Giving birth in water can sound very appealing, especially if you imagine one in the comfort of your own home and the “aquadural” effect it can have on labour pain. So how do you make waterbirth happen, and what are the risks?

Waterbirths are generally recommended for low-risk pregnancies where trained, experienced midwives can be present and strict hygiene guideline policies can be followed. Giving birth anywhere involves maternal consent, and if you really want a waterbirth, nobody can force you to do otherwise, but there are high-risk circumstances in which it is not recommended by healthcare professionals or will be against midwife-led unit or hospital rules. As with everything to do with labour and birth, good planning can get you that bit closer to the experience you want, even if nothing can guarantee it. This article refers specifically to births that happen in water, but it may be useful to note that water can be used in labour even if you have a so-called “land birth” (the term used to describe non-waterbirths by researchers!), and it’s safe to get in a bath of warm water for pain relief (known as water immersion) and distraction in early labour or have a showerhead of hot water directed at your back or warm or cold compresses used to comfort you. You can usually have a bath or shower in plain water even if your waters have broken, though it is important to confirm this is safe in your specific case with your doctor or midwife.

How long have waterbirths been happening?

Waterbirth is an instinctive and natural practice that has been popular in the developed world since the 1960s, but there is evidence that it's taken place in some cultures since ancient times.

Are waterbirths safe?

Waterbirths are considered safe in low-risk pregnancies, provided your labour has not been induced or you have not had an opioid injection for pain relief (you will not be allowed an epidural or spinal for a waterbirth either). First-time labours can be long, even in low-risk situations, and where a woman has been induced,tion, you are probably (though not always) in a hospital if you’ve been induced, and waterbirth isn’t always an option outside of a home or midwife-led birth setting unless you are in the UK. her healthcare provider may not recommend a waterbirth. In addition, you are probably (though not always) in a hospital if you’ve been induced, and waterbirth isn’t always an option outside of a home or midwife-led birth setting unless you are in the UK. In the US, negative statements about waterbirths made by the AAP and ACOG mean hospitals don’t usually allow them.

How do I arrange a waterbirth?

You need to let your midwife and doctor know about your desire for a waterbirth as early as possible so you can talk through the pros and cons for your specific pregnancy and, if you decide to go ahead, so that a booking and preparations can be made. There are a limited number of pools in each hospital and midwife-led unit. Often, you won’t need to do much besides writing your birth plan, deciding what to wear (a T-shirt and yoga pants over a bikini is fine), understanding labour and birth, and preparing psychologically—the midwives will bring all the necessary kit to your home or arrange for it to be ready at your chosen birth centre, midwife-led unit, or hospital.

Can my obstetrician be at my waterbirth?

This can depend on how your obstetric care is provided; most births are overseen by midwives, but many doctors will want to accommodate a mother who really wants them to be present.

What if I want to get out of the pool during a waterbirth?

If you find the water is not meeting your pain relief expectations or you just want to get out because you're cold or not enjoying the experience for some other reason, your midwife will usually be happy to help you out and arrange for an epidural or anything else you need to deliver comfortably. As Unii has specified elsewhere, birth location is all about maternal consent, and you can change your mind very late in the game, including during labour.

Can my baby get an infection or drown in the water during a waterbirth?

As long as hygiene guidelines are followed (e.g., filling the pool close to the time of birth rather than allowing for stagnation) and clean water is used, your baby is unlikely to get an infection. The midwives caring for you will have been trained in both water hygiene protocols and not to leave the baby submerged for long enough for drowning to occur. They should also be able to swiftly identify any issues that might mean your baby needs special care at birth.

Snapping of the umbilical cord is a bit more common with waterbirths, especially where an umbilical cord is naturally short (this won’t be your fault and you can’t prevent it), and this breaking has been linked to anaemia and shock in newborns. However, your midwife will be trained to deal with it quickly by clamping the newborn’s end of the umbilical cord. He or she will also be experienced in taking actions that can prevent this snapping where possible.

For more advice on taking care of yourself in pregnancy, labour, and birth, check out Unii’s Antenatal Course, with prenatal video episodes taught by senior NHS midwives, an award-winning obstetrician and gynaecologist, and six other leading healthcare experts. Coming soon to unii.com.

Antenatal Class Questions: Is waterbirth always safe?

Unii looks at the evidence for this birth option.