The Claim: Laboring in a tub of water helps relax expectant mothers, significantly relieving the pain of childbirth.
The Verdict: A review of 11 trials, encompassing 3,146 women, published by the Cochrane Collaboration, a global network of scientists and clinicians, concludes that laboring in a tub during the first stage of labor reduces the need for epidural anesthesia. But the safety of staying in a tub during the birthing stage hasn’t been established—prompting some doctors to urge caution.
Sitting in water during labor, sometimes called hydrotherapy, can promote relaxation, improve blood flow and reduce swelling, according to scientific literature. Tubs—with or without massaging jets—are available at many birthing centers and some hospitals. For home births, women can use a bathtub or rent a birthing tub for about $200 to $300.
Typically the water is heated to body temperature, says Jenna Shaw-Battista, director of the Nurse-Midwifery Education Program at the University of California, San Francisco. The tub is filled to cover the belly and sometimes as high as the chest, Dr. Shaw-Battista says. Clothing is optional, she adds, and many women wear a sports bra or a hospital gown.
The scientific literature supports claims that hydrotherapy offers pain relief and relaxation—and may even shorten labor. But some clinicians draw the line at giving birth underwater.
In a joint opinion published this month, the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics, said that due to reports of newborn drownings, near drownings, and infection described in medical literature, the procedure should remain “experimental” and be performed only in the context of clinical trials.
In theory, in a water birth the baby is brought to the surface safely before it takes its first gasp. But if a baby is experiencing distress—for example if the umbilical cord is crimped—it may gasp earlier and “that’s all you need to get water in the lungs or to swallow that water into the stomach,” says Tonse N.K. Raju, chief of the pregnancy and perinatology branch at the National Institute of Child Health and Human Development in Bethesda, Md., and a liaison to the committee that issued the opinion. Another concern, he says, is that tub water can easily get contaminated with bacteria.
Problems are rare, Dr. Raju says. And the doctors’ concerns are based not on large randomized trials but on individual case reports, which some midwives say is a flawed approach as births on land can also have complications. So far, a number of observational studies of water births in low-risk women—including a 1999 British report of 4,032 water deliveries—have found no higher newborn mortality than a birth out of water. In data released last week by the American Association of Birth Centers, a trade group for free-standing birth centers, there were no infant deaths in 3,998 water births conducted at 79 centers over four years. And 1.5% of babies delivered underwater needed to be transferred to a hospital for observation or treatment, compared with 2.8% delivered on land.
The data, which the association hopes to publish, reflects that centers steer women likely to have complicated deliveries away from water birth, says the association’s director, Lesley Rathbun. Even if a water birth is planned, during labor the baby’s heartbeat is carefully monitored and if there’s any suggestion of distress, “we’re going to get the woman out of the tub” before delivery, she says.