What the research says about waterbirth

You'll find our articles on water birth have everything you need to know. But if you want to delve deeper into the research, we've put together the findings so far. Here's the inside track on what the experts know about water birth.

Is it safe to labour and give birth in water?

As long as you are healthy and your pregnancy is straightforward it is safe for you to labour in water. There's little difference in the health of babies born to healthy mums who laboured in water compared to babies born to healthy mums who laboured in air (Cluett and Burns 2009).

There is also some evidence that labouring in water is helpful for mums who have had a previous caesarean (Garland 2006). This is provided their doctors are happy for them to use water. The use of water for pain relief is also recommended for women who have been induced. But provision may depend on the reason for induction (NCCWCH 2008).

Evidence for or against the safety for giving birth or delivering the placenta in water is harder to find. Births in water have similar rates of babies needing special care as those for air births (Cluett and Burns 2009). They also have similar Apgar scores and other indicators of the wellbeing of the baby (Cluett and Burns 2009).

Find out more about the safety of water birth.

What effect does water have on the length of labour?

Length of labour appears to be similar whether mums-to-be labour in water or not. A 2009 Cochrane Review found no real difference in length of labour between mums who laboured in water and those who laboured in air (Cluett and Burns 2009).

What effect does water have on easing pain in labour?

Labouring in water can help you cope with the pain of labour. The 2009 Cochrane Review found that being in water during labour reduced perceptions of labour pain. It also reduced the need for some pain-relieving drugs (Cluett and Burns 2009).

Mums-to-be were much less likely to need an epidural or spinal if they used a pool, tub or bath during the first stage of labour (Cluett and Burns 2009).

No difference in the use of pethidine-type pain-relieving drugs was found between mums-to-be using a birth pool and mums-to-be labouring in air (Cluett and Burns 2009).

What should the temperature of the water be?

The National Institute for Health and Clinical Excellence (NICE) recommends that for labouring, the temperature of the water should not be above 37.5 degrees C (NCCWCH 2007: 96).

However, there is little evidence on which the NICE temperature guidance is based. There have been no studies comparing the effects of different water temperatures on the wellbeing of mums and babies (Cluett and Burns 2009).

If you are using a birth pool, your midwife will check both the temperature of the water and your temperature. This is to make sure that you are comfortable and not becoming feverish (NCCWCH 2007). She will also monitor your baby's heart rate at regular intervals, using a waterproof Sonicaid monitor.

When is the best time to get into a pool during labour?

The 2009 Cochrane Review looked at women who needed to have their labours speeded up, because their labours had slowed down. They found no difference in the use of ways to speed up labour between those who had laboured in water and those who had not (Cluett and Burns 2009).

Only one study in the review investigated whether getting into a birth pool earlier on in labour (before cervical dilation of at least five centimetres) made a difference. Women who got in early were more likely to have an epidural and to need their labour speeded up, when compared to women who got in later in labour (Cluett and Burns 2009).

This one study had some flaws, though. It wasn't clear what proportion of the women in the early group were in latent or active phases of first stage of labour. Women in latent phase may have been expected to progress more slowly.

The current NICE guideline concluded that there wasn't enough evidence on timing of use of water in labour (NCCWCH 2007). So it should be up to you as to when you want to get in (or out) of a birth pool in labour.

Will I be less likely to need an assisted birth or a caesarean?

Not necessarily. The 2009 Cochrane Review looked at the type of birth mums had after they laboured in water or in air for the first stage of labour. It showed no real difference in rates of assisted birth or caesarean birth between the two groups (Cluett and Burns 2009).

Two trials in the review studied the use of water in the second stage (the pushing stage and birth). One found no difference (Cluett and Burns 2009).

The other found a reduced risk of assisted birth for mums who had used water during labour than for those who had not (Cluett and Burns 2009).

A UK study published in 2012 reported that the place of birth had an impact on birth intervention rates, particularly for mums-to-be having their first baby (Burns et al 2012).

Mums-to-be were more likely to have a straightforward vaginal birth when using a birth pool in a community midwife-led unit, compared to an alongside midwife-led unit or a labour ward. Fewer first-time mums also required transfer to hospital in the community setting compared to the alongside units.

What are my chances of tearing if I labour in water?

Your chances of tearing are the same whether you give birth in water or in air. The 2009 Cochrane Review found no difference in the likelihood of tearing (Cluett and Burns 2009). Episiotomy rates were also similar.

One study has since suggested that although the rate of tears is similar between water and air births, the incidence of third degree tears may be increased in water births (Cortes et al 2011). In this study the pushing stage tended to be quicker in the water birth group, which could have been a factor.

Another possible factor is the limited extent to which the midwife is physically able to protect the mum-to-be's perineum during water birth (Cortes et al 2011).

Last reviewed: January 2013


Anderson T. 2004. Time to throw the waterbirth thermometers away. MIDIRS Midwifery Digest 14(3):370–4

Burns et al. 2012. Characteristics, Interventions, and Outcomes of Women Who Used a Birthing Pool: A Prospective Observational Study. Birth 39(3):192-202

Cluett ER, Burns E. 2009. Immersion in water in labour and birth. Cochrane Database of Systematic Reviews (2): CD000111. [pdf file, accessed January 2013]

Cortes E, Basra R, Kelleher CJ. 2011. Waterbirth and pelvic floor injury: a retrospective study and postal survey using ICIQ modular long form questionnaires. Eur J Obstet Gynecol Reprod Biol 155(1): 27-30

Garland D. 2002. Collaborative waterbirth audit - supporting practice with audit. MIDIRS Midwifery Digest 12(4):508-11

Garland D. 2006. Is waterbirth a "safe and realistic" option for women following a previous caesarean section? Completion of a three-year data study. MIDIRS Midwifery Digest 16(2):217-20

Geissbuehler V, Eberhard J, Lebrecht A. 2002. Waterbirth: water temperature and bathing time – mother knows best! J Paediatr Med 30:371–8



RCOG/RCM. 2006. Immersion in water during labour and birth. Royal College of Obstetricians and Gynaecologists/Royal College of Midwives, Joint statement 1. [Accessed January 2013]

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