Waterbirth – 3

Waterbirth Basics – Research & References

Current Research, Facts, Tips and References

By Barbara Harper, Founder and President of Waterbirth International and Global Maternal-Child Health (www.waterbirth.org)

August 21, 1999 should be remembered as a landmark in the history of birth pools. On that day the British Medical Journal published an unprecedented study about waterbirth. This study is authoritative for several reasons: The conclusions are based on large numbers: the authors traced the 4032 babies born under water in England and Wales between April 1994 and March 1996; the authors belong to a prestigious department of epidemiology and public health (Institute of Child Health, London, UK); the report has been published in a respected peer review medical journal.


From April 1994 to April 1996, all 1500 consultant pediatricians in the British Isles were surveyed each month by the British Paediatric Surveillance Unit and asked to report whether or not they knew of any births that met the case definition of “perinatal death or admission for special care within 48 hours of birth following labour or delivery in water.” At the same time a postal questionnaire was sent to all National Health Service maternity units in England and Wales in 1995 and 1996 to determine the total number of deliveries in water during the study period.


There were five perinatal deaths among 4032 births in water; that is a rate of 1.2 per 1000. In the context of the UK this rate is similar to low risk deliveries that do not take place in water. Furthermore, none of these five deaths were attributable to delivery in water. There were 34 babies admitted for special care; that is a rate of 8.4 per 1000. Rates of admission for special care of babies born to low risk primiparous women are significantly higher than for babies born in water.


Give great importance to the time when the laboring woman enters the pool. The BMJ survey clearly indicates that many women stay too long in the bath. The midwife should help women be patient enough so that they can ideally wait until five centimeters dilation to enter the water. Avoid planning a birth under water. When a woman has planned a birth under water she may be the prisoner of her project; she is tempted to stay in the bath while the contractions are getting weaker, with the risk of long second and third stages. There are no such risks when a birth under water follows a short series of irresistible contractions. Temperature: It is easy to check that the water temperature is never above 37 degrees C (the temperature of the maternal body). The fetus has a problem of heat elimination.

Michel Odent, excerpted from A Landmark in the History of Birthing Pools

Midwifery Today Issue 54

Read this article online at:


Waterbirth Facts and Tips— by Barbara Harper, RN Founder of Global Maternal Health

Practitioners throughout the world recognize increased safety for the breech baby if it is born in water. The most experienced doctor we know of is Herman Ponette, an obstetrician who practices in Ostend, Belgium. He has attended well over 2000 waterbirths, including breeches and twins. To him, a frank breech position as an indication for a waterbirth.

Perineal trauma is reported to be generally less severe, with more intact perineums for multips, but some of the literature reports the same frequency of tears for primips in or out of the water (Burn, Garland).

A useful way to identify the extent of postpartum hemorrhage is how dark the water is getting. Can you still assess skin color of the mother’s thighs even though there is blood in the water? A few drops of blood in a birth pool diffuse and cause the water to change color.

A waterproof flashlight comes in handy at this point. Dropping a flashlight onto the bottom of the birth pool allows you to look for bleeding as well as meconium during the birth.

Some hospitals still restrict a woman from laboring in the water if her membranes are ruptured. Based on the current and past literature, this is absurd. No evidence exists of increased infectious morbidity with or without ruptured membranes for women who labor and/or birth in water (Eriksson et al., Garland).

Some parents are concerned about mother-to-mother infections or contamination from viruses such as HIV or hepatitis. There is no reason to restrict an HIV-positive mother from laboring or giving birth in water. All evidence indicates that the HIV virus is susceptible to the warm water and cannot live in that environment (Favero). Universal precautions still must be adhered to, however, and proper cleaning of all the equipment after the birth must be carried out.

From Midwifery Today, Issue 54


Burn, E., Greenish, K. (1992). Pooling information. Nursing Times 89(8): 47-49

Garland, D., Jones, K. (1997, June). Waterbirth: Updating the evidence. British Journal of Midwifery 5(6): 371

Erikkson, M. et al. (1996, Aug.). Warm tub bath during labor: A study of 1385 women with prelabor rupture of the membranes after 34 weeks of gestation. Acta Obstetricia et Gynecologieca Scandinavica 75(7): 642-44.

Garland, D., Jones, K. ibid. Favero, M. (1986). Risk of AIDS and other STDs from swimming pools and whirlpools is nil. Postgraduate Medicine 80(1): 283

suzanneWaterbirth – 3