Water birth--is it safe?

Water births have gradually become more popular in industrialized countries during the last decade. People advocating this form of delivery argue that the buoyancy in water helps the mother to relax and that the warmth helps reduce pain, meaning that the whole labor process and experience is positively influenced and even accelerated. Due to the sitting position and lower pressure gradient, there are supposedly fewer injuries to the birth canal, and delivery is also claimed to be easier on the child. However there is a great lack of scientific data. We have found only one publication in a peer reviewed journal with some 100 water births described. In a case controlled study not published the authors found fewer birth canal injuries and less use of analgesics but the difference was only slight. There was no difference in the length of labor. Several neonatal deaths are reported during uncontrolled water births. Based on the knowledge available to date, physiologic and general considerations (e.g. risk of infections, risk of hypoxia, risk of aspiration), water births must be classified as a type of obstetrical management, whereby the risks are still too undetermined to be said to be a safe form of birth. Water births should, thus, be restricted to centers with adequate medical assistance, and only in randomized, controlled studies who fulfill the Declaration of Helsinki. In any other setting water births should be rejected, since too little is known about the safety of this method.