Is a waterbirth safe for mom and baby?

Waterbirth has been a topic of discussion the past three decades in health care and parenting groups because of the benefits and risks that it can pose for those who want to use a water tub during labor and give birth in it. Laboring in water is considered safe, and this option is widely available. Giving birth in water, or “waterbirth” is more controversial.

The potential benefits include a medication-free way to lessen or control pain through the labor and delivery process, easier movement and positioning, improved outcomes for mom and baby – like less vaginal tearing, mothers feeling more in control and safe – lowering stress, increased immediate skin-to-skin contact between mom and baby and overall a drug-free option for low-risk pregnancies.

The potential risks listed by some have been maternal and neonatal infection, neonatal respiratory distress, contaminated water sources and potential unknown risks.

Currently, the ​American College of Nurse-Midwives in the United States and the Royal College of Obstetricians/Royal College of Midwives in the United Kingdom recommend waterbirths as an evidence-based option for those who have low-risk pregnancies. But the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics say there has not been enough evidence to assure that it is safe and beneficial for both the mother and baby. They state that waterbirth is an experimental procedure that needs more study.

One of the biggest midwife practices in Wisconsin has embarked on a two-year clinical trial at Aurora Sinai Medical Center in Milwaukee, Wis., to address this lack of evidence by conducting evidence-based research on waterbirth safety, benefits and risk in the hospital setting.

“As midwifes our philosophy of patient care focuses on helping our patients know all of the options available to them in pregnancy, labor, delivery and postpartum,” says Emily Malloy, a certified nurse midwife leading the clinical trial, “Whatever they decide we support, whether it be waterbirth, pain medications, different positions or an epidural.”

From the latest data, the U.S. maternal and infant mortality rate is 46^th in the world causing a lot of concern in health care and patients. Plus, with the U.S. C-section rate at 31.8%, researching all available options is needed as patients, including populations with higher health inequity, want more input, control and better models of care. Malloy believes midwives are part of the solution.

“Currently, less than 12% of babies are birthed by midwives in the U.S. but here at Aurora Sinai we have several midwifery groups, and our C-section rate is around 20-25%. These are a few of the reasons we want to research and offer more options to our patients like waterbirth. Besides us, the closest place to have a hospital waterbirth is in Madison, Wis. More studies and research are being done on waterbirths across the country to bring about more evidence on its safety, making it a mainstream option.”

As an Advocate Aurora Research Institute clinical trial, Malloy and the research team plan to enroll 120 healthy women at or around the 28th week of their low-risk pregnancy. Already seven months in, they have 74 participants and 14 waterbirths have occurred. The study is computer randomized where all participants receive the same care, but some are offered the additional option of waterbirth for pain relief and others are not. Those that choose to use the water birth option are given a hospital-grade, inflatable tub with individual disposable liners in their labor and delivery room.

If the trial is successful, Aurora Sinai hopes to offer permanent waterbirth tubs and suites.

“This is why I became a midwife at Aurora Sinai,” Malloy shares. “To offer our patients high quality and safe care options for their pregnancy and delivery. Whether it be current options, researching or teaching our residents, I get to collaborate with an amazing group of nurses, midwives and physicians to benefit our patients and their babies.”

Malloy had all three of her children delivered by midwives at Aurora Sinai Medical Center.

Interested in participating in this water birth trial? Patients receiving prenatal care with the midwives and physicians at Aurora Sinai Medical Center may schedule an appointment to go over criteria and details by calling 414-219-6649.

Explore open Advanced Practice Clinician positions at Advocate Aurora Health.