Featured Review: Immersion in water during labour and birth

Labouring in water may reduce the number of women having an epidural but does not appear to affect mode of birth or serious perineal tears.

Water immersion during labour and birth is increasingly popular and is becoming widely accepted across many countries, and particularly in midwifery-led care settings. However, there are concerns around neonatal water inhalation, increased requirement for admission to neonatal intensive care unit (NICU), maternal and/or neonatal infection, and obstetric anal sphincter injuries (OASIS).

A team of Cochrane authors based in the United Kingdom worked with Cochrane Pregnancy and Childbirth to update the 2011 Cochrane Review assessing the effects of water immersion during labour and/or birth (first, second and third stage of labour) on women and their infants. This review includes 15 trials conducted between 1990 and 2015 with a total of 3663 women.

Labouring in water may reduce the number of women having an epidural. Giving birth in water did not appear to affect mode of birth, or the number of women having a serious perineal tear. This review found no evidence that labouring in water increases the risk of an adverse outcome for women or their newborns. The trials varied in quality and further research is needed particularly for waterbirth and its use in birth settings outside hospital labour wards before we can be more certain of these effects. Research is also needed about women’s and caregivers experiences of labour and birth in water.

“Immersion in water during labour and waterbirth facilitates physiological labour and birth, offers women a non-pharmacological pain relief option and facilitates a sense of choice, control and comfort; qualities strongly associated with women’s satisfaction with their birth experience,” says Dr Elizabeth R Cluett, the lead author of the Cochrane Review. “Labouring and/or giving birth in water may enable healthy women who have a straightforward pregnancy to have fewer interventions leading to a spontaneous birth and provides them a choice that is available in all birth settings”

Dr. Ethel Burns, Cochrane Review author added, “An extensive search review and selection process was completed and 3 new trials that meet the Cochrane criteria on this topic were added to this update. We hope that more research will be conducted in birthing settings outside of hospital labour wards for the next update of this important Cochrane Review”