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Water Birth

ACNM has been closely monitoring the media coverage since the release of the ACOG/AAP Committee Opinion, “Immersion in Water During Labor and Delivery.” ACNM, ACOG, and AAP are in agreement that immersion in water during the first stage of labor may be associated with numerous benefits to women; however, ACNM believes this document does not accurately reflect the large and growing body of research that supports water birth as a reasonable choice for healthy women experiencing normal labor as well as birth. ACNM has been in communication with ACOG to express our concerns and our disagreement with the conclusions of this committee opinion, and we will be sending additional up-to-date information on water birth outcomes to ACOG and AAP for the committee’s consideration.

In the meantime, it is critical that ACNM members are equipped to have informed discussions with women and families as well as professional colleagues as this committee opinion is disseminated and media stories emerge. The nation’s top experts in water birth have been working closely with our national office staff team and leadership to encourage the dissemination of accurate information about water birth. We have created the following resources to assist you in these conversations.

ACNM Position Statement: Hydrotherapy During Labor and Birth

Talking Points

• Women need accurate, reliable information when making decisions about the birth of their child, including how to manage their pain so they can be as comfortable as possible. Consulting with a qualified healthcare provider will ensure that the risks, benefits, alternatives and research are discussed so women can make informed choices. After consulting with her health care provider, if a woman chooses to labor and give birth in water, she should receive all the support she needs to make it a safe and pleasant experience.

• Midwives are experts at working with low-risk women to ensure that their concerns are heard and their questions are answered. They help women understand the evidence and choose what is best for their pregnancy, labor and birth and they listen to the personal preferences of the women they serve.

• Most water births occur under the care of a midwife and it has been a safe option for decades that provides comfort with good outcomes for the mom and her baby. ACNM members serve women who are having water births in hospitals, birth centers and the home. ACNM supports ongoing access to water birth and we encourage more maternity care providers to become educated about its safe use in order to ensure that women are fully informed.

• ACNM concurs with results of randomized clinical trials – a reliable form of research – that demonstrate that “immersion in water during the first stage of labor may be associated with decreased pain or use of anesthesia and decreased duration of labor.” With healthcare organizations (like ACNM, ACOG and AAP) in agreement on this, more healthy women are likely to have access to this information and practice—which is great news for women.

• However, this new ACOG/AAP opinion statement cautions about immersion in water during the second stage of labor. These cautions are similar to those in their prior publications, including warnings about a lack of data on the safety and benefits of water birth. The organizations refer to case studies of adverse outcomes, but case studies are not a reliable form of research, and should not be the foundation for their conclusion—that water births should only be considered as part of “experimental” clinical trials.

• ACNM believes that this committee opinion does not accurately reflect the large and growing body of research that supports water birth as a reasonable choice for healthy women experiencing normal labor and birth. Despite limitations, the best available research indicates that water birth is associated with perinatal outcomes similar to those expected in a low-risk population. In other words, healthy women and their babies generally stay healthy during and after normal labor and water birth. Therefore, water birth is a reasonable choice for healthy women to make in collaboration with their care provider, given the state of the science.

• We agree that more research about water birth is needed, particularly in the US, but international studies already support water immersion as an option that women should consider for their labor and birth.

• ACNM welcomes the ACOG/AAP call for higher quality research regarding the use, safety and benefit of obstetric interventions. However, the implicit assumption that most interventions in U.S. childbirth are evidence-based must be examined. Many routine obstetric interventions have not been subjected to larger randomized clinical trials, while other obstetric interventions are commonly used or overused despite evidence they are ineffective or harmful (e.g., pharmacologic pain relief methods compared to other comfort measures to facilitate physiologic labor, and continuous electronic fetal monitoring for low-risk women in normal labor). In order to ensure access to evidence-based choices in childbirth, evaluation criteria should be applied uniformly to all interventions, rather than selectively in the case of water birth, a midwife-led care practice.


American College of Nurse-Midwives.
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