour in water through the publication of Intrapartum care guidelines issued in 2007 by the National Institute for Health and Care Excellence (NICE). The Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives have jointly supported labour and birthing in water, and encourage hospitals to ensure birth pools are available to all women.<ref name="RCM_RCOG">{{cite web |year=2006 |title=Immersion in water during labour and birth |url=http://www.rcog.org.uk/files/rcog-corp/uploaded-files/JointStatmentBirthInWater2006.pdf |archive-url=https://web.archive.org/web/20090413130622/http://www.rcog.org.uk/files/rcog-corp/uploaded-files/JointStatmentBirthInWater2006.pdf |archive-date=2009-04-13 |access-date=2012-08-29 |publisher=Royal College of Midwives/Royal College of Obstetricians and Gynaecologists}}</ref>
Birthing pools are available in many public hospitals in the UK.<ref>{{Cite web |date=2018-02-07 |title=What you need to know about giving birth in water |url=https://www.hey.nhs.uk/news/2018/02/07/need-know-giving-birth-water/ |access-date=2024-11-13 |website=Hull University Teaching Hospitals NHS Trust |language=en-GB}}</ref><ref>{{Cite web |title=How to prepare for a water birth |url=https://www.tommys.org/pregnancy-information/giving-birth/where-can-i-give-birth/how-prepare-water-birth |access-date=2024-11-13}}</ref><ref>{{Cite web | title=Archived copy | url=https://www.uhcw.nhs.uk/download/clientfiles/files/Patient%20Information%20Leaflets/Women%20and%20Children_s/Maternity/Information%20leaflet%20for%20patients%20requesting%20a%20waterbirth.pdf | archive-url=https://web.archive.org/web/20230329215943/https://www.uhcw.nhs.uk/download/clientfiles/files/Patient%20Information%20Leaflets/Women%20and%20Children_s/Maternity/Information%20leaflet%20for%20patients%20requesting%20a%20waterbirth.pdf | archive-date=2023-03-29}}</ref><ref>{{Cite web | title=Archived copy | url=https://www.uhs.nhs.uk/Media/UHS-website-2019/Patientinformation/Pregnancyandbirth/Using-water-for-labour-and-birth-1681-PIL.pdf | archive-url=https://web.archive.org/web/20241109052906/https://www.uhs.nhs.uk/Media/UHS-website-2019/Patientinformation/Pregnancyandbirth/Using-water-for-labour-and-birth-1681-PIL.pdf | archive-date=2024-11-09}}</ref><ref>{{Cite web |title=Water Labour & Birth |url=https://www.nhstayside.scot.nhs.uk/OurServicesA-Z/MaternityServices/PROD_341731/index.htm |access-date=2024-11-13}}</ref>
=== Australia and New Zealand === The Royal Australian and New Zealand College of Obstetricians and Gynaecologists supports the use of water immersion during labour within safety and clinical guidelines, noting that there is evidence of benefits to the mother and no evidence of adverse effects to the mother or baby.<ref name="auto1"/> The New Zealand College of Midwives supports water immersion during labour when there are no factors that would prevent it, noting that there is no evidence for adverse fetal or maternal outcomes, but that further evidence is required for the delivery of the placenta.<ref name="auto"/> The Australian College of Midwives also supports immersion in water during labour and/or birth.<ref name="auto2"/>
Birthing pools are available at many public and private hospitals in Australia<ref>{{Cite web|url=https://www.pregnancy.com.au/birth/waterbirth/waterbirth-hospitals/|title=Waterbirth Hospitals|first=Jane|last=Palmer}}</ref> and New Zealand.<ref>{{Cite web | title=Archived copy | url=https://nationalwomenshealth.adhb.govt.nz/assets/Womens-health/Documents/Policies-and-guidelines/Water-for-Labour-and-Birth.pdf | archive-url=https://web.archive.org/web/20190819001109/http://nationalwomenshealth.adhb.govt.nz:80/assets/Womens-health/Documents/Policies-and-guidelines/Water-for-Labour-and-Birth.pdf | archive-date=2019-08-19}}</ref><ref>{{Cite web | title=Archived copy | url=https://www.lakesdhb.govt.nz/assets/Maternity-Guidelines/163514-Waterbirth-and-Labouring-Guideline.pdf | archive-url=https://web.archive.org/web/20221127013859/https://www.lakesdhb.govt.nz/assets/Maternity-Guidelines/163514-Waterbirth-and-Labouring-Guideline.pdf | archive-date=2022-11-27}}</ref><ref>{{cite web |title=Wellington Hospital Maternity | CCDHB |url=https://www.ccdhb.org.nz/our-services/a-to-z-of-our-services/maternity/giving-birth-in-our-maternity-units/wellington-hospital-maternity/}}</ref>
=== United States === Water birth is not commonly available in hospitals in the United States, and American clinical opinion is generally skeptical of the practice. The American College of Obstetricians and Gynecologists does not recommend birthing in water, although its 2016 Committee Opinion on the matter states that immersion in water during the first stage of labour may be offered to women with uncomplicated pregnancies.<ref>{{Cite web |last=American College of Obstetricians and Gynecologists |date=November 2016 |title=Clinical Guideline: Immersion in Water During Labor and Delivery |url=https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2016/11/immersion-in-water-during-labor-and-delivery |access-date=August 4, 2020}}</ref>
In a 2005 commentary, the Committee on Fetus and Newborn of the American Academy of Pediatrics (AAP) released an analysis of the scientific literature regarding underwater births. The Committee noted several positive studies for underwater birth but went on to criticize them for lacking proper scientific controls, a significant number of infant deaths and diseases, and the general lack of information to support the use of water births.<ref name="AAP">{{Cite journal |author1=<!-- comment to keep out Citation Bot --> |last1=Committee On Fetus Newborn |last2=Blackmon |first2=D. G. |last3=Adamkin |first3=L. R. |last4=Bell |first4=D. H. |last5=Denson |first5=E. F. |last6=Engle |first6=S. E. |last7=Martin |first7=W. A. |last8=Stark |first8=G. I. |last9=Barrington |first9=A. R. |last10=Raju |first10=K. J. |last11=Riley |first11=T. N. |last12=Tomashek |first12=L. |last13=Wallman |first13=K. M. |last14=Couto |first14=C. |last15=Couto |first15=J. |year=2005 |title=Underwater Births |journal=Pediatrics |volume=115 |issue=5 |pages=1413–1414 |doi=10.1542/peds.2004-1738 |pmid=15867054 |s2cid=31354079}}</ref>
==References== {{Reflist}}
{{Pregnancy}} {{Authority control}}
{{DEFAULTSORT:Water Birth}} Category:Childbirth Category:Natural childbirth Category:Midwifery Category:Obstetrics Category:Maternity in the United Kingdom Category:Water Category:Pain management