How valid are the common concerns raised against water birth? A focused review of the literature

Background: Women have birthed in water for many years, with researchers finding a number of benefits
for mother and baby. Despite these benefits, many health institutions and clinicians are hesitant to
support women’s access to water immersion in birth for a number of reasons. As such, this paper aimed
to (1) select five common concerns raised against water birth and (2) examine whether research
supports these concerns as being evidence-based.
Method: A literature review was conducted to (1) select the concerns for review and to (2) review each
selected concern as to whether they were supported by the current evidence. A recent review of women’s
access to, and uptake of, water immersion in Queensland, Australia, was also used to determine the
concerns for review in order to better capture concerns relevant to Australian practice.
Findings: Three clinical concerns were selected for review: water aspiration, neonatal and maternal
infection, and neonatal and maternal thermo-regulation; and two concerns around the practice of water
birth were selected: skills and education of workforce, and emergency procedures in case of maternal
collapse. The three clinical concerns were not found to be supported by the available evidence and the
two practice concerns can be addressed by appropriate policy, guidelines and practice.
Conclusion: The reviewed common concerns against water birth are not evidence-based nor are they
sufficient to prevent women from accessing the use of water in labour and birth. Health institutions and
clinicians should ensure they take adequate precautions to enable women access to this valued and
effective method of birth