The American College of Obstetricians and Gynecologists (ACOG) has updated its 2014 guidelines for immersion in water during labor and delivery. The guidelines recommend that “birth occur on land, not in water.” They note that beneficial effects of labor in water have been demonstrated, but the risks and benefits of water delivery have not been researched.
In the United Kingdom, the Royal College of Midwives supports immersion during both labor and birth; however, the National Institute for Health and Care Excellence advises that there is not enough evidence to support or discourage water birth. The American College of Nurse-Midwives supports the practice.
The ACOG makes the following recommendations:
- During the first stage of labor, immersion in water may be associated with shorter labor and decreased use of pain medications. This option may be offered to healthy women with uncomplicated pregnancies between 37 and 41 weeks of gestation.
- There is not enough research on the risks and benefits of immersion in water during the second stage of labor and delivery for either the baby or the mother to make a recommendation. “Therefore, until such data are available, it is the recommendation of the College that birth occur on land, not in water.”
- They acknowledge that some women will request to give birth while submerged in water. They should be informed that the risks and benefits to the mother and baby have not been studied, and that there are sometimes serious neonatal complications associated with water delivery.
- Facilities that offer immersion during labor and delivery need to establish rigorous protocols for candidate selection, cleaning, infection control, monitoring of women and fetuses, and emergency plans if urgent maternal or fetal concerns or complications develop.
