Water Birth Guide: Benefits, Safety, and What to Expect

Water birth offers a gentle, natural approach to childbirth that can provide significant pain relief and create a peaceful environment for both mother and baby. This comprehensive guide covers everything you need to know about water birth—from the science-backed benefits to practical planning considerations—so you can decide if this option is right for you.

What Is Water Birth?

Water birth is the process of giving birth in a tub of warm water, typically maintained at a temperature of 97-100°F (36-37.5°C). The practice involves immersing yourself in water during labor and delivery, though some women choose to labor in water but deliver on land.

Water birth has been practiced for decades and has gained mainstream acceptance as research demonstrates its safety and benefits. The warm water provides buoyancy and relaxation, creating what many describe as a more peaceful and empowering birth experience.

There are two main approaches to using water during birth:

• Hydrotherapy during labor: Using water immersion for pain relief during contractions but exiting the tub before delivery
• Water birth: Remaining in the water through delivery, with the baby born directly into the water

Both approaches can be beneficial, and many women make the decision about whether to stay in the water based on how they feel during active labor. The key is having the option available and feeling empowered to choose what feels right in the moment.

The Science-Backed Benefits of Water Birth

Research on water birth has grown significantly over the past two decades, providing evidence for numerous benefits. Here's what studies have found:

Significant Pain Relief Without Medication

Perhaps the most notable benefit of water birth is effective pain management without pharmaceutical intervention. The warm water works through multiple mechanisms:

• Buoyancy: Water supports your body weight, reducing pressure on joints and muscles and making movement easier
• Warmth: Heat relaxes muscles, eases tension, and stimulates the release of endorphins (your body's natural pain relievers)
• Sensory input: The sensation of water on your skin provides alternative sensory stimulation that can reduce pain perception
• Relaxation response: Immersion in water triggers a relaxation response that counters the stress hormones that can slow labor

Studies show that women laboring in water report significantly less pain and use epidurals and other pain medications at much lower rates. One systematic review found that water immersion during the first stage of labor reduced the use of epidural/spinal analgesia and shortened labor duration.

Shorter Labor Duration

Multiple studies have found that water immersion can shorten labor, particularly the first stage. The relaxation provided by warm water helps reduce stress hormones (cortisol and adrenaline) that can inhibit labor progress, while promoting oxytocin—the hormone that drives contractions.

A Cochrane review of studies involving over 3,000 women found that water immersion during the first stage of labor shortened labor by an average of 32 minutes. While this might not seem dramatic, any reduction in labor duration when achieved naturally (without Pitocin) is beneficial.

Reduced Perineal Trauma

One of the most compelling benefits of water birth is reduced tearing and trauma to the perineum. Research consistently shows:

• Lower rates of severe tearing (third and fourth degree tears)
• Significantly reduced episiotomy rates
• Higher rates of intact perineums (no tearing at all)
• Less need for suturing after birth

The water softens perineal tissues, making them more elastic and pliable. Additionally, the buoyancy allows for easier position changes, enabling women to find optimal positions that reduce perineal stress.

Greater Mobility and Positioning Options

Water's buoyancy makes it much easier to move and change positions during labor. You can easily squat, kneel, float, or sway without supporting your full body weight. This freedom of movement offers several advantages:

• Ability to follow your body's instincts for positioning
• Easier rotation into optimal positions for baby's descent
• Reduced fatigue from changing positions
• Partner can more easily provide physical support

Position changes during labor help the baby navigate the pelvis and can speed labor progress. The ease of movement in water means you're more likely to actually change positions frequently.

Lower Intervention Rates

Studies consistently show that water birth is associated with lower rates of medical interventions:

• Reduced use of epidural anesthesia (up to 50% reduction in some studies)
• Lower rates of augmentation with Pitocin
• Decreased episiotomy rates
• Fewer instrumental deliveries (forceps or vacuum)
• Lower cesarean section rates in some studies

It's important to note that water birth is typically chosen by women seeking minimal intervention, so selection bias may play a role in these statistics. However, the physiological effects of water immersion—better pain management, shorter labor, easier movement—logically contribute to reduced intervention needs.

