Should a pool be part of my birth plan? Many pregnant women find themselves asking this exact question. While the number of water births in the United States is unknown, according to the New York Times, increasing sales and rentals of birthing pools suggest more women are choosing the method (see celebrities like Hilary Duff and Bekah Martinez as an example).
But water births are are less popular with hospitals and some medical organizations. In recent years both the American Academy of Pediatrics (AAP) and the American College of Obstetricians and Gynecologists (ACOG) have raised concerns about water births, citing a lack of research and "case reports of rare but serious adverse effects in the newborn" and it's estimated that fewer than 10% of American maternity wards offer water birth as an option.
But a new study published in the journal Birth concludes water births are just as safe non-water births and that women who give birth in pools and tubs have fewer first and second-degree tears.
"The long and short of it is that if you use proper techniques...the outcomes are very good," says Lisa Kane Low, the study's senior author and professor at the University of Michigan School of Nursing. "They mirror what we see in international studies of water birth."
The study suggests that for healthy moms with uncomplicated pregnancies, water births can be an option. This affirms the position of the American College of Nurse-Midwives (ACNM), which states: "Researchers indicate that women who experience uncomplicated pregnancies and labors with limited risk factors and evidence-based management have comparable maternal and neonatal outcomes whether or not they give birth in water."
This is why in some countries water births are more accessible than they are stateside. In the United Kingdom, in-hospital water births are more common than they are in the United States. It is estimated half of UK hospital maternity wards are equipped with pools to offer water birth and both the Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives support the practice (provided mom is healthy and the pregnancy is uncomplicated).
However, the UK's National Institute for Clinical Excellence (NICE) official stance is complicated. It states that being in water during labor is good for pain relief, but also that "there is insufficient high‑quality evidence to either support or discourage giving birth in water."
For many experts, there is a distinction to make here: They may support laboring in the tub but not actually giving birth under the water. "Immersion in water during the first stage of labor may offer some benefits: It may shorten labor and is associated with a decreased use of epidurals," says Joseph R. Wax, chair of the ACOG Committee on Obstetric Practice that developed the 2016 ACOG Committee Opinion on the topic. "However, it is important to differentiate between laboring in water and delivering in water. There is no evidence to support delivering a baby in water has benefits to the baby."
The authors of the University of Michigan study suggest that even if there is a lack of evidence regarding benefits to the baby, the benefits to mothers should be a factor. Ruth Zielinski is the study's co-author and clinical associate professor of nursing who says more US facilities should offer water birth and have guidelines for implementing it, and she wants to see more studies on the satisfaction level of mothers who have water births.
Moms' satisfaction and opinions matter. It is her birth. And that's why it is time for more research and perhaps more birthing pools in hospitals.