What Is Water Birth? Benefits, Risks and Who May Be Suitable

Created: 06.07.2024 · Last Updated: 17.08.2026 · Category: Obstetrics and Gynecology · Prepared by the Academic Hospital Web and Editorial Board.

What Is Water Birth?

Water birth describes the use of a specially designed pool or bath containing appropriately warmed water during labour, with the baby sometimes also being born while the mother remains in the water.

The buoyancy of water can make movement and changing position easier. Warm water may also help some women relax and cope with labour pain.

Is Labouring in Water the Same as Water Birth?

No. The distinction is important.

Labouring in water means using the pool during contractions and the first stage of labour, while leaving the water before the baby is born.

Water birth usually means remaining immersed during the second stage so that the baby is actually born under water.

This distinction matters clinically. Evidence supporting water immersion for comfort and pain management during the first stage of labour is stronger than evidence concerning delivery of the baby under water.

Why Do Some Women Choose Water During Labour?

Warm-water immersion is one of the non-pharmacological approaches that can be used to help women cope with labour.

Women may choose water because it can:

  • Promote relaxation
  • Help with pain coping
  • Allow easier movement and changes of position
  • Provide a calmer and more private environment
  • Increase the woman's sense of control during labour

The choice should take account of the woman's preferences, pregnancy risk profile, fetal wellbeing and the safety protocols of the birth setting.

What Are the Potential Benefits?

Evidence suggests that water immersion, particularly during the first stage of labour, can have some maternal benefits.

Potential benefits include:

  • Improved ability to cope with labour pain
  • Reduced use of spinal or epidural analgesia in some women
  • Relaxation and improved satisfaction with the birth experience
  • Greater freedom of movement because of buoyancy
  • A possible reduction in the duration of the first stage of labour in some studies

NICE's 2025 evidence review also found that water birth may be associated with a lower risk of severe perineal trauma in multiparous women and a lower risk of postpartum haemorrhage. These findings do not mean that every woman will experience these benefits.

The most consistent potential advantages of water immersion relate to maternal comfort and coping with labour pain. Claims that water necessarily increases uterine oxygenation, strengthens contractions or makes every labour faster should not be presented as established facts.

Are There Proven Benefits for the Baby?

There is no established evidence that being born under water provides a direct physiological health benefit to the newborn.

Claims that water birth:

  • Provides more oxygen to the baby
  • Reduces neonatal stress hormones
  • Improves fetal head positioning
  • Prevents breastfeeding problems
  • Provides a proven benefit because the baby moves from amniotic fluid into water

are not sufficiently supported to be presented as established neonatal benefits.

NICE's recent evidence review found an association between water birth and a lower rate of neonatal-unit admission, but this does not establish that underwater birth itself has a direct protective biological effect.

What Are the Risks of Water Birth?

Water immersion can be used in appropriately selected low-risk pregnancies, but delivery under water has specific considerations.

Potential or reported risks include:

  • Umbilical cord avulsion when the baby is brought to the surface
  • Maternal or neonatal infection if pool hygiene is inadequate
  • Rare respiratory complications associated with aspiration of water
  • The need to leave the pool rapidly if an urgent maternal or fetal problem develops
  • Practical challenges with fetal monitoring in some situations
Pool hygiene is an essential safety requirement. Birthing pools and associated equipment should be cleaned and maintained according to an established infection-control protocol.

Who May Be Suitable for Water Birth?

Water immersion and water birth are generally considered for low-risk pregnancies at term.

Factors commonly considered include:

  • Term pregnancy
  • Singleton pregnancy
  • Cephalic presentation
  • Reassuring maternal and fetal condition
  • Reassuring fetal heart-rate assessment
  • No obstetric contraindication to vaginal birth
  • An informed maternal preference for using water
  • Appropriate facilities, infection-control procedures and an experienced clinical team

Exact eligibility criteria vary according to the clinical situation and local birth-unit protocol.

When May Water Birth Not Be Suitable?

Conditions requiring individual assessment or an alternative birth plan can include:

  • Preterm labour
  • Non-cephalic fetal presentation
  • Multiple pregnancy
  • Non-reassuring fetal heart-rate findings
  • Significant vaginal bleeding
  • Placenta previa or another contraindication to vaginal birth
  • Severe pre-eclampsia or uncontrolled hypertension
  • Maternal or fetal conditions requiring close monitoring or urgent intervention
  • Certain active infections with a relevant transmission risk
  • A condition that would make safe movement or rapid exit from the pool difficult

Factors such as previous caesarean birth, meconium-stained liquor, maternal infection or chronic medical disease should be assessed individually rather than treated as universal contraindications in every setting.