Improved Birth Experience and Satisfaction

Beyond measurable medical outcomes, women consistently report high satisfaction with water birth. Common themes include:

• Feeling more in control of their birth experience
• Greater sense of privacy and intimacy
• More peaceful and calm environment
• Positive memories of their birth experience
• Feeling empowered by their ability to manage pain naturally
• Closer connection with their partner during the process

Gentler Transition for Baby

While harder to measure scientifically, many midwives and parents observe that babies born in water often seem calmer and more peaceful. The theory is that transitioning from the warm, fluid environment of the womb to warm water—rather than to air—provides a gentler first experience.

Research shows no difference in Apgar scores (newborn health assessment) between water birth and land birth babies, and some studies suggest water birth babies may have slightly better outcomes in terms of umbilical cord blood pH levels, indicating less stress during birth.

Water Birth Safety: What the Research Shows

Safety is naturally the top concern for any birth choice. Extensive research has examined water birth safety for both mothers and babies.

Is Water Birth Safe for Babies?

The most common question about water birth is: "Won't my baby breathe in water?" The answer is no, and here's why:

• Continued oxygen supply: The baby continues to receive oxygen through the umbilical cord even after birth, as long as the cord is still attached and pulsing
• Dive reflex: Babies have an innate dive reflex (also called the bradycardic response) that prevents them from gasping or inhaling when submerged in water
• Inhibiting factors: Several factors prevent babies from breathing while underwater: the water temperature being similar to amniotic fluid, the baby's face being in contact with water, and lack of air stimulation on the face
• First breath trigger: Babies are triggered to take their first breath when they encounter air on their face and a temperature change, not by being born

Multiple large-scale studies have examined the safety of water birth for babies. A comprehensive review published in the British Medical Journal analyzed outcomes for over 16,000 water births and found no increased risk for babies when water birth was conducted by trained providers for appropriate low-risk candidates.

Key findings on baby safety:

• No increased risk of infection for babies born in water
• No difference in Apgar scores compared to land birth
• No increased admission to neonatal intensive care units
• Similar or slightly lower rates of respiratory issues
• Umbilical cord avulsion (cord tearing) is rare but can occur with any birth—proper technique prevents this

Is Water Birth Safe for Mothers?

Research also demonstrates that water birth is safe for mothers when appropriate candidates are selected:

• Infection rates: No increased risk of infection for mothers giving birth in water when proper hygiene protocols are followed
• Hemorrhage: No increased postpartum bleeding risk; some studies show slightly lower blood loss in water births
• Perineal outcomes: Better perineal outcomes as discussed earlier
• Water embolism: Theoretical risk but extremely rare; proper water temperature and technique prevent this

The American College of Obstetricians and Gynecologists (ACOG) states that immersion in water during the first stage of labor may be associated with shorter labor and decreased use of spinal and epidural analgesia, and does not appear to increase adverse effects on maternal and neonatal outcomes.

However, ACOG recommends against birth in water (as opposed to laboring in water) outside of controlled research settings, citing limited data. This conservative stance contrasts with positions from the Royal College of Obstetricians and Gynaecologists (UK) and midwifery organizations, which support water birth based on extensive positive outcomes data from countries where it's more common.

Who Is a Good Candidate for Water Birth?

Water birth works best for healthy, low-risk pregnancies. Here's what makes someone a good candidate:

Ideal Candidates

• Healthy pregnancy with no major complications
• Single baby in head-down position
• Full-term pregnancy (37-42 weeks)
• Normal amniotic fluid levels
• No infections requiring treatment
• No excessive bleeding
• Desire for minimal intervention birth
• Willingness to exit tub if complications arise
• Provider trained in water birth support

Contraindications: When Water Birth May Not Be Recommended

Water birth may not be appropriate or safe in certain situations:

Absolute Contraindications

• Multiple pregnancy: Twins, triplets, or more
• Breech or transverse position: Baby not head-down
• Preterm labor: Before 37 weeks gestation
• Active maternal infections: Herpes outbreak, HIV, hepatitis, or other infections that could be transmitted
• Excessive bleeding: Any significant bleeding during labor
• Thick meconium: Heavy meconium staining suggests baby may be in distress
• Maternal sedation: Having received narcotic pain medications that could impair alertness
• Preeclampsia or uncontrolled high blood pressure

Relative Contraindications (Discuss with Provider)

• Previous cesarean section (VBAC in water—policies vary)
• Very large baby (macrosomia)
• Maternal obesity (getting in and out of tub may be challenging)
• Prolonged rupture of membranes (increased infection concern)
• Need for continuous fetal monitoring
• Epidural or spinal anesthesia (impaired mobility and sensation)

Always discuss your individual situation with your healthcare provider to determine if water birth is appropriate for you.

