Is Water Birth a Safe Option? Recent Evidence and What You Should Know.

Laboring or birthing in water is one of several childbirth options people may consider, often appreciated for its pain relief, and making labor and birth. more comfortable and mobile. As with all medical choices, safety is a top concern—not just for the birthing person, but also for the baby. A new systematic review and meta-analysis in American Journal of Obstetrics & Gynecology helps clarify what the current evidence says.

What the Study Did

• The review pooled data from 52 studies, including both randomized and nonrandomized ones, comparing water birth (delivery while submerged) vs land-birth (conventional, non-water). AJOG+2PubMed+2

• They looked at a number of maternal outcomes (infection, postpartum hemorrhage, perineal injury, etc.) and neonatal outcomes (Apgar scores, infection, need for resuscitation, NICU admission, cord avulsion, neonatal mortality). The primary outcome was maternal infection. PubMed

• Data sources covered publications up to Feb 28, 2023.

What the Results Show

Here are the main findings—what risks seem to go up, which go down, and where things seem similar.

Outcome	Comparison: Water Birth vs Land Birth	Key Note / Numbers
Maternal Infection	No increase	Odds ratio (OR) ~0.93; 95% CI 0.76-1.14. → Means water birth did notincrease risk of infection compared with land births. PubMed
Postpartum Hemorrhage	Reduced risk	OR ~0.80 (95% CI 0.68-0.94). So fewer heavy maternal bleeding events in water birth. PubMed
Perineal Lacerations / Anal Sphincter Injury	Mixed / probably not worse	The study included those as secondary outcomes but did not show substantial increased risk. (The meta-analysis looked but didn’t find major harm.) PubMed+1
Umbilical Cord Avulsion	Increased risk	OR ~1.75 (95% CI 1.38-2.24). This means babies born underwater had higher odds of cord avulsion (the cord getting dislodged or snapping) compared with land births. PubMed
Low Apgar Scores	Reduced risk	OR ~0.69 (95% CI 0.58-0.82). Better Apgar outcomes in many water birth cases. PubMed
Neonatal Infection	Reduced risk	OR ~0.64 (95% CI 0.42-0.97). Slightly lower risk of baby having infection in water birth in the pooled data. PubMed
Neonatal Aspiration Resuscitation	Reduced	OR ~0.60 (95% CI 0.43-0.84): fewer babies needing resuscitation because of aspiration. PubMed
NICU Admission	Reduced	OR ~0.56 (95% CI 0.45-0.70): fewer babies admitted to NICU after water births. PubMed
Neonatal Mortality (within 30 days)	No evidence of increased mortality	The study didn’t find water birth associated with an increase in neonatal death. PubMed

So, Is It Safe?

For many people with low‐risk pregnancies, water birth can be a safe option, with some potential benefits: possibly less postpartum hemorrhage, lower rates of neonatal intensive care admission, fewer low Apgar scores, etc. However, it is not risk‐free. Some specific risks (cord issues, the need for well-prepared care) need to be understood and planned for. The safety depends heavily on where you do the water birth and how well the facility is equipped for emergency situations.

Water birth appears to be a reasonable option for many people, provided they meet criteria for safety and are in a supportive facility with experienced medical professionals. The recent meta‐analysis strengthens confidence that, for low-risk pregnancies, water birth does not generally increase major maternal or neonatal risks—and may even offer several benefits. Still, it’s something that should be discussed in depth with one’s healthcare provider, weighing personal circumstances, preferences, and available resources.

Sources:

McKinney, Jessica, et al. “Water Birth: A Systematic Review and Meta-Analysis of Maternal and Neonatal Outcomes.” American Journal of Obstetrics & Gynecology, vol. 230, no. 6, 2024, pp. 627–640. Elsevier, https://doi.org/10.1016/j.ajog.2023.07.036.