Since babies receive oxygen from the placenta via the umbilical cord while inside the womb and only take their first breath once they are exposed to air, it is quite safe for a baby to be born underwater.
Since it is not possible to detect when the placenta may begin to detach from the uterus, the baby should be gently lifted from the water within a few seconds, and placed into her mother's arms.All healthy women with uncomplicated pregnancies at term should have the option of water birth available to them and should be able to proceed to a water birth if they wish.1
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Below are statements about giving birth in water, based on evidence-based research:
According to a joint position paper produced on behalf of the Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives, "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. 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." 1
The most recent evidence on giving birth in water is a Cochrane review by Cluett et al.2
This research showed that there was no difference found in the use of analgesia, although women who were immersed 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 was also no difference in neonatal outcomes for the babies.
There is very little available evidence on underwater birth and what there is, is restricted to healthy women with uncomplicated pregnancy at term. However, there have been no reported problems where induction of labour and VBAC's (vaginal birth after previous cesarean) have been managed using water for labour and birth.
Where women have not only labored in water, but also given birth underwater, various studies report that there is no evidence of higher perinatal mortality or admission to special care baby units for babies who were birthed in water.3,4,5
The RCOG and RCM Joint Poisition Paper therefore states that "All healthy women with uncomplicated pregnancies at term should have the option of water birth available to them and should be able to proceed to a water birth if they wish."
In the UK, in response to public demand, the Winterton Report recommended that all maternity services provide women with the option to labour and/or give birth in water.6
In the USA, The American College of Obstetricians and Gynecologists is reported to have made no public statement on giving birth in water to date.
1. Royal College of Midwives. 2006. "Immersion in water during labour and birth." Joint Position Paper no. 1. London, Royal College of Obstetricians and Gynecologists and Royal College of Midwives.
2. Cluett ER, Nikodem VC, McCandlish RE, Burns EE. Immersion in water in pregnancy, labour and birth. Cochrane Database Syst Rev. 2004;(2):CD000111.
3. Gilbert RE, Tookey PA. Perinatal mortality and morbidity among babies delivered in water: surveillance study and postal survey. BMJ 1999;319:483-7.
4. Woodward J, Kelly SM. A pilot study for a randomised controlled trial of waterbirth versus land birth. BJOG 2004;111:537-45.
5. Geissbuehler V, Stein S, Eberhard J. Waterbirths compared with landbirths - an observational study of nine years. J Perinat Med 2004;32:308-14.
6. House of Commons Health Committee. Second Report on the Maternity Services (Winterton report). London: HMSO; 1992.
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