What is Water Birth?

abby3377
Jul 29
5 min read

Updated: Jul 30

The benefits, risks, and physiology of what happens to our bodies in the water

The moment my daughter emerged, my husband couldn't hide his anxiety. Biting his lip, he urged me through gritted teeth: "Can you keep pushing?" He eyed the bath water, then he eyed my daughter's submerged head. Though his worry was palpable, so was my need to pause. I had just pushed out my daughter's head -- which I later found out was part of a 9-pound body -- and I needed this rest. In that moment I knew she was safe, and I was elated, happy to take a deep breath before my next, final push.

I wasn't quite sure how I knew everything would be okay. Should I have been concerned about birthing in the bath -- the temperature, the germs, the chance that she might try to breathe? In the moment, I didn't know these answers, but I knew one thing: Stepping into the bath had released all my tension, and as soon as I experienced one (relaxing!) contraction in the water, I had gotten the overwhelming urge to push. This felt like the right place for me.

What is water birth?

Water birth is just what it sounds: The practice of giving birth in warm water, which works to provide a soothing place to usher the baby out gently. Water birth has been used for centuries and can be a wonderful, evidence-based option for low risk pregnancies.

Why might I choose to have a water birth?

Observing the effects of water on a laboring person is mesmerizing. In the midst of a grueling labor, the tension and the look of pain appear to melt as the laboring person steps into the tub. It honestly feels like… magic. So what is the science behind this, and what are the evidence-based effects of birth in the water?

Pain relief. Hydrostatic pressure, provided by all the water surrounding you as you immerse yourself in the tub, stimulates sensory receptors on your skin and in your body, which feel what's happening: the touch of the water and the temperature increase. Fortunately for the laboring person, this sensation then does a few things, first triggering an endorphin and oxytocin release. (Remember the power of oxytocin during labor?)

Even better, by stimulating your nerve fibers in a positive way, this sensation competes with the pain you are feeling from contractions. The results? Less perception of pain. This distraction is part of the Gateway Theory of Pain.

Muscle relaxation. Submerged in water, aided by warmth, and feeling less of gravity's pull... it's easy to see why muscles have an easier time relaxing in water than on land. This relaxation can help to facilitate the laboring person's movement, easing them into finding new positions, which can further help the baby rotate into its best position for the progression of labor.

Increased sense of control. One advantage of a water birth is the separation of the birthing person from the rest of the room. This may sound a bit silly -- who wouldn't want care providers close at hand? -- but labor is, well, intimate. Sometimes having a bit of your own physical space can do wonders to provide you with your own sense of self.

Decreased lacerations. Both randomized trials and observational studies have found that water birth is associated with fewer perineal tears, and the largest observational study found that water birth is associated with a lower rate of severe perineal tears (3rd or 4th degree lacerations).

Overall, water birth is protective of vaginal birth, providing pain relief that can lead to less epidurals and other cascading labor interventions.

And what about the baby?

Imagine that for your entire life, you have experienced only a few sensations: the rhythm of a heartbeat, the squish of the sounds of organs working, and the warmth and softness of an amniotic sac. Then things change. All of a sudden, the temperature is different, light enters your eyes for the first time, you hear voices that you don't know, and things -- fingers? a towel? a cold metal device? -- are touching your skin. This is a baby's entrance to the world, and it can be harsh. When a baby enters the world through the water, those changes are introduced more gradually, more gently.

As for breathing, the good news for babies is that their bodies do not give the signal to breathe through their mouths until their faces come in contact with the air. Until this happens, the baby experiences the dive reflex, which (as long as they are under water) tells the brain not to breathe, and closes the airway. Instead, a baby's first breath is prompted by a specific combination of stimuli: air touching the face, a temperature change between the warm water and the cooler air, and the physical sensation of being handled. In their moments under water before they are fully birthed and then lifted above the water, none of these happen. Baby is not given the signal to breathe. Add to that, they will continue to receive oxygen through their umbilical cord as long as the placenta is still attached inside the birthing person.

As for germs, while it is best practice to give birth in a sanitized tub more likely found at a birthing institution rather than at home, numerous studies comparing water and land births noted no increased risk of infection for babies born in the water.

Are there risks to a water birth?

Water birth is safe for uncomplicated pregnancies, but may not be accessible to laboring persons who experience complications which need to be proactively monitored on land. Further, interventions such as epidural do not make water birth a safe option.

In the numerous studies conducted to compare water birth to land birth, the only notable increase in risk to babies born in the water was that of cord avulsion, or the snapping of the cord from the placenta as the baby emerged from the water. Normally before a cord is cut it is also clamped, which prevents the baby from exposure to any outside bacteria. In the case of cord avulsion, there is risk of bacterial exposure before the cord is clamped. Fortunately, cord avulsion is not considered an emergency for a skilled provider, because as long as the cord avulsion is recognized and the cord immediately clamped, the risk of infection can be avoided.

Three years after my first water birth, I had my son, once again using the pain relief and relaxation of the birth tub. This time my husband knew of both the safety and effects of the tub, and fortunately for me, rather than expressing worry as he watched my son emerge, he simply held my hand, ready for the next push.