Labor and birth occurs over three stages. The first stage is the beginning of contractions that gradually increase in intensity and frequency. Stage two is active labor and pushing that ends with the birth. The third stage is the pass of the placenta. The first two stages in particular are physically taxing and painful for the mother as contractions of the uterus work to position the baby for birth. There are many options to help manage pain and anxiety through labor and delivery such as focused breathing techniques (eg, Lamaze), coaching, medications, and anesthesia. Immersion in warm water, another less commonly used method, is believed to help the mother relax and provide some buoyancy to make it easier to move about. While this technique has been used for many years, it has only recently become more available in traditional birthing centers.
The Cochrane Library group reviewed several past studies to assess the benefits and risks of water immersion during labor and birth. The review, published in the Cochrane Database, found that water immersion in the first stage of labor increased the mother’s relaxation and decreased the need for pain medication. The study also found no increased risk of illness or death of the mother and baby with a water birth.
The systematic review included 11 previously published randomized trials. The trials all compared labor and/or births in water to labor and births on dry land. A total of 3,146 births were reviewed. Compared to the women that did not participate in water immersion, during the first stage of labor:
When comparing both groups there was no significant difference in delivery complications, cesarean deliveries, and infections in the mother. There was also no significant difference in the health of the infant or the likelihood of infant complications. None of the studies evaluated the effect of water immersion during the third stage of labor or reviewed the different tubs available for water births.
The trials included in this study were high quality studies which meant their results are considered reliable. However, there was limited information on some outcomes in these studies. For example, the majority of studies, nine out of the eleven, only examined the first stage of labor and only two studies reviewed the benefits of water immersion for the second stage of labor and birth. Overall, water immersion does appear to help reduce pain and anxiety for the birth mother. Relaxation is felt to improve the progression of labor. While the information available showed no increase in health risks for the mother or the baby, researchers did encourage further study because of the low number of trials focused on water births (stage 2).
Water immersion labor and birth are becoming available in more birthing centers. If you are interested in having the warm bath available for your labor or birth, talk to your obstetrician. This method is not ideal for all pregnancies and should be avoided for mothers who:
Keep in mind that the birthing experience is different for each woman. If you have options to choose from, seek out a birth center or professional that can help you with your choices. While a birth plan is recommended, keep in mind that your baby may have plans of his or her own and changes may be needed as the labor and birth progresses.
Cluett ER, Burns E. Immersion in water in labour and birth.Cochrane Database of Systematic Reviews. 2009. Issue 2. Art. No.: CD000111. DOI: 10.1002/14651858.CD000111.pub3.
Last reviewed July 2009 by Richard Glickman-Simon, MD Last Updated: 7/13/2009