Birthing Tubs: Great for Labor, Not So Safe For Birth

A new report from OB/GYNs says laboring in tubs is fine, but you need to get out when it's time to deliver.

Water Birth Safety
If you've done a hospital tour of the maternity floor, you probably saw large tubs in some of the rooms. More and more women want to labor in water, and so many hospitals now offer these tubs as an option. But should you actually give birth in them? New guidelines from the American College of Obstetricians and Gynecologists (ACOG) say no.

The risks aren't clear

The committee of doctors who developed the report reviewed the available studies and concluded that immersion during the first stage (before you're fully dilated) can help shorten labor and reduce the need for epidurals. But they draw the line at laboring in the second stage (the pushing stage) and giving birth, citing a lack of evidence to prove its safety. "The opinion notes that there are insufficient data on which to draw conclusions regarding the relative risks and benefits of immersion during the second stage of labor, and that until such data are available, delivery is recommended to occur on land, not in water," Joseph R. Wax, MD, chair of the ACOG Committee on Obstetric Practice, tells Fit Pregnancy. "Women who choose to deliver in water despite this recommendation should be informed of the potential risks."

Although the likelihood of these risks hasn't been established, the report notes that case studies have shown instances of infection, the baby having breathing trouble and the cord snapping as the baby is lifted out. Water births have been a hotly debated topic as women strive to have more control over the birth process, and midwives say that giving birth in tubs in safe. Even some medical organizations, like the Royal College of Obstetricians and Gynecologists in the UK, say it's OK.

But, ACOG argues, studying these births has been difficult. First of all, there is no one definition of "water birth" — it's often unclear how long the woman labored while immersed, what stage of labor she was in, what temperature the bath was and how deep it was. These and other inconsistencies in the evidence have made it impossible for ACOG to assure women that actually giving birth in tubs is safe.

Laboring in water has benefits

The good news is, though, that laboring in a tub until you fully dilate is perfectly fine, and even has some benefits. ACOG found evidence that it may shorten the length of your labor and lessen the need for pain meds. This may be because—no shock to those of us who love baths—immersion has a relaxing effect, both physically and mentally. It might also help women to maintain a greater sense of control over their labor, as well as a greater feeling of privacy from not being as exposed.

Women laboring in tubs, though, should still be monitored at regular intervals, and need to get out when they are fully dilated or if it appears something might be going wrong, says Wax. In addition, only low-risk women should attempt it, and tubs need to be well-maintained and cleaned—so that means no blow-ups pools in the middle of your living room. "Each facility offering immersion should have protocols with strict criteria for selecting appropriate candidates for immersion, and end points for discontinuing immersion," Wax says. "ACOG respects a woman's right to her choice of birth location, but believes that hospitals or accredited birth centers are the safest places to give birth, regardless of whether or not immersion is chosen."