Frequently Asked Questions

Is every woman a candidate for a water birth?

So long as there are no medical contra-indications, any woman is a possible candidate for a water birth. Once health concerns are set aside, it is important to think (and be realistic) about your philosophies, thoughts, and fears relating to birth. This realistic appraisal will be helpful in assessing whether you might be a realistic candidate for a water birth. It is best to set-up an appointment with a water birth consultant/doula.

What’s the difference between water immersion and water birth?

Water immersion means that the woman labors in water but gets out of the tub to deliver the baby. Water birth means that the woman labors in the water and delivers the baby into water.

Where can you do a water immersion or water birth?

You can do a water immersion or water birth at home, in a hospital, at a birth center or in the ocean.

What are the most common reason women want to labor and/or give birth in water?

The most common reason women like the water is because it feels good. Water helps women cope with the sensations and surges of labor and birth. Many women report that the water enables them to override the epidural. In fact, when speaking with a woman whose labor I attended, I noted, “From my observations of you during labor, if you had not had the tub available, I believe there was an 80 percent chance you would have gotten an epidural.” “Eighty!” She exclaimed back, “200 percent I would have gotten the epidural. The water saved me.”

What is the appropriate temperature for the water?

The water should not exceed the body temperature, which is approximately 97 degrees Fahrenheit (37 degrees Celsius). Temperatures exceeding this level can lead to hyperthermia and dehydration in the mother and the baby. Temperatures above 97 degrees also can cause baby’s heart rate to go up. Keeping mom hydrated and offering her a spray bottle filled with cool water for her to spray her face and neck can help with comfort. It’s less of a concern if the tub water drops a bit while the mom is laboring, as babies withstand cooler water temperatures well.

When should I get into the tub?

Before getting into the tub, it is recommended that you wait until your contractions are strong and consistent, which occurs around 5 centimeters. Some women have utilized the water for rest and regeneration in early labor (before 5 centimeters) if there has been a long prodromal stage (irregular contractions, with a small amount of dilation or none at all). Some caregivers feel that getting in the tub too early can cause a woman’s labors to slow down because she may become too relaxed, but each woman’s labor should be considered individually.

How deep should the water be?

Ideally, deep immersion is a key factor. If the bath or pool is not deep enough, up to breast level and completely covering the belly, then the benefits may be less noticeable. Full immersion promotes more physiological responses, the most notable being a redistribution of blood volume, which stimulates the release of oxytocin and vasopressin.

How long should I stay in the water?

Most studies have indicated staying in the water for an hour or two. Twenty minutes in the bath is not enough for the physiologic responses to work effectively. Primips (first timers) and multips (multiple birthers) can get into the water at 7 cm or 8 cm dilation and begin to experience pushing urges within the first hour of immersion. If the contractions begin to space out and slow down, it is advisable to get out of the tub and become ambulatory.

Will I be able to switch positions while in the tub?

You are encouraged to try different positions and to do what works best for you at the time. You are much more able to switch positions with less effort while in the water than on land.

Can my husband/partner get in the tub with me?

Another person can get into the tub with you. If the father or anyone else gets in the tub, make sure they have showered and are not harboring any staff infections on their bodies. Make sure the tub is filled with less water, since the water level increases 1″ to 2″ for every person in the tub. Some women prefer that their partners support them from outside the tub, while others like their partner to join them in the water.

Can I drink while I am in the tub?

It is imperative the woman and her attendants drink fluids with glucose while in the birth room. Some labor tea with agave is nice, or even water infused with electrolytes. Dehydration of the mother leads to low blood volume and could possibly result in orthostatic hypotension, passing out when standing up to get out of the pool.

Is there a risk of infection for the baby?

So long as you clean the tub beforehand, use clean water, a new hot water hose and a disposable tub liner (if your tub calls for one) risk of infection is small. Because the mother and the baby share the same antibodies, there is no risk of the baby “catching” anything from the mother. Note, however, that if the water has been in the tub for more than 24 hours, change the water as a sanitary precaution.

Is there a risk of infection for the mother?

There is little known risk of infection to the mother. Water also dissipates bacteria so pathogens would more than likely be weaker in the water. Since the baby is moving downward and out of the birth canal, it does not follow logically that bacteria can travel upward and into the birth canal. A mother is more apt to get an infection from too many vaginal exams; probes, Amini-hooks or scalp hooks before laboring in water after her membranes have ruptured.