Where Can You Have a Water Birth?

Water birth is available in several settings, each with different advantages and considerations:

Hospital Water Birth

An increasing number of hospitals offer water birth or at least hydrotherapy during labor, though availability varies widely by region and institution.

Advantages:

• Immediate access to medical interventions if needed
• Neonatal intensive care available on-site
• Insurance typically covers hospital birth
• May feel safer for first-time parents
• Anesthesiologist available if you change your mind about pain relief

Considerations:

• Not all hospitals offer water birth—call ahead to ask
• Some hospitals allow laboring in water but not delivering
• Hospital policies may restrict water birth to certain criteria
• May need to rent or bring your own portable birth pool
• Availability may depend on which provider is on call
• Hospital tubs may be smaller than home birth pools

Finding a hospital that offers water birth:

• Call labor and delivery units directly to ask about water birth policies
• Ask during hospital tours
• Check if hospitals have permanent birthing tubs or allow portable pools
• Ask your OB or midwife which hospitals they have privileges at that support water birth
• Look for "baby-friendly" designated hospitals, which tend to be more supportive of natural birth options

Birth Center Water Birth

Freestanding birth centers are often the most supportive environment for water birth, as they specialize in low-intervention births for healthy pregnancies.

Advantages:

• Water birth is standard practice—all staff are trained
• Large, comfortable birthing tubs designed specifically for labor
• Home-like environment with fewer restrictions
• Midwife-led care focused on physiological birth
• Lower cost than hospital birth in many areas
• More privacy and personalized care

Considerations:

• Transfer to hospital required if complications arise
• No epidural or cesarean available on-site
• Insurance coverage varies—check your plan
• Must meet low-risk criteria to qualify for birth center care
• Fewer birth centers than hospitals in many areas

Birth centers are licensed and regulated, with emergency protocols and transfer agreements with nearby hospitals. Midwives at birth centers are trained to recognize when transfer is needed and can accompany you to the hospital.

Home Water Birth

Home birth with a licensed midwife is another option for low-risk pregnancies, and most home birth midwives support water birth.

Advantages:

• Ultimate comfort and privacy in your own space
• Complete control over your environment
• Continuity of care with your chosen midwife
• No time limits or hospital policies
• Family members (including other children) can be present
• One-on-one care throughout labor
• Lower cost than hospital or birth center

Considerations:

• Must rent or purchase birth pool and equipment
• Responsible for setup and cleanup
• Transfer to hospital if complications arise (plan needed)
• No immediate access to surgical interventions or blood transfusions
• Insurance coverage varies widely by state and plan
• Must have licensed midwife to ensure safety
• Not appropriate for high-risk pregnancies

Research on planned home birth with qualified midwives for low-risk pregnancies shows outcomes comparable to hospital birth, with lower intervention rates and high satisfaction. Water birth is a natural fit for the home birth model.

Equipment Needed for Water Birth

Whether you're planning a home water birth or bringing a portable pool to a hospital, here's what you'll need:

The Birth Pool

The most important piece of equipment is the birth pool itself. Options include:

Inflatable Birth Pools:

• Most common for home birth
• Typically 5-6 feet in diameter and 2 feet deep
• Can be rented ($200-400) or purchased ($300-800)
• Comes with disposable liner for sanitation
• Easy to set up and take down
• Popular models: La Bassine, Aqua Doula, Birth Pool in a Box

Hard-Sided Pools:

• More permanent option, often used in birth centers
• Some can double as large bathtubs after birth
• More expensive ($800-2,000+)
• Take up more space but offer more room

Regular Bathtubs:

• Can work for laboring but usually too small for actual birth
• Limited mobility due to size
• Harder for midwife or partner to assist
• Better than nothing for hydrotherapy

Water Heating and Temperature Control

Maintaining proper water temperature (97-100°F / 36-37.5°C) is crucial for safety:

• Thermometer: Floating thermometer to monitor water temperature
• Water heating: Hot water heater capacity sufficient to fill pool (40-50 gallons minimum); may need to heat water in large pots on stove as backup
• Temperature maintenance: Adding hot water as needed; some pools have built-in heaters

Water that's too hot (over 101°F) can cause maternal hyperthermia and fetal distress. Water that's too cool (under 95°F) won't provide adequate pain relief and warmth.

