Review Article| Volume 33, ISSUE 6, P566-573, November 2020

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Women and waterbirth: A systematic meta-synthesis of qualitative studies

Published:December 25, 2019DOI:



      The practice of waterbirth is increasing worldwide and has been a feature of maternity services in the United Kingdom for over twenty years. The body of literature surrounding the practice focusses on maternal and neonatal outcomes comparing birth in and out of water.


      To undertake a review of qualitative studies exploring women’s experiences of waterbirth. This understanding is pertinent when supporting women who birth in water.


      A literature search was conducted in databases British Nursing Index, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Maternity and Infant Care, Medline, Applied Social Sciences Index and Abstracts and Web of Science, using search terms waterbirth, labour/labor, childbirth, women, mothers, experience, perception and maternity care. Five primary research articles published between 2003 and 2018 which explored the views of women who had birthed in water were selected for inclusion. Using meta-ethnography, qualitative research studies were analysed and synthesised using the method of ‘reciprocal translational analysis’ identifying themes relating to women’s experiences of birthing in water.


      Four themes were identified: women’s knowledge of waterbirth; women’s perception of physiological birth; water, autonomy and control; and waterbirth: easing the transition.

      Discussion and conclusion

      Despite the paucity of qualitative studies exploring women’s experiences of waterbirth, meta-synthesis of those that do exist suggested women identify positively with the choice. The experience of birthing in water appears to enhance a woman’s sense of autonomy and control during childbirth suggesting waterbirth can be an empowering experience for women who choose it.


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        • Burns E.
        • Greenish K.
        Water birth. Pooling information.
        Nurs. Times. 1993; 89: 47-49
        • Nightingale C.
        Waterbirth in practice.
        Mod. Midwife. 1994; 4: 15-19
        • Beech BAL
        Water birth unplugged: proceedings from the first international water birth conference.
        in: Beech BAL International Water Birth Conference; 1995. London: Books for Midwives Press, London1996
        • Garland D.
        • Jones K.
        Waterbirth: updating the evidence.
        Br. J. Midwifery. 1997; 5: 368-373
        • Harper B.
        Birth, bath, and beyond: the science and safety of water immersion during labor and birth.
        J. Perinatal Educ. 2014; 23: 124-134
        • Garland D.
        Waterbirth- an international overview: Diane Garland, a freelance UK-based midwife lecturer, spoke at the ICM Brisbane Congress and now gives an update on the practice of waterbirth around the world.
        Int. Midwifery. 2006; 19: 24
        • Kavosi Z.
        • Keshtkaran A.
        • Setodehzadeh F.
        • Kasraeian M.
        • Khammarnia M.
        • Eslahi M.
        A comparison of mothers’ quality of life after normal vaginal, caesarean, and water birth deliveries.
        Int. J. Commun. Based Nurs. Midwifery. 2015; 3: 198-204
        • Ros H.B.
        Effects of waterbirths and traditional bedbirths on outcomes for neonates.
        Curationis. 2009; 32: 46-52
        • Maude R.M.
        • Foureur M.J.
        It’s beyond water: stories of women’s experience of using water for labour and birth.
        Women Birth. 2007; 20: 17-24
        • Cluett E.R.
        • Burns E.
        • Cuthbert A.
        Immersion in water in labour and birth.
        Cochrane Database Syst. Rev. 2018; (Art No: CD000111). Available from:)
        • Cluett E.R.
        • Burns E.
        Immersion in water in labour and birth.
        Cochrane Database Syst. Rev. 2009; (Art No: CD000111): 1-101
        • National Institute for Health and Care Excellence
        Intrapartum Care for Healthy Women and Their Babies. Clinical Guidelines.
        (Available from:) NICE, London2014
        • NHS England
        Better Births: Improving Outcomes of Maternity Services in England. A Five Year Forward View for Maternity Care: National Maternity Review.
        NHS England, London2016
        • Department of Health
        Maternity Matters: Choice, Access and Continuity of Care in a Safe Service.
        Department of Health, Partnerships for Children, Families and Maternity, London2007
        • Department of Health
        Changing Childbirth (The Report of the Expert Maternity Group).
        HMSO, London1993
        • Department of Health
        NHS Constitution: the NHS Belongs to is all.
        (Available from:) DoH, London2015
        • Wenzel L.
        • Jabbal J.
        User Feedback in Maternity Services.
        (Available at:) Kings Fund, London2016
        • Care Quality Commission
        2015 Survey of Women’s Experiences of Maternity Care: Statistical Release.
        (Available from:) CQC, London2015
        • NHS Digital
        NHS Maternity Statistics 2017-18: Summary Report.
        (Available from:) NHS Digital, London2018
        • Campbell R.
        • Pound P.
        • Morgan M.
        • Dkaer-White G.
        • Britten N.
        • Pill R.
        • Yardley L.
        • Pope C.
        • Donovan J.
        Evaluating meta-ethnography: systematic analysis and synthesis of qualitative research.
        Health Technol. Assess. 2011; 15: 1-164
        • Sandelowski M.
        • Docherty S.
        • Emden C.
        Qualitative metasynthesis: issues and techniques.
        Res. Nurs. Health. 1997; 20: 365-371
        • Heyman B.
        Reflecting on a meta-synthesis of qualitative papers concerned with pregnant women’s decision-making about prenatal screening for Down syndrome: a commentary on Reid, Sinclair, Barr, Dobbs and Crealey.
        Soc. Sci. Med. 2009; 69: 1574-1576
        • Zimmer L.
        Qualitative meta-synthesis: A question of dialoguing with texts.
        J. Adv. Nurs. 2006; 53: 311-318
        • Barnett-Page E.
        • Thomas J.
        Methods for the synthesis of qualitative research: a critical review.
        BMC Med. Res. Methodol. 2009; 9 (Available from:)
        • Noblit G.
        • Hare R.
        Meta-ethnography: Synthesising Qualitative Studies.
        11th ed. Sage Publications, London1988
        • Walsh D.
        • Downe S.
        Meta-synthesis method for qualitative research: a literature review.
        J. Adv. Nurs. 2005; 50: 204-211
        • Walsh D.
        • Downe S.
        Appraising the quality of qualitative research.
        Midwifery. 2006; 22: 108-119
        • Wu C.J.
        • Chung U.L.
        The decision-making experience of mothers selecting waterbirth.
        J. Nurs. Res. 2003; 11: 261-268
        • Lewis L.
        • Hauck Y.L.
        • Crichton C.
        • Barnes C.
        • Poletti C.
        • Overing H.
        • Keyes L.
        • Thomson B.
        The perceptions and experiences of women who achieved and did not achieve a waterbirth.
        BMC Pregnancy Childbirth. 2018; 18: 1-10
        • Ulfsdottir H.
        • Saltvedt S.
        • Ekborn M.
        • Georgsson S.
        Like an empowering micro-home: A qualitative study of women’s experience of giving birth in water.
        Midwifery. 2018; : 26-31
        • Waters I.
        An ethnography of water birth and its representations on YouTube.
        Inquires J. 2011; 3: 1-3
        • Sidebottom A.
        • Vacquier M.
        • Simon K.
        • Fontaine P.
        • Dahlgren-Roemmich D.
        • Hyer B.
        • Jackson J.
        • Steinbring S.
        • Wunderlich W.
        Who Gives Birth in Water? A retrospective cohort study of Intended versus Completed Waterbirths.
        J. Midwifery Women’s Health. 2019; 64: 403-409
        • Earle S.
        • Hadley R.
        Men’s views and experiences of infant feeding: a qualitative systematic review.
        Mater. Child Nutr. 2017; 14 (e12586): 1-13