Water Birth

Early accounts and a Soviet movement

The Cochrane review of immersion in water during labor and birth states that there is evidence of immersion in water being used as a treatment for physical and psychological ill health in the past. It credits Igor Tjarkovsky, a Russian boat builder, with stimulating the foundation of a movement to promote waterbirth, and says that Michel Odent subsequently popularized water immersion in other European countries. The sources reviewed for this page give no dates or further detail for Tjarkovsky's work, and the review does not describe how his ideas reached Western Europe.

Michel Odent and the Pithiviers unit

A historian's account of childbirth debates in France describes Odent as a surgeon and head of maternity services at the Hôpital de Pithiviers until the mid-1980s. Labor rooms there were free of medical instruments, and a few years after the unit opened Odent introduced 'blue rooms' to accommodate water births. The account reports that the unit's annual birth rate doubled from 500 to 1000 in a few years, and that Odent left in 1985 and moved to London. The same article credits the 1974 bestseller by the obstetrician Frédéric Leboyer as a turning point in French childbirth debates. The sources reviewed do not describe a direct link between Leboyer's book and the use of birth pools.

Odent published a short report titled 'Birth under water' in The Lancet in 1983. The PubMed record for that report carries no abstract, so this page does not describe what it reported.

Spread into maternity services

The 2006 joint statement of the Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives says that a perception of relaxation, pain relief, ease of movement and a more holistic experience made labor in water a popular choice during the 1980s, and that the concept was then extended to birth under water following widely quoted experience from France. It reports that the Winterton Report recommended that all maternity services provide women with the option to labor or give birth in water. The Cochrane review adds that water immersion in labor gained acceptance as a care option in the UK in 1993 and that the first international waterbirth conference was held in London in 1995.

In the United States, a 2022 report from the American Academy of Pediatrics states that most birthing centers have birthing tubs, that hospitals are increasingly interested in tubs mainly for laboring, and that no data are available on how many water births occur nationally. The American College of Obstetricians and Gynecologists (ACOG) similarly notes that prevalence is uncertain because the data are not recorded on birth certificates.

Immersion in labor versus birth in water

The Cochrane review uses 'water immersion' for immersion in water by a pregnant woman during any stage of labor and 'waterbirth' for a birth in which the neonate is born under the water. The Royal Colleges' joint statement stresses that evidence on immersion during the active phase of labor should be separated from evidence on actual birth in water, and the later guidance of ACOG and NICE follows the same division between the first stage of labor and the second stage and delivery.

Names and how studies use them

Sources use several names for the practice, including waterbirth, water birth, underwater delivery, water immersion birth and bathing. A 2022 meta-analysis of 36 studies grouped 25 studies of planned or actual waterbirth, seven of immersion in labor only, and three that covered both, and a 2026 review of bathing in the first stage of labor included only trials of labor immersion. Because the terms overlap, a finding reported for 'water birth' may describe labor immersion, birth in water, or a mixture, and each study needs to be read for the stage it examined.

Settings and equipment in general terms

The American Academy of Pediatrics describes water immersion birth as giving birth in warm water, with the stated goal of creating a gradual transition from the in utero environment while decreasing stress and increasing comfort for the pregnant person. It notes that planned water births may occur in birthing centers, in hospitals, or at home with midwives in attendance. A 2022 meta-analysis reports that in the UK most birthing pool use occurs in midwife-led settings, while its included studies were mainly from obstetric units. All trials in the Cochrane review were run on hospital labor wards, and none took place in a midwife-led setting.

Care frameworks described by professional bodies

ACOG states that facilities planning to offer immersion need protocols for candidate selection, maintenance and cleaning of tubs and pools, infection control, monitoring of women and fetuses at appropriate intervals, and moving women out of the tub if urgent maternal or fetal concerns develop. The Royal Colleges' joint statement describes similar elements, including fetal heart monitoring, a locally agreed procedure for helping a woman out of the pool if she becomes compromised, and attendants who are alert to the possibility of cord rupture. NICE recommends offering women the opportunity to labor in water for pain relief, and recommends that the temperature of the woman and of the water be monitored hourly. This page does not set out pool temperatures, depths or procedures, which are matters for local clinical protocols.