Filling and Drainage

• Garden hose: New, clean hose dedicated to birth (not used for yard work)
• Faucet adapter: To attach hose to your sink or bathtub faucet
• Drainage hose: For emptying pool after birth (can use same hose)
• Pump: Sump pump or pool pump speeds up filling and draining

Additional Supplies

• Pool liner: Disposable liner for sanitation (usually included with pool rental)
• Waterproof cushions: For comfort while kneeling in pool
• Fishnet or sieve: To remove any debris from water
• Towels and blankets: Plenty for after birth
• Waterproof covering: To protect floor around pool
• Step stool: For getting in and out of pool safely
• Birth supplies: Whatever your midwife requires (gloves, receiving blankets, etc.)

Where to Get Equipment

• Rental from midwife or doula: Many birth workers rent out pools and equipment
• Online retailers: Your Water Birth, Birth Pool in a Box, Amazon
• Local baby stores: Some carry or can order birth pools
• Buy secondhand: Check local parenting groups (ensure thorough cleaning)

What Happens During a Water Birth

Understanding the process helps you prepare mentally and practically for a water birth experience.

Setting Up

For home birth or portable pool in hospital:

• Pool is typically set up when labor begins or shortly before due date
• Fill pool when you're in active labor (to ensure water stays warm)
• Filling takes 30-60 minutes depending on water pressure and pool size
• Pool should be filled deep enough to cover your belly when sitting (usually 18-24 inches)
• Temperature checked and adjusted before entry

When to Get in the Pool

Timing matters for water birth effectiveness:

• Too early: Getting in water during very early labor (before 4-5 cm) can sometimes slow contractions
• Optimal time: Active labor (typically 4-6 cm or more) is ideal for water immersion
• Your midwife will guide you: Based on your labor pattern and how you're coping
• Listen to your body: If you feel strong urge to get in water, that's often a good sign it's time

Many women report that getting into the water at the right time feels like immediate, dramatic relief—often described as "nature's epidural."

During Labor in Water

What to expect while laboring in the pool:

• Freedom to move: Float, sway, lean on pool sides, or squat with support
• Position changes: Try different positions to find what works best
• Partner support: Your partner can get in water with you or support from outside
• Hydration: Drink water regularly (you'll sweat in warm water)
• Monitoring: Your midwife will monitor your baby's heart rate with waterproof Doppler
• Temperature checks: Regular monitoring of both water and your temperature
• Getting in and out: You can exit the pool anytime for bathroom, position change, or if you prefer

The Birth Itself

When it's time to push and deliver:

• Push in whatever position feels right: Hands and knees, squatting, semi-reclined, or floating
• Midwife assists from outside pool: Guiding but allowing your body to work
• Baby is born into water: Your provider may guide baby gently but baby emerges into warm water
• Baby brought to surface immediately: You or your midwife gently lift baby to surface within seconds
• Baby on your chest: Immediate skin-to-skin contact in the water
• Cord stays intact: Umbilical cord continues pulsing, providing oxygen while baby adjusts
• First breath: Baby takes first breath when face meets air and temperature change
• Delayed cord clamping: Often practiced with water birth

After the Birth

The immediate postpartum period:

• Bonding in water: You can stay in pool for initial bonding and skin-to-skin
• Warmth maintained: Warm blankets placed over you and baby
• Placenta delivery: May happen in water or you may exit pool for this (varies by preference and provider)
• Exiting pool: When you're ready, you'll get out with assistance
• Continued bonding: Move to bed for continued skin-to-skin and breastfeeding
• Newborn procedures: Delayed until after bonding (typically at least an hour)

Transitioning Out of Water for Delivery

You might choose or need to exit the water before delivery. This is completely fine and doesn't mean you "failed" at water birth.

