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Ob-Gyns Weigh In: Laboring in Water is OK, Delivering in Water has No Proven Benefit

March 20, 2014

Washington, DC -- Undergoing the early stages of labor in a birthing pool may offer some advantages to pregnant women. However, underwater delivery has no proven benefit to women or babies and may even pose a risk of serious health problems for the newborn. These recommendations on laboring and delivering in water were released today by the American College of Obstetricians and Gynecologists (the College) and the American Academy of Pediatrics (AAP) in a joint Committee Opinion.

"Many labor and delivery units are equipped with tubs to be used by laboring women, and immersion in water for relaxation and pain relief is appealing to some,” said Jeffrey L. Ecker, MD, chair of the College’s Committee on Obstetric Practice that developed the Committee Opinion. “But it is important to recognize that laboring in water is not the same as delivering underwater. Laboring in water may offer some potential benefits, but delivering underwater does not seem to have clear advantages, and the risk of rare, but serious, consequences to a delivering baby's health is something women and providers should all be aware of.”

Labor and Delivery"The members of the committees conducted a thorough review of the literature, and came to the conclusion that there is no evidence to support delivering babies in water has benefits to the baby,” says Tonse Raju, MD, chief, Pregnancy and Perinatology Branch, the National Institute of Child Health and Human Development (NICHD), who served as the NICHD-liaison to the AAP Committee on Fetus and Newborn.

The new recommendation acknowledges that there may be some positive effects of water immersion to pregnant women during the early stages of labor, such as decreased pain or use of anesthesia and shorter labors. However, there is no evidence that giving birth underwater improves newborn outcomes.

To protect the health and safety of the baby during labor, the College and AAP lay out recommendations for hospitals or birth centers that plan to offer water immersion in the first stage of labor. These include:

  • Developing rigorous protocols for candidate selection;
  • Maintaining and cleaning tubs and immersion pools;
  • Following infection control procedures;
  • Monitoring pregnant women at appropriate intervals while immersed; and
  • Moving women out of the tubs if maternal or fetal concerns develop.

The Committee Opinion stresses that the safety and efficacy of immersion in water during the second stage of labor (underwater delivery) have not been established, nor has there been any benefit shown to women or newborns. Additionally, rare but serious health problems in the newborn have been reported. Potential risks of underwater delivery include a higher risk of maternal and neonatal infections; difficulty in the regulation of the baby’s body temperature; increased chance of umbilical cord damage; respiratory distress resulting from the baby inhaling tub water; and potential for seizures or asphyxiation of baby following birth.

The College and AAP say that underwater delivery should only be performed within the context of an appropriately designed clinical trial with informed consent.

Committee Opinion #594 “Immersion in Water for Labor and Delivery” will be published in the April issue of Obstetrics & Gynecology.

The AAP will publish the clinical report, “Immersion in Water for Labor and Delivery,” in the April 2014 print issue of Pediatrics. It will be early-released online on Thursday, March 20, 2014.

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Other recommendations issued in this month’s Obstetrics & Gynecology:

Committee Opinion #592 “Sexual Assault” (Revised)

ABSTRACT: Reproductive-aged victims of sexual assault are at risk of unintended pregnancy, sexually transmitted infections, and mental health conditions, including posttraumatic stress disorder. Health care providers should screen routinely for a history of sexual assault and offer victims both emergency contraception and sexually transmitted infection prophylaxis. The health care provider who examines victims of sexual assault has a responsibility to comply with state and local statutory or policy requirements for the use of evidence-gathering kits.

Committee Opinion #593 “Management of Women With Dense Breasts Diagnosed by Mammography” (NEW!)

ABSTRACT: Women with dense breasts have a modestly increased risk of breast cancer and experience reduced sensitivity of mammography to detect breast cancer. However, evidence is lacking to advocate for additional testing until there are clinically validated data that indicate improved screening outcomes. Currently, screening mammography remains the most useful tool for breast cancer detection and has consistently demonstrated a reduction in breast cancer mortality. The American College of Obstetricians and Gynecologists does not recommend routine use of alternative or adjunctive tests to screening mammography in women with dense breasts who are asymptomatic and have no additional risk factors. The American College of Obstetricians and Gynecologists recommends that health care providers comply with state laws that may require disclosure to women of their breast density as recorded in a mammogram report.

The American College of Obstetricians and Gynecologists (The College), a 501(c)(3) organization, is the nation’s leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of more than 57,000 members, The College strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women’s health care. The American Congress of Obstetricians and Gynecologists (ACOG), a 501(c)(6) organization, is its companion organization. www.acog.org

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The American Academy of Pediatrics is an organization of 62,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org.