What to Know About a Water Delivery

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Water births, especially at-home water births, have become increasingly more popular over the past few decades. Water delivery is when at least a portion of labor happens in a tub of warm water.

The information about the safety and benefits of water labor and delivery is still limited. This article discusses what happens during a water birth and the potential benefits and risks of a water delivery.

mother holding newborn baby in birthing pool

Frank Herholdt / Getty Images

Stages of a Labor With a Water Delivery

There are three different stages of labor:

  1. Contractions begin and the cervix starts to dilate, opening up to 10 centimeters.
  2. After the cervix dilates to 10 centimeters, the second stage begins, and the baby moves through the vagina to be born.
  3. The final stage is when the placenta, also called afterbirth, is delivered.

Some people choose to stay in the water through delivery, while others get out of the water to deliver the baby.

The American College of Obstetricians and Gynecologists (ACOG) reaffirmed their stance on water labor and delivery in 2021, stating, “Immersion in water during the first stage of labor may be associated with a shorter labor and decreased use of spinal and epidural analgesia.”

Their statement also says there is insufficient information to support any benefits or risks of delivering in water. They don’t recommend staying submerged in water past the first stage of labor because the risks are poorly understood.

Benefits

A few small studies assessed the potential benefits of water births, and while more research is needed, there are a few benefits associated with water delivery.

Benefits of water delivery may include:

  • Reduced use of pain medications such as an epidural, spinal, and paracervical analgesia
  • Shorter first stage of labor
  • Increased maternal relaxation
  • Easier movement in water (compared with rolling over in a bed)
  • Potentially lower risk of requiring a cesarean section

There is insufficient information about benefits to the newborn from delivering in water.

Risks

Water delivery could also add some potential risks to yourself and your baby. These risks are rare but need to be discussed with your healthcare provider before deciding whether a water delivery is right for you.

Maternal risks may include:

  • You could get an infection.
  • If you have complications after delivering, medical attention is delayed by minutes because you will need to be lifted out of the water.

There are some known potential risks to your baby. While these are rare, they can be serious. Newborn risks may include:

  • Legionella infection—caused by inhaling water droplets contaminated with bacteria. Symptoms include fever, cough, and pneumonia, and sometimes lead to death.
  • Difficulty maintaining infant temperature
  • Gasping for air before being lifted out of the water and breathing bathwater into lungs
  • The umbilical cord could be damaged or snap while lifting the baby from the water.

Are You a Candidate for a Water Delivery?

Many facilities do not offer water delivery since it is not recommended by the American College of Obstetricians and Gynecologists. You can discuss with your doctor or midwife if their facility offers water births and try to ascertain if the proper safety protocols are in place. People are considered good candidates for water births if:

  • They are between the ages of 17 and 35.
  • They have a history of uncomplicated pregnancies.
  • They are delivering between 37 and 41 weeks of gestation.

Water births are not recommended if:

  • You have an infection.
  • You are younger than 17 or older than 35 years old.
  • You have excessive vaginal bleeding.
  • You have a history of cesarean sections.
  • You are carrying more than one baby.
  • Your baby is in a breech position (feet or bottom facing down).
  • You have preeclampsia or gestational diabetes.
  • You need close monitoring with equipment (like baby heart monitoring).
  • Your baby is premature (before 37 weeks).

How to Prepare

Preparing for a water birth will depend on where you decide to deliver your baby. Some birthing centers and hospitals have tubs available for water births. Create your birthing plan early if you are considering a water birth and ask questions like:

  • Does a hospital or birthing center near you offer the service?
  • If you're considering a home birth, are you a good candidate for it (i.e., low-risk pregnancy)?
  • Will a midwife or OB-GYN be delivering your baby?

Answering these questions and discussing the plan with your healthcare team will help you prepare for a water birth, if it is considered a safe option for you.

Preparing for an At-Home Water Delivery

If you choose to do an at-home water delivery, understand that this method of delivery is not recommended by ACOG. Make sure you're well aware of the risks.

If you plan for an at-home water delivery, discuss the supplies you will need with your midwife.

The most significant piece of equipment you will need is the tub. Usually, bathtubs in the home aren't used because it can be challenging to guarantee sanitation, they may be too shallow, and the area around the tub may not be as accessible for your team.

With your home tub likely not an option, this leaves you with buying or renting a tub. The cost of renting or buying a tub can range from $60 to over $500, depending on the style of the tub.

Additional supplies include:

  • A tarp for under the tub
  • Brand-new hose to connect to the sink or your water supply
  • Faucet adapter to connect the hose to your sink
  • Liner for the tub
  • Net or strainer to remove solids from the birthing process
  • Cleaning supplies to sanitize the tub
  • Access to a water heater (temperature should stay within 97 degrees to 100 degrees Fahrenheit)
  • Thermometer to measure the water temperature

What to Expect During a Water Delivery

Once you go into labor, you'll either head to your birthing facility or start preparing the water for your home tub. If you're giving birth at home, you'll wait for your midwife or healthcare team to arrive before getting in the tub.

You'll want to drink plenty of water to prevent dehydration, and you may want a damp, cold washcloth to cool your face and neck.

During the first stage of labor, you will try to relax in the tub while experiencing contractions and wait for your cervix to dilate to 10 centimeters.

Your practitioner will tell you when it's time to get out of the tub if you plan to deliver your baby out of the water.

If you have discussed and accepted the risks of giving birth submerged in water, your practitioner will tell you when it’s time to begin pushing.

Your helper or midwife can use the filter or fishing net to remove solids from labor from the water, such as mucus, bloody discharge, and feces. 

Once the baby is delivered, they will be carefully lifted (to protect the umbilical cord) onto your chest.

After your midwife has taken care of you and your baby, they (or your helper) will pump the water out of the tub and help with sanitizing it.

Cost

The cost of a water delivery will depend on what your insurance plan covers. The average cost of having a vaginal delivery in the United States is between $5,000 and $11,000, depending on your insurance plan.

Working with a midwife can be cheaper, ranging from $2,400 to $4,200.

The cost of a water birth is similar to that of a standard vaginal delivery, but it could be higher because of the additional equipment needed.

A Word From Verywell

Water deliveries have increased in popularity over the years, but there are still unknowns when it comes to the benefits and risks of water births.

If you're interested in having a water birth, discuss with your healthcare provider or midwife the risks and benefits, and check if you are a candidate. Have a backup plan ready in case complications develop for you or your baby.

While there is some research to support potential maternal benefits during the first phase of labor, there isn't enough evidence to understand the benefits and risks of water delivery.

Discuss your birthing options with your healthcare team to choose the right plan for you and your baby.

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Article Sources
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  1. The American College of Obstetricians and Gynecologists. Immersion in water during labor and delivery. Updated 2021.

  2. Liu, Y., Liu, Y., Huang, X. et al. A comparison of maternal and neonatal outcomes between water immersion during labor and conventional labor and deliveryBMC Pregnancy Childbirth 14, 160 (2014). doi:10.1186/1471-2393-14-160

  3. Granseth G, Bhattarai R, Sylvester T, Prasai S, Livar E. Notes from the field: two cases of legionnaires’ disease in newborns after water births — arizona, 2016MMWR Morb Mortal Wkly Rep. 2017;66(22):590-591. doi:10.15585/mmwr.mm6622a4

  4. Association of Ontario Midwives. Water birth at home.

  5. The American Journal of Managed Care. How much does it cost to give birth in the United States? It depends on the state. Updated May 15, 2020.