Reasons to Get Out

• Personal preference: You simply feel like getting out
• Labor stalls: Sometimes exiting pool and walking can restart labor
• Temperature concerns: If you or baby show signs of overheating
• Meconium appears: Fresh meconium in water is reason to exit
• Bleeding: Excessive bleeding requires leaving pool
• Fetal heart rate changes: Concerning patterns may require different monitoring
• Your instinct: Trust your intuition about what your body needs

Remember: Using water for pain relief during labor even if you deliver on land still provides tremendous benefit. There's no rule that says you must deliver in water just because you labored there.

Including Water Birth in Your Birth Plan

If you're interested in water birth, include specific preferences in your birth plan:

What to Include

• Desire to use water: "I would like to use hydrotherapy and/or water birth if possible"
• Equipment: "I will bring a portable birth pool" or "I'd like to use the hospital's birthing tub"
• When to start: "I'd like to enter water during active labor based on midwife's guidance"
• Flexibility about delivery: "I'd like the option to deliver in water but may decide to exit pool based on how I feel"
• Monitoring: "Please use waterproof Doppler for intermittent monitoring while I'm in water"
• Support person: "My partner would like to be in the pool with me if possible"
• Temperature monitoring: "Please regularly check water temperature to keep it in safe range"
• Privacy: "I'd like minimal interruptions and dimmed lighting while in the pool"
• Third stage: "I prefer to deliver placenta in water" or "I'd like to exit pool before placenta delivery"
• Newborn procedures: "Please delay weighing, measuring, and eye ointment until after bonding period"

Hospital-Specific Considerations

If planning water birth at hospital, also address:

• Hospital policy about who can be in water (just you, or partner too?)
• Whether you can eat/drink while in pool
• Fetal monitoring requirements (continuous vs. intermittent)
• What circumstances would require exiting pool
• Whether you need to bring your own pool or can use hospital's
• Staff training level with water birth

Discuss your birth plan with your provider well before your due date to ensure your hospital or birth center can accommodate your wishes. Some facilities are very supportive of water birth while others have restrictive policies.

Common Concerns and Myths About Water Birth

Let's address frequent worries and misconceptions:

Myth: The Baby Will Drown

Reality: Babies don't breathe underwater due to the dive reflex and continued oxygen supply through the umbilical cord. Multiple physiological factors prevent babies from inhaling water. Thousands of water births occur safely every year worldwide.

Myth: Water Birth Is Unsanitary

Reality: When proper protocols are followed—using clean pool liners, maintaining appropriate water temperature, and changing water if needed—water birth is no more likely to cause infection than land birth. Studies show no increased infection risk for mothers or babies.

Myth: You Can't Monitor the Baby Properly in Water

Reality: Waterproof Doppler devices allow providers to monitor baby's heart rate effectively during water labor and birth. Intermittent monitoring is evidence-based and appropriate for low-risk labor.

Concern: What If There's Poop in the Water?

Reality: Bowel movements during labor are normal regardless of where you deliver. In water, it floats to the surface and is quickly scooped out with a fishnet. It's not the romantic image in birth photos, but it's completely manageable and doesn't pose health risks. Remember, babies are born through the same area regardless of birth location.

Concern: Water Temperature Could Harm Baby

Reality: This is why temperature monitoring is so important. Water kept at 97-100°F is safe. Overheating (water over 101°F) can cause problems, which is why providers regularly check the temperature and watch for signs of maternal hyperthermia.

Myth: Water Birth Is Only for "Crunchy" or Alternative Parents

Reality: Water birth is evidence-based and increasingly mainstream. Parents from all backgrounds choose water birth simply because it works—offering effective pain relief and better outcomes in many measures. It's a practical choice, not a lifestyle statement.

Myth: Insurance Won't Cover Water Birth

Reality: If you're giving birth at a hospital or licensed birth center, insurance typically covers the birth itself regardless of whether you use water. Some plans may not cover birth pool rental, but that's usually a small out-of-pocket expense ($200-400). Check your specific plan.

Concern: What If I Change My Mind?

Reality: You can get out of the pool any time you want. Many women use water during labor and deliver on land. There's no commitment or failure involved—use water as long as it helps you.