Related Machipedia pages

Water birth is one of the practices covered under the Machipedia family page Birth Support, which this page refers to rather than repeats. Related pages include Natural Childbirth, Midwifery and Doula, which describe other approaches and roles around labor, and Hydrotherapy, which covers therapeutic uses of water more broadly. The sources reviewed for this page do not describe the role of doulas in water birth specifically.

Claims made for immersion during labor

The Royal Colleges' joint statement lists perceived benefits of immersion during labor, including less painful contractions, less need for pharmacological analgesia, shorter labor and less need for augmentation, while adding that whether warm water actually reduces pain is less certain. The statement also describes lying in warm water as giving a sense of relaxation. NICE's pain relief recommendations place labor in water among non-pharmacological options that women may be offered for pain relief.

Claims made for giving birth in water

The stated aim of birth in water, according to the American Academy of Pediatrics report, is a gradual transition from the in utero environment with less stress and more comfort for the pregnant person. The NICE committee noted that water birth is generally well accepted and can improve maternal satisfaction, although this outcome was not directly reported in the studies it reviewed. ACOG states that neither the Cochrane review nor any trial in it reported a benefit to the newborn from maternal immersion during labor or delivery.

Immersion during the first stage of labor

The 2018 Cochrane review included 15 randomized trials conducted between 1990 and 2015 with 3663 healthy, low-risk women at term. For immersion in the first stage of labor compared with no immersion, it found probably little or no difference in spontaneous vaginal birth (82 percent versus 83 percent; moderate-quality evidence) and a small reduction in regional analgesia use from 43 percent to 39 percent (risk ratio 0.91, 95 percent confidence interval 0.83 to 0.99; moderate-quality evidence). Evidence on neonatal intensive care admission and neonatal infection was too limited to draw conclusions, with low to very low certainty. No trial was run in a midwife-led setting.

A 2026 systematic review of nine trials (1823 women) of bathing during the first stage of labor found no clear analgesic-sparing effect (risk ratio 0.91, prediction interval 0.82 to 1.01) but fewer instrumental vaginal births. The authors rated the certainty of evidence low to very low.

Birth in water: randomized trials

The Cochrane review found only two trials of immersion during the second stage alone and four covering both stages. For the second stage it found no clear differences in birth mode or neonatal intensive care admission, with low to very low certainty. A 2023 review limited to randomized trials of waterbirth found six trials with 706 participants. Neuraxial anesthesia was less common with waterbirth (10.5 percent versus 72.4 percent) and satisfaction was higher; the authors reported that data on neonatal outcomes were insufficient and that a composite perinatal outcome could not be calculated.

A 2025 single-site randomized trial in a United States hospital enrolled 186 low-risk participants, of whom 106 remained eligible, with 39 percent attrition. Waterbirth participants were less likely to receive intravenous narcotics (risk ratio 0.36) or epidural analgesia (risk ratio 0.38), and one cord avulsion occurred in the waterbirth group. The trial was small and unblinded.

Observational studies and meta-analyses

A 2022 meta-analysis of 36 mostly observational studies (157,546 participants) found that water immersion was associated with lower odds of epidural, injected opioids, episiotomy and postpartum hemorrhage, higher satisfaction and higher odds of an intact perineum. Waterbirth was associated with higher odds of cord avulsion (odds ratio 1.94), with absolute rates of 4.3 per 1000 in water versus 1.3 per 1000 under standard care, and no differences in other neonatal outcomes. A 2024 meta-analysis of 52 studies reported a similar cord avulsion association (odds ratio 1.75) and lower odds of neonatal intensive care admission and neonatal infection among water births.