What if debris gets in the water during labor?

If birth or fecal matter enter the water, use a kitty litter scooper (available at most pet supply stores or in your tub kit) for removal.

Is it safe to urinate and/or have a bowel movement in the tub?

Urine is a sterile substance, so it is permissible for the laboring woman to urinate in the water. Birth attendants and partners, however, should get out of the tub and use the bathroom. It is also permissible to release a bowel movement in the water (and this may very well happen during the second or third stage of labor). Remove the fecal matter from the water with a scooper as soon as possible.

What are the contraindications (risks) for a water immersion or birth for mother and baby?

*See BENEFITS/RISKS section in website.

How does the baby breathe if it is born into water?

There are 5 inhibitory factors that prevent a baby from inhaling water when born:

1. The baby in utero is oxygenated through the umbilical cord via the placenta. When a baby breathes air, the intercostal muscles and diaphragm move in a regular and rhythmic pattern. 24 to 48 hours before the onset of labor the prostaglandin E2 levels form the placenta cause a slowing down or stopping in the fetal breathing movements (FBM).(1) The diaphragm and intercostal muscles become suspended and there is a decrease in the FBM. At the birth, the baby’s muscles for breathing simply don’t work.

2. Babies are born experiencing acute hypoxia or lack of oxygen. This is built-in response to the birth process. Hypoxia causes apnea and swallowing, not breathing or gasping. If the fetus experienced severe and prolonged lack of oxygen, it may gas as soon as it was born, possibly inhaling water into the lungs. (2)

3. The temperature differential is another factor. When a baby is born into water so close to maternal temperature the baby doesn’t detect a change so no breathing is initiated. In some places where an ocean birth occurs, the water is much cooler than maternal temperature. This is an area for reconsideration since lower temperatures do not seem to stimulate the baby to breathe while immersed either.

4. Water is a hypotonic solution and lung fluids present in the fetus are hypertonic. Hypertonic solutions are denser and prevent hypotonic solutions from merging or coming into their presence. Thus, as water passes through the larynx it does not pass into the lungs.

5. The ‘mammalian dive or autonomic reflex’ built into all newborns is present at birth and mysteriously disappears around 6 to 8 months. This reflex is associated with the taste buds along the larynx. When a solution hits the back of the throat and crosses the larynx, the taste buds interpret what substance it is and the glottis automatically closes: the solution is then swallowed, not inhaled. (3)

(*These five inhibitory factors are from Waterbirth Basics, From Newborn Breathing to Hospital Protocols by Barbara Harper, Midwifery Today with International Midwife, Summer 2000, Number 54.

It has been discovered newborns exposed to water training up to 8 months after birth are able to avoid atrophy of the mammalian dive reflex.

(Waterbirth and the Emergence of the Newborn, by Marina Alzugaray, CNM, Midwifery Today with International Midwife, Summer 2000, Number 54.

What causes the baby to start breathing?

There is a complex chain of chemical, hormonal and physical responses, resulting in the baby breathing when the environment changes from water to air. Babies born in the water tend to breath slower due to the initiation of the breath stemming from the lower lobes of the lungs.

Some midwives have stated the babies remain blue a bit longer but they are alert and have tone in their bodies.  Studies have indicated it is better to give the first APGAR score at one minute 30 seconds and not at one minute due to this difference.

Physiologically what happens at birth is: the shunts in the heart close; fetal circulation turns to newborn circulation; the lungs experience oxygen for the first time; the umbilical cord is stretched causing the umbilical arteries to close down.

The fluids that are present in the lung alveoli are pushed into the vascular system from the pressure of pulmonary circulation increasing blood volume for the newborn by 1/5th or 20 %F.  The lymphatic system absorbs the rest of the fluids through interstitial spaces in the lung tissue.  The increase of blood volume is important for the baby’s health, taking about six hours for all the lung fluids to disappear. (4)

When should the baby be lifted from the water?

The baby should be gently lifted from the water as soon as the entire body is born. The reasoning behind this is if the placenta separates quickly and the baby remains under water, oxygen to the baby may be compromised. The umbilical cord continuing to pulsate isn’t a certain indicator that the baby is still receiving enough oxygen. If she desires, the new mother can reach down and lift the baby up to her chest. Alternatively, the father/partner or midwife may lift the baby up as well. It is important to lift the baby slowly so as not to accidentally tear a short cord or dislodge the placenta. Some caregivers, however, feel that the baby should be given time underwater to compose itself and be lifted out of the water only when he or she begins moving the legs, indicating the organic crawl toward the mother’s breasts for breastfeeding.