How Warm Should the Water Be?

The water should be comfortable for the woman while avoiding maternal overheating.

NICE recommends that:

  • Maternal and water temperature are monitored regularly.
  • The water temperature should not exceed 37.5°C.
  • Maternal fever or discomfort should prompt reassessment.

How Are Mother and Baby Monitored?

Using a birthing pool does not mean that routine maternal and fetal monitoring stops.

Assessment can include:

  • Maternal wellbeing
  • Pulse and blood pressure when indicated
  • Maternal temperature
  • Water temperature
  • Progress of labour
  • Fetal heart rate

Appropriate equipment can be used for fetal heart-rate assessment while the woman remains in the water.

When Might You Need to Leave the Pool?

A birth plan can change during labour. The woman may be asked to leave the pool if continuing in water is no longer considered appropriate.

Examples include:

  • Concerning changes in the fetal heart rate
  • Maternal fever or deterioration
  • Unexpected or excessive bleeding
  • Delayed labour progress
  • A need for urgent obstetric intervention
  • The woman deciding that she no longer wishes to remain in the pool
Water birth is an option within a birth plan, not a goal that must be completed at all costs. Moving to birth outside the pool when clinical circumstances change is part of safe maternity care.

How Long Does Water Birth Take?

There is no standard duration specific to water birth.

The length of labour depends on factors including:

  • Whether it is the first birth
  • Cervical dilatation when established labour begins
  • The pattern of uterine contractions
  • Fetal position and descent
  • Maternal and fetal wellbeing

A woman does not need to remain in water throughout the entire labour. She can leave the pool and, if circumstances remain appropriate, may return later.

What Do Current Guidelines Say About Water Birth?

International professional guidance is more consistent regarding labouring in water than it is regarding actually giving birth under water.

NICE

NICE recommends offering women the opportunity to labour in water for pain relief.

Following its 2025 evidence update, NICE also advises considering water birth and discussing the available evidence, including possible reductions in some maternal complications and an increased risk of umbilical cord snapping before clamping.

ACOG

The American College of Obstetricians and Gynecologists considers first-stage water immersion a potential option for healthy women with uncomplicated term pregnancies.

However, ACOG considers the evidence on underwater delivery insufficient and continues to recommend that the baby be born on land.

Water birth should therefore be an informed and individualised choice. Discussion should cover potential benefits, uncertainties, alternative birth options and circumstances in which leaving the pool may become necessary.

Plan Your Birth According to Your Pregnancy

Suitability for water birth depends on gestational age, fetal presentation, pregnancy risk factors and maternal and fetal wellbeing during labour.

Frequently Asked Questions

What is water birth?
Water birth describes labour or delivery taking place in a specially designed birthing pool or bath containing appropriately warmed water.
Is labouring in water the same as water birth?
No. Labouring in water means using the pool during contractions. Water birth means that the baby is also born while the mother remains in the water.
Can water immersion reduce labour pain?
Warm-water immersion, particularly during the first stage of labour, may help some women cope with pain, improve relaxation and reduce the use of spinal or epidural analgesia.
Does water birth provide more oxygen to the baby?
There is insufficient clinical evidence that water birth provides more oxygen to the baby or produces a direct and established physiological benefit for the newborn.
At what gestational age can water birth be considered?
Water immersion and water birth are generally considered in low-risk pregnancies at term. Individual suitability depends on gestational age, fetal presentation, maternal and fetal wellbeing and the birth unit's protocol.
How warm should a birthing pool be?
The water should remain comfortable for the woman. NICE recommends that water temperature should not exceed 37.5°C and that maternal and water temperature are monitored regularly.
Can I change my mind during a water birth?
Yes. A woman can leave the pool whenever she wishes. The healthcare team may also recommend continuing labour or birth out of the water if maternal or fetal circumstances change.
Is water birth safe?
Appropriate patient selection, an experienced team, maternal and fetal monitoring and robust infection-control procedures are important for safety. Evidence is stronger for water immersion during the first stage of labour, while international guidelines differ regarding delivery of the baby under water.
Academic Hospital note: Water birth is not appropriate for every pregnancy. Gestational age, fetal presentation, maternal and fetal health and findings during labour should be considered together. The birth plan can change during labour, and birth can be continued safely outside the pool when necessary. You can book an appointment.

References

  1. Academic Hospital. Water Birth
  2. National Institute for Health and Care Excellence (NICE). Intrapartum Care: Recommendations – Water Immersion and Water Birth
  3. American College of Obstetricians and Gynecologists. Immersion in Water During Labor and Delivery