A retrospective comparison of water birth and conventional vaginal birth among women deemed to be low risk in a secondary level hospital in Australia

Published:November 02, 2012DOI:https://doi.org/10.1016/j.wombi.2012.10.002



      Water birth involves the complete birth of the baby under warm water. There is a lack of consensus regarding the safety of water birth.


      This study aimed to describe the maternal and neonatal outcomes associated with water birth among labouring women deemed at low risk for obstetric complications and compare these outcomes against women of similar risk who had a standard land birth.


      A retrospective audit and comparison of women giving birth in water with a matched cohort who birthed on land at Bankstown hospital over a 10 year period (2000–2009).


      In total 438 childbearing women were selected for this study (N = 219 in each arm). Primigravida women represented 42% of the study population. There was no significant difference in mean duration of both first and second stages of labour or postpartum blood loss between the two birth groups. There were no episiotomies performed in the water birth arm which was significantly different to the comparison group (N = 33, p < 0.001). There were more babies in the water birth group with an Apgar score of 7 or less at 1 min (compared to land births). However, at 5 min there was no difference in Apgar scores between the groups. Three of eight special care nursery admissions in the water birth group were related to feeding difficulties.


      This is the largest study on water birth in an Australian setting. Despite the limitations of a retrospective audit the findings make a contribution to the growing body of knowledge on water birth.


      To read this article in full you will need to make a payment
      Subscribe to Women and Birth
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Embry M.
        Observation sur un accouchement termine dans le bain.
        Annales de la Societe de Medecine Pratique de Montpellier. 1805; 5: 13
        • Odent M.
        Birth under water.
        Lancet. 1983; 2: 1476-1477
        • Cluett E.R.
        • Burns E.
        Immersion in water in labour and birth.
        Cochrane Database of Systematic Reviews. 2009; ([Art. No. CD000111])https://doi.org/10.1002/14651858.CD000111.pub3
        • Jessimann W.C.
        Immersion on water: use of a pool by women in labour.
        British Journal of Midwifery. 2009; 17: 583-587
        • Newburn M.
        • Singh D.
        Creating a better birth environment: women's views about the design and facilities in maternity units: a national survey. An Audit toolkit.
        NCT, London2003
        • Miller J.
        All women in labour should have the choice of water birth.
        British Journal of Midwifery. 2009; 14: 484-485
        • Benfied R.
        • Hortobagyi T.
        • Tanner C.J.
        • Swanson M.
        • Heitkemper M.M.
        • Newton E.R.
        The effects of hydrotherapy on anxiety, pain, neuroendocrine responses and contraction dynamics during labour.
        Biological Research for Nursing. 2010; 12: 28-36
        • Maude R.M.
        • Foureur M.J.
        It's beyond water: stories of women's experiences of using water for labour and birth.
        Women and Birth. 2007; 20: 17-24
        • Otigbah C.M.
        • Mandish K.D.
        • Harmsworth G.
        • Chard T.
        A retrospective comparison of water birth and conventional vaginal deliveries.
        European Journal of Obstetrics and Gynaecology and Reproductive Biology. 2000; 91: 15-20
        • Eberhard J.
        • Dtein S.
        • Geissbuehler V.
        Experience of pain and analgesia with water and land births.
        Journal of Psychosomatic Obstetrics and Gynecology. 2005; 26: 127-133
        • Benfied R.
        • Herman J.
        • Katz V.L.
        • Wilson S.P.
        • Davis J.M.
        Hydrotherapy in labour.
        Research in Nursing and Health. 2001; 24: 57-67
        • Royal College of Obstetricians and Gynaecologists/Royal College of Midwives
        Joint statement no. 1: immersion in water during labour and birth.
        • Pinette M.G.
        • Wax J.
        • Wilson E.
        The risks of underwater birth.
        American Journal of Obstetrics and Gynecology. 2004; 190: 1072-1082
      1. RANZCOG College statement: C-Obs 24; July 08.
        • Mammas I.N.
        • Thiagarajan P.
        Water aspiration syndrome at birth – report of two cases.
        Journal of Maternal Fetal Neonatal Medicine. 2009; 22: 365-367
      2. Duley LMM. Birth in water: RCOG statement no. 1; 2001.

        • Carpenter L.
        • Weston L.
        Neonatal respiratory consequences from water birth.
        Journal of Paediatrics and Child Health. 2012; 48: 419-423
        • NICE
        Principles for best practice in clinical audit.
        Ratcliffe Medical Press, Oxford2002
      3. Bankstown Hospital Water Birth Protocol. http://www.swslhd.nsw.gov.au/bankstown/.

        • Thoni A.
        • Murari S.
        Birth in water: a comparative study after 555 births in water.
        Minerva Ginecologica. 2001; 53: 29-34
        • Eckert K.
        • Tunbull D.
        • Maclennan A.
        Immersion in water in the first stage of labour: a randomized controlled trial.
        Birth. 2001; 2: 84-93
        • Pellantova S.
        • Vebera Z.
        • Puchek P.
        Water delivery: a 5 year retrospective study.
        Ceská Gynekologie. 2003; 68: 175-179
        • Burns E.
        • Greenish K.
        Pooling information.
        Nursing Times. 1993; 89: 47-49
        • Harper B.
        Water birth basics: from newborn breathing to hospital protocols.
        Midwifery Today Magazine. 2000; 54: 9-15
        • Woodward J.
        • Kelly S.M.
        A pilot study for a randomised controlled trial of waterbirth versus land birth.
        BJOG: An International Journal of Obstetrics and Gynecology. 2004; 111: 537-545
        • Gilbert R.E.
        • Tookey P.A.
        Perinatal mortality and morbidity among babies delivered in water; surveillance study and postal survey.
        British Medical Journal. 1999; 319: 483-487
        • Davies M.W.
        Water births and the research required to assess the benefits versus the harms.
        Journal of Paediatrics and Child Health. 2010; Junehttps://doi.org/10.1111/j.1440-1754.2010.01781.x