From 1985 to 1999, it’s estimated there have been over 150,00 cases of water birth worldwide.  A study conducted in England between 1994 and 1996 and published in 1999, reports on the outcomes of 4032 births in water.  Perinatal mortality was 1.2 per 1000, but no deaths were attributed to birth in the water.  Two babies were admitted to special care for possible water aspiration. (5)

A death reported early on with water birth was caused not by aspiration but by asphyxiation due to leaving the baby underwater too long after the full body of the baby was born.  The placenta detaches from the uterine wall as or shortly after the baby is born and thus the supply of oxygen to the baby is compromised.  An autopsy on one baby was reported to have no water in the lungs and its death was attributed to asphyxia. (6)

Can I birth the placenta into water?

This is a matter to discuss with your individual medical caregiver. Some women choose to birth their placentas into water in order to extend the bonding with their babies. Make sure there is an adequate sized ‘waiting bowl’ to hold the placenta as it floats in the water, attached to the cut or uncut umbilical cord. However, if the mother remains in the water and the placenta takes too much time to present (this is relative to your caregiver perception of time,) it is best to get out of the tub.

Is it important that the doula I hire is not highly experienced in water birth or water labor?

There is so much information made readily available to the public on water labor and water birth that it is relatively easy and worthwhile for a doula to read up and educate herself. The Internet, books, articles, magazines and videos offer a plethora of information. Going to a “Water Birth Consultant” for a consultation is also advisable. It is most important you have a strong connection with the doula who will attend your birth. Educating and participating is a moment-to-moment experience.

How to support someone to have a water birth?

Hospitals are more cooperative today than ever before as more and more women begin to start asking for what they want.  The process can be started by inquiring if a tub might be brought into the hospital to labor or birth in.  The motivation within the mother or couple is paramount.  Next she/they need to seek a provider willing to assist this sort of labor or birth whether it is a nurse midwife or obstetrician. The most vital component is a cooperative nurse manager can be the making or breaking point of the game plan.  The busy nurse manager needs to communicate the mother’s desires effectively to engineering, infection control, OB staff, nursing staff, administration and risk management.  Approach the nurse manager from a factual, no nonsense place and provide the tools she needs to be an advocate.
Download these water birth protocols from online: 1. RCOG and RCM Joint Waterbirth Recommendations 2.  Guideline for a Safe Water Birth  3. Safety recommendations for Pool Use 4.  Hospital Waterbirth Policy in the UK  5. RCOG Waterbirth Guidelines – January 2001 6. Parto en agua protocolos- En Español.

Read through the articles on Birth Balance to get familiar with the latest research and studies on water birth statistics and procedure: Waterbirth Latest Articles and Protocols.  Contact Birth Balance directly to attend a private water birth consultation to find facilities in the NYC, New Jersey, Connecticut and Pennsylvania area: 212-222-4349.  Rent a birth pool kit from Birth Balance.

Contact Waterbirth International: for support references and additional research.

Keep a strong heart, mind and focus on bringing in the team you deserve to help fulfill your wishes.  Good luck getting into hot water!

1.  Johnson, Paul (1996) Birth under water – to breathe or not to breathe. British Journal of Obstetrics and Gynecology, Vol. 103, pp.202-208

2.  Fewell, JE, Johnson, P (1983) Upper airway dynamics during breathing and during apnea in fetal lambs. Journal of Physiology Vol 339, pp 495-504

3. Harding, R., Johnson, P., McClelland, M. (1978) Liquid sensitive laryngeal receptors in the developing sheep, cat, and monkey. Journal of Physiology, Vol 277, pp 409-422

4.  Karlberg, P. et al. (1987) Alteration of the infant’s thorax during vaginal delivery. Acta Obstetrica Gynecol Scandavia. Vol. 41, p 223

5. Gilbert, R, Tookey, P, (1999) Perinatal mortality and morbidity among babies delivered in water: surveillance study and postal survey. British Medical Journal Vol 39, 21 August pp 483-487

6.  Personal interviews (1989) Barbara Harper