Pros and Cons of Water Births

When I was pregnant, I planned to have a home water birth. This didn’t happen (I’ll go into more detail about that later). But I was fully prepared to use a birthing tub. So I want to offer some information about water-births and hydrotherapy tubs.

History of Water-Tubs

I recently watched the beautiful film Song of the Sea. It’s based on Irish folklore where some women are also seals, or “Silke's”. In the movie, the mother gives birth in the ocean. Many ancient civilizations have water birth practices.

Westernized versions of water tubs are cited around 1805 in France.

It’s currently practiced and thoroughly supported in over 90 countries worldwide.

As a pelvic health therapist, I'm interested in how water births affect perineal tearing. Tearing can (but doesn’t always) lead to pelvic floor dysfunction down the road.

Perineal tears are common. Especially in these conditions:

• When people give birth vaginally for the first time
• When they're over 35 years of age
• Have had longer pushing phases during labor
• Give birth to larger babies
• Or give birth in upright positions.

Current research states:

Water births may have a slightly higher rate of 1st and 2nd-degree tears. They possibly have lower rates of severe tears (3rd or 4th degree). Especially in high-episiotomy settings. 3rd and 4th-degree tears affect the anal sphincter and 1st and 2nd-degree tears do not.

What is using a birth tub actually like?

This depends on your provider and setting. Some women choose to labor and deliver in the birth tub, while others just labor, and others just deliver. It all depends on how things are progressing. Listen to your intuition and your healthcare provider’s guidance.

Water Birth Pros

1. Being in water may help make giving birth less stressful and physically challenging. This study looked at rates of anxiety, pain, contractions, and the effect on the neuroendocrine system in women who utilized a birth tub during their delivery. Only 11 women were in the study. But what I like about it is that they use chemical blood markers to measure the above variables. The data was quantitative. While in the tub, cortisol levels dropped, intrauterine contraction frequency decreased. The conclusion was that water births are helpful to our physiology when delivering.
2. It may shorten your labor. This study mentions hydro births shortening the second stage of labor.
3. It’s a noninvasive modality. It can be something you dip in and out of. Warm water can help you relax without medicine. Some believe that is a more “gentle entrance” into the world for your baby. A water tub provides an intermediary time between the womb and being born into full-fledged air.

Water Birth Cons

1. Birth is unpredictable and timing is tricky. My son came at 39 weeks... and fast. I came home from work at 10:15 a.m. and he was born at 1:44 that afternoon. I was in denial that I was even in labor until about an hour before he was born. I thought I was just experiencing Braxton Hicks’s contractions. So, I waited too long to call my midwife and the only thing I asked my husband to do was go make a grocery store run. I was laboring alone in our apartment without even realizing that’s what I was doing. That meant the birth tub did not get set up. That being said, if I had been in a facility (either hospital or birth center) that supported water births, perhaps my birth story would be a little different.
2. Temperature management. It can be a little tricky to keep the water temperature warm enough. Especially if your labor winds up being lengthy.
3. Getting one. They can take some detective work to get ahold of, especially if using them is not commonplace in your area. We borrowed one from our midwife and then bought our birth pool liner.
4. The current estimated number of U.S. hospitals offering water immersion options is lower than 10% of all maternity care facilities.
5. Not everyone is comfortable with them. If this is on your radar, be sure you check with the facility/midwife/healthcare practitioner who will be overseeing your birth. Make sure they are comfortable and practiced with water birth deliveries. If you are doing a home birth, make sure your partner has done a practice run with setting it up before B-Day. It'll likely be on them to make sure everything is good to go.
6. When you already have a lot of uncertainties swirling around in your mind, it can be another thing that starts the bombardment of questions. Will the hose reach? What if there’s a leak? When and how does it get cleaned afterward?

Thoughts about maternal safety

The main conclusion is that water births are safe for low-risk pregnancies. As long as you (the mother) and your healthcare provider are comfortable with the option.

Thoughts for your baby’s safety

• And, when it comes to your baby’s health: A Cochrane Collaboration review of water birth in three randomized controlled trials (RCTs) shows no research that demonstrates adverse effects to the fetus or neonate.
• Also, APGAR scores (the gold standard check for neonatal function) are found to be unaffected by water births. 

To learn more visit: 

1. Waterbirth International 
2. Evidence-Based Birth. It has a TON of information and cites an incredible amount of information from high-level studies.  
3. The New York Times did an amazing piece about water births in 2019. Read It Here.