In water or on land? Evaluation of perinatal and neonatal outcomes of water births in low-risk women

Authors: Kubeczková Lenka 1;  Kučerová Daňková Jana 1,2;  Prašivková Pavla 3;  Gelnar Michaela 1;  Mrózek Michal 1;  Wiecek Petr 1;  Janíček Daniel 1;  Heczko David 1;  Canibal Hynek 3;  Blachut Vít 2;  Otevřel Pavel 4;  Vrána Tomáš 4
Authors‘ workplace: Gynekologicko-porodnické oddělení, Nemocnice s poliklinikou Havířov p. o. 1;  VUT v Brně 2;  Dětské oddělení, Nemocnice s poliklinikou Havířov p. o. 3;  Klinika reprodukční medicíny, Ostrava 4
Published in: Ceska Gynekol 2021; 86(5): 311-317
Category: Original Article
doi: 10.48095/cccg2021311


Objective: Evaluate perinatal and neonatal outcomes comparing a water birth to regular childbirth in low-risk women. File and methods: Retrospective analysis of a set of childbirths that took place over a given period of time in the hospital and health center of Havířov. We compared a set of low-risk women that had given a water birth to a selected control group of low-risk women that had given regular childbirth. We evaluated statistical comparability, as well as perinatal and neonatal outcomes in both sets. Results: From 1. 1. 2020 to 28. 2. 2021, 1,083 women gave birth in the delivery department of Havířov hospital; from this set 122 were water births (11.3%). In our study, we only included 101 water deliveries (we designed our study to monitor low-risk births in order to be able to statistically correlate our findings; 21 water deliveries were excluded from our study due to perinatal risk factors – gestational diabetes and induced deliveries). We selected 60 low-risk women for our control group. Both sets of women were compared and we ruled out any statistically significant differences in age, education, body mass index, number of births given, gestation week at time of labor, number of smokers, premature rupture of membranes, women with previous history of one cesarean section, becoming pregnant by in vitro fertilization, presence of streptokoka skupiny B, and fetal weight. Water birth does not affect the Apgar score, neonatal adaptation to extra-uterine life, umbilical blood pH decrease, complications of infection, need of intensive care, and neonatal mortality. In the water birth set, we found increased occurrence of non-infectious conjunctivitis, treatable by regular eye drops without antibio­tics. We have not observed the effect of water birth on duration of the first and second stage of labor, total amount of uterotonics used, blood loss determined by the obstetrician, and uterine hypotonia. In the water birth group, we observed a prolonged third stage of delivery, lesser need for pharmacological stimulation (augmentation) of labor, notably lower use of analgesics, lower occurrence of birth injuries, shorter in-patient time, and more frequent bonding. Conclusions: We discovered that water birth does not increase the risk for mother and neonate in low-risk women. Despite initial concerns, our outcomes and mother satisfaction have clearly shown that water births are not only a temporary whim, but probably a new integral part of our obstetric care.


childbirth – water birth – analgesia with water – perinatal and neonatal outcomes


1. Cluett ER, Burns E, Cuthbert A. Immersion in water during labour and birth. Cochrane Database Syst Rev 2018; 5 (5): CD000111. doi: 10.1002/14651858.CD000111.pub4.

2. Odent M. Birth under water. Lancet 1983; 2 (8365–8366): 1476–1477. doi: 10.1016/s0140-6736 (83) 90816-4.

3. Pellantová Š, Vebera Z, Půček P. Porod do vody – pětiletá retrospektivní studie. Ceska Gynekol 2003; 68 (3): 175–179.

4. Neiman E, Austin E, Tan A et al. Outcomes of waterbirth in a US hospital-based midwifery practice: a retrospective cohort study of water immersion during labor and birth. J Midwifery Womens Health 2020; 65 (2): 216–223. doi: 10.1111/jmwh.13033.

5. Gogela J, Vebera Z. Doporučené postupy v perinatologii. 11. Podmínky, za kterých lze akceptovat porod do vody na pracovištích, která se k takové alternativě rozhodnou. Ceska Gynekol 2013; 78 (Suppl): 27–28.

6. Taylor H, Kleine I, Bewley S et al. Neonatal outcomes of waterbirth: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed 2016; 101 (4): F357–F365. doi: 10.1136/arch dischild-2015-309600.

7. Bábková B, Marešová K. Nemoci slzného kanálku. Pediatr pro Praxi 2007; 8 (5): 281–283.

8. Zanetti-Daellenbach RA, Tschudin S, Zhong XYet al. Maternal and neonatal infections and obstetrical outcome in water birth. Eur J Obstet Gynecol Reprod Biol 2007; 134 (1): 37–43. doi: 10.1016/j.ejogrb.2006.09.012.

9. Liu Yi, Liu Yu, Huang X et al. A comparison of maternal and neonatal outcomes between water immersion during labor and conventional labor and delivery. BMC Pregnancy Childbirth 2014; 14: 160. doi: 10.1186/1471-2393-14-160.

10. Cooper M, Warland J. What are the benefits? Are they concerned? Women‘s experiences of water immersion for labor and birth. Midwifery 2019; 79: 102541. doi: 10.1016/j.midw.2019.102541.

11. Odent M. Can water immersion stop labor? J Nurse Midwifery 1997; 42 (5): 414–416. doi: 10.1016/s0091-2182 (97) 00051-7.

12. Bugg GJ, Stanley E, Baker PN et al. Outcomes of labours augmented with oxytocin. Eur J Obstet Gynecol Reprod Biol 2006; 124 (1): 37–41. doi: 10.1016/j.ejogrb.2005.04.015.

13. Bailey JM, Zielinski RE, Emeis CL et al. A retrospective comparison of waterbirth outcomes in two United States hospital settings. Birth 2020; 47 (1): 98–104. doi: 10.1111/birt.12473.

14. Aasheim V, Nilsen AB, Reinar LM et al. Perineal techniques during the sekond stage of labour for reducing perineal trauma. Cochrane Database Syst Rev 2011; 12: CD006672. doi: 10.1002/14651858.CD006672.pub2.

15. Sidebottom AC, Vacquier M, Simon K et al. Maternal and neonatal outcomes in hospital-based deliveries with water immersion. Obstet Gynecol 2020; 136 (4): 707–715. doi: 10.1097/AOG.0000000000003956.

16. Bovbjerg ML, Cheyney M, Everson C. Maternal and newborn outcomes following waterbirth: the midwives aalliance of North America statistics project, 2004 to 2009 cohort. J Midwifery Womens Health 2016; 61 (1): 11–20. doi: 10.1111/jmwh.12394.

Paediatric gynaecology Gynaecology and obstetrics Reproduction medicine

Article was published in

Czech Gynaecology

Issue 5

2021 Issue 5

Most read in this issue
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account