Childbirth in water means giving birth in the aquatic environment. However, there are two situations:

• the mother-to-be does only part of the work in the water. Certain maternities, and in particular the physiological centers, offer birthing baths or “dilation baths” with water heated to 37 ° C. The mother-to-be can do part of her work there, but she will come out when the baby is pushed and born.
• the mother-to-be experiences her childbirth in water from the start to the end of labor, including during the baby’s expulsion and delivery. This scenario is much less frequent and very few structures practice it in France.

This type of childbirth is reserved for uncomplicated pregnancies and healthy pregnant women. The future mother cannot benefit from an epidural. Childbirth in water also requires specific training for midwives because in water, the actions are different, especially when the baby is expelled.

Advocates of childbirth in water argue different benefits of this practice:

• greater freedom of movement thanks to Archimedes’ thrust and hydrostatic pressure. Immersed in water, the body weighs only 30% of its weight, which would allow better muscle relaxation and better relaxation.
• hydrostatic pressure may have an effect on maternal cardiovascular physiology, notably with better venous return and mobilization of extravascular fluids (1) (2). These modifications would have the effect of reducing the pain of contractions, a feeling of well-being, and better control.
• giving birth in water would reduce the duration of childbirth (3).
• immersion in water would improve tissue elasticity and more specifically that of the perineum, thus reducing the risk of episiotomy (4).
• for the newborn, childbirth in water would ensure a smoother transition between the in-utero environment and the ex-utero environment, by passing it from amniotic fluid to warm water.

However, studies on the benefits of childbirth in water are contradictory.

In their joint report (5) published in 2014, the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics indicate that while individual retrospective analyzes and case series confirmed one or more benefits, a 2009 Cochrane systematic review (6) including randomized controlled trials shows inconsistent results. A reduction in the duration of the first part of labor and a decrease in the use of epidurals have however been noted.

Still according to the same report, several studies have highlighted different risks during childbirth in water, and more particularly during expulsion:

• increased risk of infection for mom and baby, especially if membranes ruptured
• baby’s thermoregulation difficulties
• umbilical cord complications when the baby is handled in water
• respiratory distress and hypotranemia

In the end, if the report recognizes that immersion in the first phase of work can bring certain benefits, on the other hand in the second phase of work, the safety and value of immersion in water have not been demonstrated.