A 2016 review of 29 comparative studies found no significant difference in neonatal mortality, intensive care admission, Apgar scores, cord gases or infection rates, but described most studies as small with limited follow-up. It found no definitive evidence that waterbirth harms neonates and insufficient evidence to conclude there are no additional risks or benefits.

ACOG and the American Academy of Pediatrics

ACOG's Committee Opinion 679 (November 2016, replacing an April 2014 opinion and endorsed by the American Academy of Pediatrics) states that immersion in the first stage of labor may be associated with shorter labor and less spinal and epidural analgesia and may be offered to healthy women with uncomplicated pregnancies between 37 0/7 and 41 6/7 weeks. It finds insufficient data on the second stage and delivery and recommends that birth occur on land, not in water, while saying that a woman who requests a water birth should be told the benefits and risks have not been studied sufficiently to support or discourage the request. The American Academy of Pediatrics report of 2022 repeats the 2014 joint position and advises that families be cautioned against water birth during and past the second stage. No later ACOG update was found in the sources reviewed.

UK Royal Colleges and NICE

The 2006 joint statement of the Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives supports labor in water for healthy women with uncomplicated pregnancies and says that the evidence supporting underwater birth is less clear but that complications are seemingly rare. NICE guideline NG235 recommends considering birth in water and, in a 2025 recommendation, advises discussing that evidence suggests water birth may be associated with a lower risk of severe perineal trauma in women who have given birth before, a lower risk of postpartum hemorrhage, an increased risk of the cord snapping before clamping and a lower risk of neonatal unit admission, and that evidence on the risk of the baby dying was inconclusive. The committee described the evidence as generally of low to very low certainty.

Documented rare harms

Case reports and case series describe complications in newborns after immersion births, including hypothermia, drowning or near-drowning, respiratory distress and infections, according to the American Academy of Pediatrics. The Royal Colleges' statement lists rare but clinically significant risks of respiratory problems, cord rupture with hemorrhage and waterborne infections, and cites one review of 16 articles that identified 63 neonatal complications attributed to water birth. The Cochrane review notes case reports of transient tachypnea of the newborn after waterbirth and concern that a woman could develop a raised temperature when immersed in water warmer than her own core temperature.

Cord avulsion, meaning the umbilical cord tearing or snapping before clamping, is the harm most consistently higher in comparative studies, with absolute rates the 2022 meta-analysis put at 4.3 per 1000 water births, within a reported range of 0.2 to 11.8 per 1000 across studies. For infection, the American Academy of Pediatrics reports infections and deaths from Pseudomonas and Legionella species in newborns, states that the overall incidence is unknown because water births are not tracked, and cautions that sepsis can follow even when the infant is initially well. Meta-analyses of comparative studies have not found higher overall neonatal infection rates.

Who may be unsuitable

Trials and guidance address healthy women with uncomplicated pregnancies at term, and the Cochrane review limited inclusion to singleton pregnancies at term. The sources reviewed do not establish the effects of water immersion in higher-risk pregnancies, and the Royal Colleges note that a trial in women with prolonged labor found fewer obstetric interventions but more babies admitted to the neonatal unit. NICE advises that women should not enter water within 2 hours of opioid administration or if they feel drowsy, and that women with mobility issues should be supported through an individual needs assessment.

Hygiene and facilities

Professional bodies address pool hygiene in general terms only. NICE recommends that baths and birthing pools be kept clean using a protocol agreed with local microbiology or infection control guidance and, for birthing pools, the manufacturer's guidelines. ACOG lists maintenance and cleaning of tubs and pools and infection control procedures among the requirements for facilities offering immersion. The American Academy of Pediatrics says midwives and obstetricians offering the option must have rigorous cleaning and disinfection in place.

Care boundary

This page is general information and not medical advice. ACOG and NICE both describe moving a woman out of the water if urgent maternal or fetal concerns develop,. Anyone considering labor in water or a water birth can discuss it with their obstetrician or midwife, and no practice described here should delay or replace necessary medical care.