Working with Your Provider

The success of your water birth often depends on having a supportive, knowledgeable provider.

Questions to Ask Your Provider

• Have you attended water births? How many?
• What is your philosophy on water birth?
• What are the policies at your hospital/birth center regarding water birth?
• Can I labor in water even if I don't deliver in water?
• What circumstances would require me to leave the water?
• How do you monitor the baby during water labor?
• Can my partner get in the water with me?
• Do I need to bring my own birth pool or does the facility have one?
• What happens with the placenta—in water or out?
• Are there any additional costs for using water?

If Your Provider Doesn't Support Water Birth

If your current provider is unsupportive or your hospital doesn't allow water birth, you have options:

• Switch providers: If you're not too far along, consider finding a midwife or OB who supports water birth
• Switch birth locations: Look for a nearby birth center or hospital with different policies
• Consider home birth: If you're low-risk and interested, home birth with a licensed midwife offers the most control
• Compromise: See if your provider supports laboring in water even if hospital policy requires exiting for delivery
• Hire a doula: A birth doula experienced with water birth can help you navigate hospital policies and support your preferences

Cost Considerations

Water birth costs vary by setting and location:

Hospital Water Birth

• Hospital birth cost: Whatever your insurance covers (same as any hospital birth)
• Birth pool rental: $200-400 if you need to bring your own
• No additional hospital charges: Most hospitals don't charge extra for using water

Birth Center Water Birth

• Total cost: $3,000-8,000 typically (varies by location)
• Often less than hospital: Birth centers usually cost significantly less than hospitals
• All-inclusive: Usually includes all prenatal care, birth, and postpartum visits
• Insurance: Many plans cover licensed birth centers; check your benefits

Home Water Birth

• Midwife fee: $3,000-6,000 typically for all care
• Birth pool rental: $200-400 or purchase $300-800
• Total: Often the least expensive option
• Insurance: Coverage varies widely; some states mandate coverage of licensed midwives, others don't

Preparing for Your Water Birth

Take these steps to prepare for a successful water birth experience:

Education and Classes

• Take comprehensive childbirth education classes
• Consider water birth-specific classes if available
• Read books and watch videos about water birth
• Talk to other women who have had water births
• Tour your birth location and see the birthing tub

Physical Preparation

• Practice labor positions in your bathtub at home
• Stay physically active throughout pregnancy (with provider approval)
• Practice breathing and relaxation techniques
• Pelvic floor exercises (Kegels) to prepare for birth
• Perineal massage in final weeks (may reduce tearing)

Practical Preparation

• Secure your birth pool well in advance (rental or purchase)
• Test filling your pool before labor to identify any issues
• Ensure you have all necessary supplies ready
• Make sure your partner knows how to set up and fill the pool
• Have backup plans (what if pool develops leak? what if you need to transfer?)
• Create your detailed birth plan including water birth preferences

Mental and Emotional Preparation

• Visualize your ideal water birth experience
• Practice positive affirmations
• Address any fears or concerns with your provider
• Develop flexibility—know you may change your mind and that's okay
• Build trust with your birth team
• Connect with water birth communities for support

Frequently Asked Questions

The Bottom Line

Water birth is a safe, evidence-based option for healthy, low-risk pregnancies that offers significant benefits: effective pain relief without medication, shorter labor duration, reduced perineal trauma, lower intervention rates, and high maternal satisfaction. The warm water provides a peaceful, supportive environment that helps you work with your body's natural birthing process.

Whether you choose to labor and deliver in water, or simply use hydrotherapy during labor before delivering on land, water immersion can be a valuable tool for managing the intensity of childbirth. The key is finding a supportive provider, choosing an appropriate birth setting, and preparing thoroughly with knowledge and equipment.

Water birth isn't right for everyone, and it's not available in all situations, but for women with healthy pregnancies who desire a natural approach to birth, it offers a compelling option worth exploring. Talk with your healthcare provider, do your research, and trust yourself to make the decision that feels right for you and your baby.

Remember that flexibility is important—labor is unpredictable, and you may change your mind in the moment. That's perfectly okay. The goal is a healthy baby and a positive birth experience, however that unfolds for you. Water birth can be one beautiful path to that goal.