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The evidence about waterbirth comes from a systematic review that compared the outcomes for women and their babies of immersion in water with no immersion in water during the first stage of labour, or the second stage of labour (waterbirth), or both first and second stages.  All the trials in the review involved low-risk mothers.  No trials evaluated third-stage of labour management (delivery of the placenta), and all took place in a hospital labour ward setting. 

The limitations of the evidence are that there was not enough information to support, or not to support, the use of waterbirth during the second stage. Also there have not been any trials in a midwifery-led setting so no conclusions can be drawn about the risks of waterbirth under those arrangements.

The review found no evidence that labouring in water increases the risk of a bad outcome for women or their newborns, and it found that labouring in water during the first stage may reduce the chance of needing an epidural. 

What might this mean for a woman considering waterbirth?

When considering immersion in water in the first or second stages of labour, it may be helpful to know that it does not appear to be risky and may help to avoid having an epidural.

This section on waterbirth forms part of our Highlight on the Management of Labour which takes an evidence-based look at induction, pain relief, waterbirth and more . To read the Highlight in full click here


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